NECROTIZING FASCIITIS By: XXXXXXXXXXX Biology 1407 April 23, 2010 Houston Community College

What is Necrotizing Fasciitis?  A progressive, rapidly spreading, inflammatory infection located in the deep fascia, with secondary necrosis (death) of the subcutaneous tissues.  Commonly called flesh-eating bacteria  25% of people who contract Necrotizing Fasciitis will die from it.

What Causes Necrotizing Fasciitis?  A group of bacteria called Group A Streptococcus cause NF (Necrotizing Fasciitis).  These bacteria also cause such diseases as strep throat, scarlet fever, and pneumonia.  Some of the bacteria from this group include Staphylococcus aureus, Vibrio vulnificus, and Clostridium perfringens.

Pathophysiology of Necrotizing Fasciitis  There is a misconception about this disease: the bacteria does not actually “eat” the skin or tissue.  The bacteria comes in through an opening in the skin, from the size of a paper cut or pin prick to a major trauma or surgery incision.

Pathophysiology of Necrotizing Fasciitis  The bacteria releases toxins (virulence factors), which activate T-cells nonspecifically, which stimulate the overproduction of cytokines.  This leads to inflammation, then leads to tissue death.

Where does the bacteria come from?  The bacteria comes from respiratory droplets  Coughing  Sneezing  Direct contact with secretions from someone carrying the bacteria.  Body fluids

Who Can Get Necrotizing Fasciitis?  Anyone can have Necrotizing Fasciitis.  It does matter if you are male or female, old or young, or of a specific race.  Also, the disease can be contracted anywhere in the world.  No one is immune to this ailment.

Higher Risk Groups to Contract NF  The higher risk groups to acquire Necrotizing Fasciitis include people with:  Weak immune systems  Chronic health problems, like diabetes, cancer, liver or kidney diseases  Cuts on skin, including surgical wounds

Higher Risk Groups to Contract NF  The higher risk groups to acquire Necrotizing Fasciitis include:  People who recently had chickenpox or a viral infection that causes a rash  People that use steroid medications Chicken Pox

Symptoms of NF  Early Stages (Within 24 hours)  Minor trauma or other skin opening (not necessarily infected)  Some pain from wound  Pain whole lot worse than wound

Symptoms of NF  Early Stages  Flu-like symptoms- diarrhea, nausea, fever, confusion, dizziness, weakness, and depression  Intense thirst

Symptoms of NF  Advanced Symptoms (within 3-4 days)  Limb or area experiencing pain begins to swell, and may turn purple  May start to have large dark marks, might turn into blisters filled with blackish fluid  May start to appear necrotic with bluish, white or dark, spotted, flaky appearance

Symptoms of NF  Critical Symptoms (usually within 4-5 days)  Blood pressure drops severely  Toxic shock  Unconsciousness

How is NF Diagnosed?  CT scan - if diagnosis is uncertain or to show depth  X-rays  Chest- to look for signs of lung damage (respiratory distress syndrome)  Others check for gas and fluid buildup at site of infection

How is NF Diagnosed?  MRI - if diagnosis is uncertain or to show depth  Tissue cultures - for bacteria  Blood Tests - CBC, blood chemistry, creatine phosphokinase, C-reactive protein- shows whether infection present or muscles have been damaged

Misdiagnosis  Many times Necrotizing Fasciitis is misdiagnosed for a variety reasons:  Early symptoms are the same as many other illnesses.  Rare disease

Treatment of NF  Usually starts with IV antibiotics: penicillin, vancomycin, and clindamycin  Aggressive debridement - removal of affected tissue by surgery  Skin grafting to cover large openings in the skin after debridement

Treatment of NF  Hyperbaric oxygen therapy - helps prevent tissue death and promote healing  Amputation  Other medications to treat symptoms, like blood pressure

Prevention of NF  Good Hygiene  Anti-microbial soap  Cover your mouth when you cough or sneeze

Prevention of Necrotizing Fasciitis  Throw away tissues  Wash hands frequently  Avoid contact with persons showing sore throat symptoms

Glossary  Autolytic - using your own body’s processes  CT Scan - sometimes called CAT scan- combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. CT scans provide greater clarity and reveal more details than regular x-ray exams.  Debridement - removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic removal of the tissue.

Glossary  Fascia - strong connective tissue which envelops and isolates the muscles of the body, and provides structural support and protection.  MRI - Magnetic Resonance Imaging - uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures.  Necrosis - death of body tissue, occurs when there is not enough blood flowing to the tissue, whether from injury, radiation, or chemicals. Necrosis is not reversible.

Glossary  Pneumonia - respiratory condition in which there is inflammation of the lung.  Scarlet fever - or scarlatina, is an illness that brings on a rash covering most of the body, a strawberry-like appearance of the tongue and usually a high fever.  Subcutaneous tissue - loose connective tissue under the dermal skin layer.

Bibliography  "CT - Body." RadiologyInfo.org. RadiologyInfo.org, Web. 25 Apr  "Debridement of a Wound, Infection, or Burn." Your Health. Aurora Health Care, Web. 15 Apr  "MRI of the Body (Chest, Abdomen, Pelvis)." RadiologyInfo.org. RadiologyInfo.org, Web. 22 Apr

Bibliography  "Necrosis." Medline Plus, Web. 24 Apr  "Necrotizing Fasciitis." Medicine Net. Medicine Net, Web. 25 Apr  "Necrotizing Fasciitis." WrongDiagnosis.com. WrongDiagnosis.com, Web. 18 Apr 2010.

Bibliography  "Necrotizing fasciitis: an uncommon disease, frequently misdiagnosed." Access My Library. Access My Library, Web. 25 Apr  "NF Fact Sheet." National Necrotizing Fasciitis Foundation, Web. 25 Apr  "Pneumonia." Google Health. Google, Web. 25 Apr

Bibliography  "Scarlet Fever." Mayo Clinic. Mayo Clinic, Web. 25 Apr  "Subcutaneous Tissue." WrongDiagnosis.com. WrongDiagnosis.com, Web. 25 Apr  "What is Fascia?." Wise Geek. Wise Geek, Web. 24 Apr