necrotising fasciitis

Necrotising fasciitis

Introduction

[Original article on NHS Choices website]

Necrotising fasciitis is a rare but serious bacterial infection that affects the tissue beneath the skin, and surrounding muscles and organs (fascia).

It’s sometimes called the “flesh-eating disease”, although the bacteria that cause it don’t “eat” flesh – they release toxins that damage nearby tissue.

Necrotising fasciitis can start from a relatively minor injury, such as a small cut, but gets worse very quickly and can be life-threatening if it’s not recognised and treated early on.

Symptoms of necrotising fasciitis

The symptoms of necrotising fasciitis develop quickly over hours or days. They may not be obvious at first and can be similar to less serious conditions such as flu, gastroenteritis or cellulitis.

Early symptoms can include:

a small but painful cut or scratch on the skin

intense pain that’s out of proportion to any damage to the skin

a high temperature (fever) and other flu-like symptoms

After a few hours to days, you may develop:

swelling and redness in the painful area – the swelling will usually feel firm to the touch

diarrhoea and vomiting

dark blotches on the skin that turn into fluid-filled blisters

If left untreated, the infection can spread through the body quickly and cause symptoms such as dizziness, weakness and confusion.

When to get medical help

Necrotising fasciitis is a medical emergency that requires immediate treatment.

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Go to your nearest accident and emergency (A&E) department as soon as possible if you think you have it. Call 999 for an ambulance if you’re too unwell to get yourself to A&E.

Blood tests and scans may be carried out to find out what’s causing your symptoms, although a diagnosis of necrotising fasciitis can usually only be confirmed by having an operation to examine the affected tissue.

Treatments for necrotising fasciitis

Necrotising fasciitis needs to be treated in hospital.

The main treatments are:

surgery to remove infected tissue – this may be repeated several times to ensure all the infected tissue is removed, and occasionally it may be necessary to amputate affected limbs

antibiotics – usually several different types are given directly into a vein

supportive treatment – including treatment to control your blood pressure, fluid levels and organ functions

People with the condition will often need to be looked after in an intensive care unit and may need to stay in hospital for several weeks.

While in hospital, they may be isolated from other patients to reduce the risk of spreading the infection.

Outlook for necrotising fasciitis

Necrotising fasciitis can progress very quickly and lead to serious problems such as blood poisoning (sepsis) and organ failure.

Even with treatment, it’s estimated that one or two in every five cases are fatal.

People who survive the infection are sometimes left with long-term disability due to amputation or the removal of a lot of infected tissue.

They may need further surgery to improve the appearance of the affected area and may need ongoing rehabilitation support to help them adapt to their disability.

Causes of necrotising fasciitis

Necrotising fasciitis can be caused by several different types of bacteria.

The bacteria that cause the infection live in the gut, in the throat, or on the skin of some people, where they don’t usually cause any serious problems.

However, in rare cases, they can cause necrotising fasciitis if they get into deep tissue – either through the bloodstream, or an injury or wound, such as:

cuts and scratches

insect bites

puncture wounds caused by injecting drugs

surgical wounds

Necrotising fasciitis typically occurs when bacteria already on the skin or in the body get into deep tissue. The infection can also be spread from person to person, but this is very rare.

Anyone can get necrotising fasciitis – including young and otherwise healthy people – but it tends to affect older people and those in poor general health.

Preventing necrotising fasciitis

There’s no vaccine for necrotising fasciitis and it’s not always possible to prevent it.

The following measures may help to reduce your risk:

Treat wounds quickly – after stopping any bleeding, clean wounds with running water and pat them dry with a clean towel.

Keep wounds clean and dry – after a wound has been cleaned, cover it with a sterile dressing (such as a plaster); change the dressing if it gets wet or dirty.

Wash your hands regularly with soap and warm water – alcohol-based hand gels can also help, but washing with soap and water is generally best.

If you’re in close contact with someone who has necrotising fasciitis, you may be given a course of antibiotics to reduce your risk of infection.

MSSA

An investigation at a rugby club into a serious infection which usually causes boils, abscesses and carbuncles found that some spread among the players may have been caused by the sharing of towels and razors or the same ice bath. The work is being presented at PHE’s annual conference this week.

The skin condition is called PVL-MSSA. This is a strain of Staphyloccocus aureus (SA) bacteria known as Methicillin Sensitive Staphylococcus aureus (MSSA) which produces a toxin known as Panton-Valentine Leukocidin (PVL).

You can find out more about Methicillin Resistant Staphylococcus Aureus or MSRA here.

Most active infections present as recurrent boils and abscesses but it can lead to serious infections which can cause the skin and tissues to die (necrotising fasciitis), and may be life threatening.

Rugby is a well-recognised sport for PVL infection (as is wrestling) as the close contact and ‘turf burns’ from artificial grass can abrade the skin allowing the bacteria to multiply and get into the body.

Between August 2013 and February 2014 the PHE team in the South Midlands carried out an investigation into cases of PVL-MSSA, which included a questionnaire completed by players and staff followed by swabbing to detect the presence of PVL-MSSA bacteria.

In total four cases with an identical strain of PVL MSSA were identified, suggesting transmission within this setting. Two cases of active PVL infection with an identical strain of bacteria were found together with a positive result for colonisation (bacteria on the skin but no active infection) in a member of staff. A further case of PVL-MSSA wound infection was identified a week after the investigation had concluded in a player who had not attended the screening in February 2014.

Out of 59 people who responded to the questionnaire in February 2014, the results were as follows:

Regularly share towels 11 people (19 per cent)
Regularly share razors 6 people (10 per cent)
Regularly share clothing 3 people (5 per cent)
Use a cold bath after game/training 22 people (37 per cent)
Suffered any skin conditions in the last year 17 people (29 per cent)
Suffered from any other infections in the last year 11 people (19 per cent)

Dr Deepti Kumar, a Consultant in Communicable Disease Control at PHE said: “PVL-MSSA can be a very serious infection and any positive result either for colonisation or active infection will require appropriate medical treatment not just of the patient but also of their close contacts or family. Because it can spread easily it is important to ensure that the correct procedures are in place to limit the spread of the bacteria.

“The investigation identified a number of high risk practices among the players which increase their chances of getting an infection, such as sharing towels and razors, and sharing ice baths with their fellow team members. We would urge any sportsperson who plays a sport where cuts and grazes are commonplace to practice good hygiene and not share any item with fellow team members to reduce their risk of developing an infection.”

1. Four cases of PVL infection with an identical strain linked to the Club were identified over a period of 8 months.

2. In the first round of screening in December 2013 55 players and 34 staff completed questionnaires. The club medical team took swabs from 13 players and staff in total.

3. In December 2013 nine staff and nine players were swabbed and of these 5 (three staff and two players) were reported as MSSA positive but only one was positive for PVL MSSA.

4. In February 2014 swabs were taken from 59 players and staff and of these 21 (36 per cent) were positive for MSSA. They were all negative for PVL-MSSA.

5. Many people carry strains of SA on their skin and can pass the bacteria to others by direct contact. Those who carry the bacteria on their skin without any signs of infection are said to be ‘colonised’ with the bacteria.

6. PHE data show that there are between 1,200-1,500 cases of PVL-MSSA nationally each year.

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