Commonly Known as The "Flesh Eating" Bacteria
Common Questions Answered as Simply as Possible
Published by the National Necrotizing Fasciitis Foundation
How do you say It?
The pronunciation is neck-row-tize-ing fash-e-i-tis, it
means decaying infection of the fascia.
What Is It?
It is a bacterial infection caused commonly by group A Strep bacteria,
which is the same bacteria that causes common Strep throat. Usually
easily killed by antibiotics, sometimes a very strong variety
of Strep occurs. This is the one that causes the life-threatening
cases and is known as the "flesh-eating" bacteria. NF
can also be caused by other bacteria, or a mixture of bacteria.
The bacteria destroys soft tissue at the subcutaneous level, and
often is coupled with toxic shock syndrome, both are deadly alone,
together they are even more so. If muscle is destroyed, it is
How do you get it?
Most often the bacteria enter the body through an opening in the
skin, quite often a very minor opening, even as small as a paper
cut, a staple puncture, or a pin prick. It can also enter through
weakened skin, like a bruise, blister, or abrasion. It can also
happen following a major trauma or surgery, and in some cases
there appears to be no identifiable point of entry.
Where does the bacteria come from?
It is most commonly transferred by respiratory droplets or direct
contact with secretions of someone carrying Strep A. For instance,
a person carrying a Strep A bacteria might not even show symptoms
or become ill at all. They cough or sneeze, another person picks
up the bacteria on their hands or directly at the point of a wound
and the infection occurs. The NF patient is not likely to be contagious,
and inanimate objects are unlikely to be points of transmission.
How can it be prevented?
It can't necessarily be prevented, but you can lessen your chances
with some basic hygienic practices. Buy anti-bacterial soap and
use it! From the offensive standpoint, cover your mouth when you
cough or sneeze, throw away tissues, wash hands frequently. You
could be the carrier and not know it. Fifteen to thirty per cent
of the population carries Strep A at any given time usually with
no symptoms. From a defensive standpoint: wash hands frequently,
avoid contact with persons showing sore throat symptoms. Clean
and care for even the smallest traumas, using an antibiotic ointment
and sterile covering with frequent changes. Click for more info
on preventing Necrotizing Fasciitis.
What are the symptoms?
The symptoms are varied, but often include:
EARLY SYMPTOMS (usually within 24 hours) :
- Usually a minor trauma or other skin opening has occurred
(the wound does not necessarily appear infected)
- Some pain in the general area of the injury is present.
Not necessarily at the site of the injury but in the same
region or limb of the body
- The pain is usually disproportionate to the injury and
may start as something akin to a muscle pull, but becomes
more and more painful
- Flu like symptoms begin to occur, such as diarrhea, nausea,
fever, confusion, dizziness, weakness, and general malaise
- Intense thirst occurs as the body becomes dehydrated
- The biggest symptom is all of these symptoms combined.
In general you will probably feel worse than you've ever
felt and not understand why.
ADVANCED SYMPTOMS (usually within 3-4 days):
- The limb, or area of body experiencing pain begins to
swell, and may show a purplish rash
- The limb may begin to have large, dark marks, that will
become blisters filled with blackish fluid
- The wound may actually begin to appear necrotic with a
bluish, white, or dark, mottled, flaky appearance
CRITICAL SYMPTOMS (usually within 4-5 days):
- Blood pressure will drop severely
- the body begins to go into toxic shock from the toxins
the bacteria are giving off
- unconsciousness will occur as the body becomes too weak
to fight off this infection.
When should I seek medical attention?
Any time all of the early symptoms are present, go to a doctor
at once, and insist that this be ruled out. The vast majority
of cases are misdiagnosed. People have been told that they had
fallen, when they didn't, they have had casts put on bones that
were not broken, have been given Tylenol for flu and been told
to come back the next day; they have been told they have an
ingrown toenail, they've been told they have arthritis; they've
been accused of burning themselves...many of these people have
gone back to the hospital two days later and died. Insist that
this be ruled out if you have all of the early symptoms.
Why are so many cases of NF misdiagnosed?
Because the beginning symptoms look like so many other minor
afflictions. None of the symptoms are exclusive to this, and
until the patient is so ill that they are critical many health
care workers don't consider NF. Although the disease is on the
increase worldwide, it is still considered uncommon, so many
emergency rooms may never have seen a case before.
How rare is NF?
The statistics vary, and are not entirely accurate. A 1996 CDC
report estimates from 500 to 1500 cases per year of necrotizing
fasciitis of which 20% die. In 1998 the NNFF estimates the figure
to be higher (based on cases reported to us measured against
the general population with access to the Internet, which is
how all of the cases we get are reported)
How is NF treated?
NF must be treated in the hospital with antibiotic IV therapy
and aggressive debridement (removal) of affected tissue. Other
treatments will take place depending upon the level of toxicity
or organ failure being experienced by the patient. Medications
to raise blood pressure, blood, and a new medicine called intravenous
immunoglobulin (IVIG) are also used. A hyperbaric oxygen
chamber is sometimes used in certain cases involving a mixed
What's the likely outcome?
Anywhere from minimal scars to death and everywhere in between.
For those lucky enough to survive most often at least some removal
of skin is required. Often this requires skin grafting. Amputation
is sometimes needed to remove the affected limb. Legs, hands,
fingers, toes, arms, have all been sacrificed to save the life
of NF patients.
What can decrease the risk of death and disfigurement?
Two words: prompt diagnosis!
What's being done to help promote prompt diagnosis?
The NNFF's mission is to educate for public awareness, recognition
of symptoms and preventive measures; to offer resources; advocate
research; and to offer support for those affected by necrotizing
fasciitis. We hope that through projects in which we couple
with medical professionals, public service campaigns, and media
exposure, we can lessen the occurrence of the severe consequences
We are also the authors of a book entitled, Surviving the
Flesh-Eating Bacteria: Understanding, Preventing, Treating,
and Living with the Effects of Necrotizing Fascitiis, which
will be published through Avery/Penguin in early November, 2000.
(See "Order our Book"
for more information.) This is the first non-fiction book ever
written about the disease.
Can I get NF from eating Costa Rican bananas?
No. If you have been the recipient of the ridiculous email going
around claiming that Costa Rican bananas are "infected"
with the bacteria that causes necrotizing fasciitis be assured
IT IS FALSE. While banana skins are not edible and do have pesticides
on them, they are not carrying strep bacteria.
About the NNFF
The NNFF is a non-profit organization run entirely with donations
and volunteer efforts. All donations are used to further our mission.
If you wish to help, please send donations to NNFF, c/o Donna
Batdorff, 2731 Porter SW, Grand Rapids, MI 49509. The NNFF can
be reached at 616-261-2538. Email addresses are Jackie,
or Donna. Our website is
Information to be used as guidelines only, not intended to
be used for diagnosis, and keep in mind that no two cases are