Necrotizing fasciitis or fasciitis necroticans, commonly known as "flesh-eating bacteria", is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue. Many types of bacteria can cause necrotizing fasciitis (eg. Group A streptococcus, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis), of which Group A streptococcus is the most common cause. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // M00-M99 - Diseases of the musculoskeletal system and connective tissue (M00-M25) Arthropathies (M00-M03) Infectious arthropathies (M00) Pyogenic arthritis (M01) Direct infections of joint in infectious and parasitic diseases classified elsewhere (M02) Reactive arthropathies (M023) Reiters disease (M03) Postinfective and reactive arthropathies in diseases classified elsewhere (M05-M14... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... Medical Subject Headings (MeSH) is a huge controlled vocabulary (or metadata system) for the purpose of indexing journal articles and books in the life sciences. ... A rare disease (sometimes known as an orphan disease) has such a low prevalence in a population that a doctor in a busy general practice would not expect to see more than one case a year. ... An infection is the detrimental colonization of a host organism by a foreign species. ... Beyond overall skin structure, refer below to: See-also. ... The distribution of the bloodvessels in the skin of the sole of the foot. ... Fascia is specialized connective tissue layer which surrounds muscles, bones, and joints, providing support and protection and giving structure to the body. ... The subcutis is the layer of tissue directly underlying the cutis. ... Phyla Actinobacteria Aquificae Chlamydiae Bacteroidetes/Chlorobi Chloroflexi Chrysiogenetes Cyanobacteria Deferribacteres Deinococcus-Thermus Dictyoglomi Fibrobacteres/Acidobacteria Firmicutes Fusobacteria Gemmatimonadetes Lentisphaerae Nitrospirae Planctomycetes Proteobacteria Spirochaetes Thermodesulfobacteria Thermomicrobia Thermotogae Verrucomicrobia Bacteria (singular: bacterium) are unicellular microorganisms. ... The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. ... This article does not cite its references or sources. ... Binomial name Clostridium perfringens Veillon & Zuber 1898 Hauduroy 1937 Clostridium perfringens (formerly known as Clostridium welchii) is a Gram-positive, rod-shaped, anaerobic, spore-forming bacterium of the genus Clostridium[1]. is ubiquitous in nature and can be found as a normal component of decaying vegetation, marine sediment, the intestinal... Species etc. ... The group A streptococcus bacterium (Streptococcus pyogenes, or GAS) is a form of Streptococcus bacteria responsible for most cases of streptococcal illness. ...

Symptoms

The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is classically, at first, very painful without any grossly visible change. With progression of the disease, tissues becomes swollen, often within hours. Diarrhea and vomiting are common symptoms as well. Inflammation doesn't show signs right away if the bacteria is deep within the tissue. If it isn't deep, signs of inflammation such as redness, swollen and hot skin show very quickly. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the death rate is high, about 30%. Even with medical assistance the antibiotics take a while to react to the bacteria making the infection even more serious.^[1] In medicine, a trauma patient has suffered serious and life-threatening physical injury resulting in secondary complications such as shock, respiratory failure and death. ... “Surgeon” redirects here. ... Historical data for native populations collected by R. Biasutti prior to 1940. ... Necrosis (in Greek Νεκρός = Death) is the name given to accidental death of cells and living tissue. ... This article needs additional references or sources for verification. ...

Pathophysiology

"Flesh-eating bacteria" is a misnomer, as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors). These include streptococcal pyogenic exotoxins and other virulence factors. S. pyogenes produces an exotoxin known as a superantigen. This toxin is capable of activating T-cells non-specifically. This causes the over-production of cytokines that over-stimulate macrophages. The macrophages cause the actual tissue damage by releasing oxygen free radicals. This article does not cite any references or sources. ... This article or section does not cite any references or sources. ... An exotoxin is a soluble chemical excreted by a microorganism, including bacteria, fungi, algae, and protozoa. ... Binomial name Streptococcus pyogenes Rosenbach 1884 Streptococcus pyogenes is a Gram-positive coccus that grows in long chains depending on the culture method. ... Superantigens (SAgs) are a group of virulent toxins that indiscriminately activate T-cells of the immune system causing system-wide inflammation and other serious, potentially fatal symptoms. ... T cells belong to a group of white blood cells known as lymphocytes and play a central role in cell-mediated immunity. ... Cytokines are small protein molecules that are the core of communication between immune system cells, and even between immune system cells and cells belonging to other tissue types. ... A macrophage of a mouse stretching its arms to engulf two particles, possibly pathogens Macrophages (Greek: big eaters, makros = long, phagein = eat) are white blood cells, more specifically phagocytes, acting in the nonspecific defense as well as the specific defense system of vertebrate animals. ... In chemistry free radicals are uncharged atomic or molecular species with unpaired electrons or an otherwise open shell configuration. ...

