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What is NF? »

Necrotizing fasciitis (pronounced NECK-roe-tie-zing FASH-ee-EYE-tis) means “decaying infection of the fascia,” the sheets of con­nective tissue surrounding the muscles. This sudden and vicious infection is caused by one or more kinds of bacteria, which the media has nick­named “the flesh-eating bacteria,” that attack the skin, the fat of the sub­cutaneous tissue (the tissue located just beneath the skin), and fasciae.

The rapid spread of organisms along the superficial and deep fascia is facilitated by bacterial enzymes and toxins, causing vascular clusion, ischemia, and tissue necrosis. Septicemia, toxic shock, subsequent major organ failure and death may occur.
What are the Statistics of NF? »

Statistics regarding the incidence of NF in the United States are tough to determine. The main reason for this is that while the CDC tracks cases of NF caused by group A streptococcus (GAS), it does NOT track cases of NF caused by the handful of other bacteria that also cause NF.

As far as NF caused by GAS, the CDC believes that there are only 250 cases per year.

It is generally agreed that there are between 1 and 5 cases per 100,000 people per year.
Bacteria that Cause NF »

The bacteria that cause NF include:

Name

Where Found?

Notable

Group A Strep

Nose, throat, skin (common)

Lightning Fast “Flesh-eating” bacteria

Staph Aureus
including MRSA

Skin, nose, nosocomial

Often polymicrobial

Bacterioides

Mouth, intestine, genitals

Anaerobic, polymicrobial

Clostridium

Soil, intestines

Highly fatal, anaerobic

Vibrio Vulnificus

Warm waters

95 % of seafood-related deaths in US

Pseudomonads

Skin, respiratory system

Generally affects those severely immunocompromised

Aeromonas hydrophila

Fresh and brackish water

Most common in young children (gastroenteritis)

The Symptoms of NF »


The following depicts general symptoms of NF as the disease advances:

EARLY SYMPTOMS

  • Trauma of some type (however slight) will probably have occurred (cut, bruise, scratch, surgery).
  • Victim begins to feel an annoying discomfort in the general region of the trauma. For example, in the case of NNFF co-founder Donna, she felt the type of pain one feels after working out a little too hard in her upper arm, the day after getting a small cut on her finger.
  • The pain described gets worse, the area more tender. This is one of the major things to keep in mind. The pain one feels is out of proportion to the injury.
  • Flu-like symptoms occur, such as vomiting, diarrhea, dehydration, general malaise, weakness, muscle pain, and fever.
  • Tissue is swollen and there may or may not be redness noted. The area will feel hot to the touch, and very painful.

    ADVANCED SYMPTOMS

  • Conditions continue to worsen.
  • Urination becomes less frequent (as the system dehydrates)
  • Blood pressure drops severely, and heartbeat is rapid.
  • A sunburn type rash may appear over the entire body, due to toxins released from the bacteria. This may or may not be present.
  • Large, dark boil-like blister(s) may or may not form in the affected area
  • Toxic shock can ensue as the body's organs shut down.
  • Death soon follows.
Opportunities for Infection »

In order for someone to contract NF, the bacteria must be introduced into the body. This occurs either from direct contact with someone carrying the bacteria, or because of the bacteria being carried by the person him or herself. The opportunities for infection are limited only by the imagination - and rarely - no inciting wound can be determined. Here is just a sample list of opportunities:

Acne

Strep Throat

Scrapes

Animal Bites

Gunshot wounds

Piercings

Boils

Hemorrhoids

Post-Surgical Wounds

Breaks

Idiopathic

Rug Burn

Bruises and bumps

Insect bites

Skin Ulcers

Childbirth (Natural & C-section)

Minor cut or scratch

Strep Throat

Dental surgery

Needle pricks

Sprains

Eczema

Nosocomial
(Hospital Acquired)

Tattoos

Frost Bite

Perforated Bowel

Trauma

Fungal infection

Scratches, cuts, and other minor wounds

Varicella (Chicken-Pox)

High-Risk Groups for NF»

Necrotizing fasciitis does not discriminate in selecting its victims. None of us is immune from the possibility of contracting the disease, whether we are healthy or not. However, there are certain higher-risk conditions and situations that can be ideal opportunities for a necrotizing soft-tissue infection.

