What You Need to Know About Flesh-Eating Bacteria | Knowledge Brush-Up

J.Adderton, BSN, MSN

It seems a new case of flesh-eating bacteria is reported in the news every few days. The stories are often similar; a short time of water play results in lengthy hospital stays, surgeries and sometimes death. Although the media refers to the infection as “flesh-eating” bacteria, there are actually several types of bacteria that can lead to serious skin infections.

The clinical condition of “flesh-eating” disease is actually necrotizing fasciitis. It is rare, serious and occurs when bacteria enters through a break in the skin. Necrotizing fasciitis quickly attacks the skin, fat and tissue covering our muscles. Toxins released by the bacteria can lead to shock and organ failure.

What causes necrotizing fasciitis?

Group A. Streptococcus is believed to be the most common cause of necrotizing wound infections according to the CDC. However, other types of bacterial infections can lead to the condition. V. vulnificus bacteria can also enter through breaks in the skin when wading or swimming in infected water. The vibrio species thrives in warm waters that stay above 55 degrees year-round. This is why reports of necrotizing fasciitis are often reported in warmer months of Summer.

Where does the bacteria enter?

The bacteria can enter through any break in the skin. This includes:

Cuts and scrapes
Trauma or surgical wounds
Rashes
Burns
Insect or animal bites
Puncture wounds, including those caused by IV drug use

Why is quick diagnosis and acting fast so critical?

Necrotizing fasciitis spreads easily, rapidly and a person’s condition deteriorates in a short amount of time. The fatality rate is high, between 20 and 80 percent. The CDC reports between 700 and 1,100 cases of necrotizing fasciitis, caused by group A streptococcus, has been reported each year since 2010.

Why is such a crucial diagnosis often delayed?

In the early stages, the signs of tissue inflammation may not be noticed or attributed to other causes. The signs and symptoms of necrotizing fasciitis become more apparent as the infection worsens. They may take 3-4 days to appear and be vague- a low grade fever and general unwell feeling.

Early symptoms may include:

Red, hot and swollen area of skin that spreads quickly
Severe pain and pain extending beyond the area of red skin
Presence of fever

Late symptoms may include:

Ulcers, blisters and black spots on the skin
Pus or oozing drainage from the infected area
Dizziness and fatigue
Diarrhea or nausea
Confusion
Dehydration
Skin changes color- violet or black
Necrotic or gangrene skin

After 4-5 days, the infection enters the bloodstream and the person becomes critically ill. Signs of sepsis will present, including high temperature, low blood pressure and altered level of consciousness and eventually organ failure.

How is necrotizing fasciitis diagnosed?

The doctor will evaluate symptoms and assess the area of infection. These diagnostic tests can be used to make an accurate diagnosis:

Tissue sample (biopsy)
Bloodwork to evaluate for signs of infection or muscle damage
Diagnostic imaging of the infected area

Who is at risk?

Although necrotizing fasciitis is rare, most cases are diagnosed in someone with a weakened immune system. These include:

Heavy use of alcohol or drugs
Breaks in skin
- Acne
- Eczema
- Punctures
- Insect bites
- Tattoos
- Rashes
Older adults
Those with chronic illness
- Diabetes
- Kidney disease
- Cirrhosis
- Cancer
Recent surgery or trauma
Peripheral vascular disease

What is the treatment?

The first line of treatment for flesh-eating bacteria is intravenous antibiotics and surgery to remove infected tissue. Multiple surgeries may be needed in serious infections and amputations may be necessary.

Is necrotizing fasciitis contagious?

It is very rare for this condition to spread person to person.

What can I do to prevent skin infections?

Simple precautions can ward off skin infections. Keep all breaks in the skin clean and dry; covered with a dry bandage if open or draining. Good hand washing is essential for preventing infection. And, see a doctor for deep or serious wounds.

If you have an open wound, avoid:

Hot tubs
Swimming pools
Lakes, rivers, oceans and other bodies of water

Enjoy the Water, But Take Precautions

Necrotizing fasciitis is very rare. Your chances of getting the infection is extremely low if you are in good health and practice good hygiene. Therefore, people should not be afraid to enjoy the water. Just be sure to practice good hygiene and prevention measures.

Additional Resources

What is Flesh Eating Bacteria and How Do You Fight Them?

Necrotizing Fasciitis: All You Need to Know

Necrotizing Fasciitis Hits Fishing Florida Man