Treatment

The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue, but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available. Amputation of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue. Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an intensive care unit. blood culture Blood culture is microbiological culture of blood. ... A copper aspirator. ... Pus is a whitish-yellow or yellow substance produced during inflammatory responses of the body that can be found in regions of pyogenic bacterial infections. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Penicillin nucleus Penicillin (sometimes abbreviated PCN) refers to a group of β-lactam antibiotics used in the treatment of bacterial infections caused by susceptible, usually Gram-positive, organisms. ... Crystal structure of a short peptide L-Lys-D-Ala-D-Ala (bacterial cell wall precursor, in green) bound to vancomycin (blue) through hydrogen bonds. ... Clindamycin (rINN) (IPA: ) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. ... Debridement is a medical term referring to the removal of dead, damaged, or infected tissue to improve the healing potential of the remaining healthy tissue. ... Hyperbaric oxygen therapy (HBOT) is the medical use of oxygen at a higher than atmospheric pressure. ... Partial hand amputation For the song Amputations by Death Cab for Cutie, see You Can Play These Songs with Chords Amputation is the removal of a body extremity by trauma (also referred to as avulsion) or surgery. ... An intensive care unit An Intensive Care Unit (ICU) or Critical Care Unit (CCU) is a specialised facility in a hospital that provides intensive care medicine. ...

Prognosis

This disease is one of the fastest-spreading infections known as it spreads easily across the [[facial] plane within the subcutaneous tissue. For this reason, it is popularly called the "flesh-eating disease" and although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the prognosis can be bleak, with a mortality rate of around 25% and severe disfigurement common in survivors. Mortality is nearly 100% if not properly treated within the first few hours. The subcutis is the layer of tissue directly underlying the cutis. ... For the band, see 1990s (band). ... Prognosis (older Greek πρόγνωσις, modern Greek πρόγνωση - literally fore-knowing, foreseeing) is a medical term denoting the doctors prediction of how a patients disease will progress, and whether there is chance of recovery. ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...

Other bacterial strains

In February 2004, a rarer but even more serious form of the disease has been observed in increasing frequency, with several cases found specifically in California. In these cases, the bacterium causing it was a strain of Staphylococcus aureus (i.e. Staphylococcus, not Streptococcus as stated above) which is resistant against methicillin, the antibiotic usually used for treatment (see Methicillin-resistant Staphylococcus aureus for details). "Super Strep" appeared in Ohio and Texas in 1992 and 1993 and was contracted by appx. 140 people. It took under 12 hours to incapacitate most and caused 3 days of very high fevers. The death rate, in 1993 was reported to be 10% with a majority of the victims having severe to mild brain damage. Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Official language(s) English Capital Sacramento Largest city Los Angeles Area  Ranked 3rd  - Total 158,302 sq mi (410,000 km²)  - Width 250 miles (400 km)  - Length 770 miles (1,240 km)  - % water 4. ... Binomial name Rosenbach 1884 Staphylococcus aureus , (literally Golden Cluster Seed) the most common cause of staph infections, is a spherical bacterium, frequently living on the skin or in the nose of a person, that can cause a range of illnesses from minor skin infections (such as pimples, boils, and cellulitis... Species S. aureus S. caprae S. epidermidis S. haemolyticus S. hominis S. lugdunensis S. saprophyticus S. warneri S. xylosus Staphylococcus (in Greek staphyle means bunch of grapes and coccos means granule) is a genus of Gram-positive bacteria. ... Streptococcus is a genus of spherical shaped Gram-positive bacteria, belonging to the phylum Firmicutes[1] and the lactic acid bacteria group. ... Antibiotic resistance is the ability of a micro-organism to withstand the effects of an antibiotic. ... Methicillin (USAN) or meticillin (INN, BAN) is a narrow spectrum beta-lactam antibiotic. ... Staphylococcus aureus - Antibiotics test plate. ... Binomial name Rosenbach 1884 Methicillin-resistant Staphylococcus aureus (MRSA) are isolates of the bacterium Staphylococcus aureus that have acquired genes encoding antibiotic resistance to all penicillins, including methicillin and other narrow-spectrum β-lactamase-resistant penicillin antibiotics. ...