While the higher-risk groups for contracting NF that we will discuss in the following paragraphs are worlds apart from each other and en­compass a broad range of people (such as those suffering from alcoholism and children with chickenpox), you will begin to see several contributory factors in common. For example, in almost all of the groups, immunodeficiency is a key factor, as is malnutrition.

  • Chronically Ill Individuals - AIDS, cancer, coronary disease, chronic renal failure, and cirrhosis of the liver, among others.
  • Children with Chicken Pox
  • Diabetics
  • People undergoing immunosupressive therapies
  • Elderly Individuals
  • Obese Individuals
  • Women giving birth
  • Peripheral Vascular disease
  • others
Diagnosis of NF »

The early diagnosis of NF is absolutely critical to save the life of the patient.

  • **Pain out of proportion to injury, and symptoms previously noted
  • High level of clinical suspicion
  • Imaging Studies
  • Ultrasound – soft tissue thickening and swelling, fluid accumulation, distorted thickened fascia. Color Doppler points to abcess, aspiration of pus with sonographic guidance
    CT Scan & MRI – soft tissue swelling and subcutaneous emphysema indicating polymicrobial infection (not present in GAS)
  • Frozen Tissue Biopsy
  • Surgical Exploration – looking for undermining, dead tissue, fluid
  • Laboratory Workup –
    CRP , CBC, WBC, BUN, etc.
Medical Treatment of NF »

The medical treatment of NF varies according to the type of bacteria, location(s) of the body affected, and other factors. Generally, however, treatment includes:

  • TEAM OF SPECIALISTS
  • Surgical Debridement (multiple often required)
  • Broad Spectrum Antibiotic Therapy (tailored with culture) include Clindamycin, Vancomycin, Penicillin, etc.
  • Amputation
  • Induced Sedation & Ventilation
  • VAC (Vacuum Assisted Closure) -  removes chronic edema, leading to increased localized blood flow, enhanced formation of granulation tissue.
  • Treatment for Complications (toxic shock, organ failure, respiratory distress)
  • IVIG – Intravenous Immunoglobulin (not standard – but has proven effective)
  • Aggressive wound care and repeated lab tests
  • Hyperbaric Oxygen Therapy (not standard – but has proven effective)
  • Skin Grafts, Home Care
  • Physical Rehabilitation, Prosthesis, Psychological, and Social Support
The Problem of Misdiagnosis »

The missed and/or delayed diagnosis of NF can also be attributed to NF’s hallmark ability to wreak its devastating damage on the body with few symptoms to show for it—until the disease has reached the critical stage. An article in the British Columbia Medical Journal, which featured NF as the focus of the April and May 1999 issues, illustrates this point. The covers of the two journals featured caricatures of a wolf in sheep’s clothing—a highly appropriate representation of how NF stealthily invades and attacks the body under the guise of a common, minor affliction.

As the clearinghouse for NF cases, we find it so difficult to hear case after case, on almost a daily basis, of yet another NF patient who suffered amputations, massive tissue loss, or death due to misdiagnosis. While each case is unique in terms of entry point, type of bacteria involved, time elapsed, and ultimate outcome, a general pattern has evolved:
    • The patient exhibits early, progressing symptoms and makes one or more attempts to seek medical treatment, but is sent home with an erroneous diagnoses.
    • His or her condition steadily worsens and becomes critical.
    • The patient is returned to the hospital, where emergency medical intervention is initiated, the effectiveness of which is considerably weakened due to the advanced stage of the disease, which directly results in loss of limbs, permanent disability, severe disfigurement, or death.

    We at NNFF are passionately dedicated to educating medical professionals of every discipline - from school nurses, to EMTs, to ER physicians, to nurses, and general practice staff, and all others, so that the high rate of misdiagnosis can be greatly reduced, thus saving limbs and lives. Please contact us at jroemmele@aol.com if you are interested in having Ms. Roemmele speak to your organization regarding NF.

Emerging Therapies »
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