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What is NF?  

Necrotizing fasciitis (NF) is a bacterial infection. This bacteria attacks the soft tissue and the fascia, which is a sheath of tissue covering the muscle. NF can occur in an extremity following a minor trauma, or after some other type of opportunity for the bacteria to enter the body such as surgery.

The Group A Strep infection (flesh eating bacteria) is most common with minor trauma. A mixed bacterial infection is often the cause after surgery.

We can personally tell you about people who developed NF after a C-section, after abdominal surgery, after scratching a rash, after giving birth vaginally, from a tiny scratch, after bumping a leg with a golf bag, after a friendly punch in the arm from a buddy, after a little cut on the finger, after a cut on the foot, after a rug burn, after having a routine blood draw in a physical exam, after a broken arm, and after a broken leg, and from no known trauma at all.

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.

Group A Strep is the same bacteria that causes strep throat. However, there are various strains of the bacteria, some of which are more powerful than others (with stronger m-protein serotypes). If the right set of conditions are present, this is when the necrotizing fasciitis occurs.

The "right" set of conditions are:
  1. A person usually has to have a contusion, abrasion, cut, or opening in the skin in order to have the bacteria enter, however, spontaneous cases where no apparent injury can be found, are also reported.

  2. They have to come into contact with the bacteria, either through direct contact with a carrier, or because the bacteria is present on the person.

  3. It usually is an invasive strain or serotype, of the strep.

There are higher risk groups for contracting NF, however, a person does not need any predisposing conditions to be prone to developing necrotizing fasciitis. It can happen to anyone...young, old, adult, child, any race, any size, healthy or not. No one is out of danger. You do not need to be immunodepressed to get this.

The name "flesh-eating-bacteria" is a little sensational, but essentially, this is what the bacteria appears to do. It gets into the body, quickly reproduces, and gives off toxins and enzymes that destroy the soft tissue and fascia, which quickly becomes gangrenous (dead). This gangrenous tissue must be surgically removed to save the life of the patient. The bacteria also stealthily hides itself from the body's innate immune system, allowing it to spread rapidly along tissue planes. NF causes excruciating pain, dangerously low blood pressure, confusion, high fever, and severe dehydration due to the toxins poisoning the body. Unfortunately, NF sometimes occurs beneath the skin with few symptoms to explain the victim's symptoms. This results in a great many cases of misdiagnosis.

If NF is detected during the early stages (before toxic shock), the need to surgically remove skin and soft tissue can be "relatively" small, with removal of flesh and subcutaneous tissue, and fat only. The bacteria usually does not attack muscle or bone (although it can happen). In more advanced cases (and this is often) major limb amputation is necessary.

Death from this condition is not uncommon, however many people are successfully treated.

In addition to the tissue decay, the bacteria causes the rest of the body's organs to go into systemic shock. This may result in respiratory failure, heart failure, low blood pressure and renal failure. Basically, every system of the body can fail as a result of the severe infection and toxicity of the system.

NF is not a reoccurring condition. Once treated, the bacteria is eradicated from the body. During treatment, surgical sites are left open for a sufficient period of time and reinspected to be sure that the remaining tissue is no longer being destroyed. When physicians are confident that the infection has been stopped, the wounds are closed, typically with skin grafting. Then the recovery process starts which involves lengthy physical therapy, and long-term psychological, emotional and spiritual recovery. NF is truly a devastating disease.

When the infection is caused by the lightening fast Group A Strep bacteria, the specific bacteria which causes the flesh-eating disease, people can go from perfectly healthy to death's door in a matter of days. Other cases of NF, caused by a mixed bag of bacteria, can be slower moving and less deadly. In all cases, however, prompt treatment is essential in this condition. It is one of the fastest spreading infections known, so time is the most important factor in survival.

For More Information

NNFF would like to thank Dr. Steven Triesenberg, MD (Infectious Disease Specialist) in Grand Rapids, Michigan for his assistance in compiling this information.

Copyright © 1997-2003 National Necrotizing Fasciitis Foundation (NNFF)
All Rights Reserved.

August 17, 2003