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Flesh Eating Bacteria, Who Is At Risk

Any wound may lead to flesh eating bacteria

When 24-year-old Aimee Copeland set off with her friends on a kayaking trip, none of them could have ever suspected the Georgia college student would soon be fighting for her life from a bacterial infection known as necrotizing fasciitis, or flesh eating bacteria. Although flesh eating bacteria is a very rare infection, the number of people at risk is great.

What is necrotizing fasciitis?

Necrotizing fasciitis is an infection that begins in the tissues immediately beneath the skin, but it does not begin unless an infection has already started in tissue. In Aimee’s case, she had suffered a zip line accident that left a gash in her calf, which required 22 staples.

“Necrotizing” means the tissue is dying, while “fasciitis” means inflammation of the fascia, which is the layer of tissues that line and separate muscles and fat. Necrotizing fasciitis most often affects the legs, arms, and abdomen wall and is fatal in up to 40% of cases.

Several different bacteria can cause necrotizing fasciitis, and occasionally fungal species have also been identified as causing the condition. However, the bacterium usually responsible is Streptococcus pyogenes, a member of a group of bacteria (group A streptococci) that causes strep throat, skin infections, and toxic shock syndrome. Most people who become infected with group A streptococci experience only mild or no symptoms at all.

Symptoms of necrotizing fasciitis include swelling, pain, and redness of the affected area, along with fever, nausea, vomiting, and flu-like symptoms. One tell-tale characteristic is that the symptoms develop rapidly, typically within 24 hours of experiencing a skin wound. Another is that the pain is more severe than seems appropriate for the wound.

Who’s at risk for flesh eating bacteria?
The exact number of people who get necrotizing fasciitis is not known, but it is estimated to affect 500 to 1,000 people in the United States each year, although some experts say the number is higher.

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According to a recent article published in the Journal of Trauma and Acute Care Surgery, “early diagnosis is missed or delayed in 85% to 100% of cases in large published series; because of the lack of specific clinical features in the initial stage of the disease, it is often underestimated or confused with cellulitis or abscess.”

Although people who have chronic medical conditions such as cancer or diabetes or who have a compromised immune system or recent vital infection accompanied by a rash are at an increased risk of flesh eating bacteria, many individuals who develop the condition are in good health before the infection sets in.

Therefore, anyone who gets an infection, whether it is from a paper cut, surgical incision, puncture wound, or other trauma, is at risk for flesh eating bacteria. People who experience a deep infection in the bone, muscle, or gastrointestinal system are at greater risk for necrotizing fasciitis because the initial infection and spread is not visible. Flesh eating infection has also been associated with the use of bath salts.

Visible infections on the skin or that involve hair follicles are usually noticed quickly and treated in a more timely manner. Necrotizing fasciitis can affect people of any age, from infants to the elderly, and for reasons unknown, males are affected about three times more often than are females.

Treatment and prognosis
The more rapid and aggressive the treatment, the better the prognosis. Hospitalization and treatment in intensive care is necessary and includes administration of antibiotics and other medications necessary to treat shock and other complications. Untreated necrotizing fasciitis frequently results in death, and even with appropriate treatment the mortality rate can be as high as 25%.

Complications of necrotizing fasciitis include loss of limbs, organ damage, sepsis, scar formation, and kidney failure. Some of the people who have survived necrotizing fasciitis have shared their experiences through an organization called National Necrotizing Fasciitis Foundation, where survivors, family members, and anyone interested in learning more about flesh eating bacteria can get information.

Lancerotto L et al. Necrotizing fasciitis: classification, diagnosis, and management. J Trauma Acute Care Surg 2012 Mar; 72(3): 560-66
Maynor ME. Emergent management of necrotizing fasciitis. Medscape.com. June 9, 2011
Necrotizing fasciitis (flesh-eating bacteria). WebMD.com. Feb. 10, 2011

Image: Wikimedia Commons