Flesh - eating Disease

Flesh eating bacteria is commonly heard term now a days. It is a infectious disease which destroys the skin, tissues and muscles in such a way that they die. Hence it is also called as necrotizing fasciitis. Necrotizing means death of the tissue. Fasciitis means infection or inflammation of the tissues underlying the skin (fascia). This dreadful disease is caused by the flesh-eating bacteria called as Streptococcus Pyogenes.

Why it is called as flesh eating?
Flesh eating bacteria doesnt mean that the bacteria eats flesh. Bacteria never eat flesh.
This term is used because the bacteria Streptococcus Pyogenes produces toxins which causes destruction of muscles, fats and tissues. It most commonly affects abdomen, arms and legs.

Sometimes other bacteria like Aeromonas hydrophilia along with streptococcus produce necrotizing fasciitis. This bacteria affects abdomen and arms.

What are Streptococcus and Aeromonas bacteria's?
Aeromonas hydrophilia is the microorganism and also known as water - loving because the main source of this organism is freshwater like river, pond and lake. This microorganism causes infections like diarrhea, sepsis, wound infection, etc.
Streptococcus Pyogenes is the member of up group A streptococci species which most likely affects the throat causing pharyngitis, skn infection and necrotizing fasciitis.

What are the causes and risk factor of developing necrotizing fasciitis?
This disease is caused by many bacteria. When the bacteria (streptococcus P) enters the body through cuts on the skin. Once they enter inside they produce dreadful toxins . These toxins kills the tissue and stops the blood flow in that area. As the blood flow stops the tissue dies and thus this bacteria spreads all over the body.
The people who have low immunity are more prone to the disease like in chronic medical illness like cancer, HIV, etc.
Commonly seen in people who suffers from diabetes and recent wound infection.
Other bacteria causing necrotizing fasciitis are Staphylococcus aureus, Clostridium P, Bacteroides fragilis and Aeromonas hydrophilia.

Signs and Symptoms of Necrotizing fasciitis (NF)
Once the bacteria enters the skin, the symptoms develop and becomes worse in 24 hours.
1) The initial symptoms seen are small, red lump on the skin which is very painful.
2) Within few hours of time the lump grows in size and becomes more painful.
3) This lump looks like bruise with black discoloration in the centre indication of the death of the centre tissue.
4) Later the lump breaks and fluid oozes out. The skin looks completely dead (gangrene), scaling and peeling of skin starts.
5) General symptoms - Fever with chills, nausea, weakness, fatigue and low blood pressure.
6) If the symptoms are not treated on time then patient may go into shock (toxic shock syndrome) where patient becomes very critical.

Diagnosis of disease and Tests
There are not specific diagnostic tests but doctors usually diagnose it by looking at the skin and lump.

  • Blood test - Certain blood tests helps to determine the risk of Necrotizing fasciitis. They are
    - C-reactive protein - The levels are elevated
    - S. sodium and BUN levels are reduced
    - WBC counts are elevated
  • Skin tissue biopsy - The tissue from infected part is taken and examined under the microscope to understand which bacteria causing the infection.
  • CT and MRI scan - Depending on the symptoms and part of body affection CT or MRI scanning is done which shows the level of tissue infection.

Treatment and Management of Necrotizing fasciitis.

A)Hospital Treatment -
The most immediate treatment of NF is hospitalization of the patient and immediate start of intravenous antibiotics. In laboratory the antibiotic susceptible and resistant study is done. This help doctors to understand that the bacteria is sensitive and resistant to what type of antibiotics. Thus the required antibiotics are given through veins in the form of injections.

B) Emergency Treatment -
Some patients may go into shock where the blood pressure drops , patient becomes very drowsy and dizzy. In such case immediate treatment is necessary. Patient is immediately taken to intensive care unit (ICU). Patient may go into sepsis where whole body and blood is infected resulting into multiple organ failure. Treatment like immediate intravenous fluids transfusion and artificial breathing (ventilation).

C) Surgical Treatment -
As soon as the necrotizing fasciitis is diagnosed the surgical removal of dead tissue is necessary in order to stop the death of more tissues. The procedure is called as Debridement of the tissue. The tissue removed during the debridement is send for examination to identify the infecting organisms. Early surgical treatment reduces the death rate of most of the patients.

Prevention of Necrotizing fasciitis.
1) Good hygienic practice - People who are diabetic must wash their hands properly if the skin has wounds or cuts. Avoid touching the infected wound with bare hands.

2) For Doctors - Most of the cases are seen where the infection has come through doctors or hospitals during the surgeries. During surgeries the sterilization technique is very important to prevent the infection. Proper care is to be taken while performing operations of intestines, bowels or episiotomy because these sites are prone to catch immediate infection.

3) It is non - contagious disease however it is possible that uninfected person getting infected if person has close contact with the infected person or has open cuts or wounds . The bacteria can be transmitted if non infected person has any open cuts or wounds and gets in contact with infected person.


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