Well-known victims

• David Walton, a leading economist in the UK and a member of the Bank of England’s Monetary Policy Committee which is responsible for setting interest rates, died of the disease within 24 hours of diagnosis on June 21, 2006.^[2]
• Lucien Bouchard, former premier of Quebec, Canada, who became infected in 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.^[3]
• Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, who lost his left arm and shoulder to the disease in 2004.^[4]
• Melvin Franklin, bass singer for The Temptations. Though Franklin's condition was diagnosed early enough to prevent complete amputation of his arm, he died from other health complications soon afterward in 1995.^{[citation needed]}
• Lana Coc-Kroft, a New Zealand television celebrity, was infected after she stepped on a coral reef in Fiji in 2005.^[5]
• Jan Peter Balkenende, Prime Minister of the Netherlands since 2002, was infected in 2004. He was in the hospital for several weeks, but fully recovered.^[6]
• Alan Coren, British writer and satinist, announced in his Christmas 2006 column for The Times that his long absence as a columnist has been due to contracting the disease whilst on holiday in France.^[7]
• Alexandru Marin, physicist, professor at MIT, Boston University and Harvard University. Major works include MUON detector at CERN.^{[citation needed]}

David Robert Walton (May 30, 1963 – June 21, 2006) was a British economist, and a member of the Bank of Englands Monetary Policy Committee from July 2005 until his death in June 2006. ... is the 172nd day of the year (173rd in leap years) in the Gregorian calendar. ... Year 2006 (MMVI) was a common year starting on Sunday (link displays full 2006 calendar) of the Gregorian calendar. ... Lucien Bouchard, PC , B.Sc , LL.B (born December 22, 1938 in Saint-Coeur-de-Marie, Quebec, Canada) is a Quebec lawyer, diplomat and politician. ... Motto: Je me souviens (French: I remember) Capital Quebec City Largest city Montreal Official languages French Government - Lieutenant-Governor Pierre Duchesne - Premier Jean Charest (PLQ) Federal representation in Canadian Parliament - House seats 75 - Senate seats 24 Confederation July 1, 1867 (1st) Area  Ranked 2nd - Total 1,542,056 km² (595... The Bloc Québécois is a centre-left federal political party in Canada that is devoted to the promotion of sovereignty for Quebec. ... Carl Wieman (left) and Eric Cornell (right) on the University of Colorado at Boulder campus Eric Allin Cornell (born December 19, 1961) is a physicist who, along with Carl E. Wieman, was able to synthesize the first Bose-Einstein condensate in 1995. ... Year 2001 (MMI) was a common year starting on Monday (link displays the 2001 Gregorian calendar). ... Hannes Alfvén (1908–1995) accepting the Nobel Prize for his work on magnetohydrodynamics [1]. List of Nobel Prize laureates in Physics from 1901 to the present day. ... Year 2004 (MMIV) was a leap year starting on Thursday of the Gregorian calendar. ... Melvin Franklin (David Melvin English) (October 12, 1942 – February 23, 1995) was an American bass singer, best known for his role as a member of Motown singing group The Temptations from 1961 to 1994. ... A basso (or bass) is a male singer who sings in the lowest vocal range of the human voice. ... “Temptations” redirects here. ... Year 1995 (MCMXCV) was a common year starting on Sunday (link will display full 1995 Gregorian calendar). ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... Dr. Jan Peter Balkenende   (born on 7 May 1956), has served as Prime Minister of The Netherlands since 22 July 2002. ... A prime minister is the most senior minister of a cabinet in the executive branch of government in a parliamentary system. ... Alan Coren (born 27 June 1938, London) is a British writer and satirist. ... The Times is a national newspaper published daily in the United Kingdom since 1788. ... Alexandru (Adalbert) Marin 1945 - November 14, 2005, physicist, professor at MIT, Boston University and Harvard University. ...

See also

• Mucormycosis, a rare fungal infection which can present like necrotizing fasciitis
• Toxic shock syndrome

Mucormycosis is a fungal infection that is quite rare but frequently fatal. ... Toxic shock syndrome (TSS) is a rare but potentially fatal disease caused by a bacterial toxin. ...

References

External links

• National Necrotizing Fasciitis Foundation official website
• Flesh-Eating Bacteria