Flesh Eating Bacteria

[Sanju]

no i have not seen these cases coz i m yet to come to clinical... but i had watched a documentry about it in Discovery channel few years back when i had not even joined MBBS and it was awful... so i thought it would be a good topic to inform about.

[Anup'da]

well in a research article published in journal of nepal medical association, necrotising cervical fascitis is caused by strep or staph group of bacteria and the sloughing off of the scruff and neck skin occurs as a result of compromised blood supply to the area.this occurs because of infective emboli formation of bacteria occluding the blood vessels,and subsequent necrosis of the skin

i didn't find anything mentioned of sort of central activation of brain and release of prostaglandin, so if u please make it more clearer on this that this happens really as u have written and does the drug effect is such worse, ....

do intimate

[Sanju]

Necrotizing fasciitis is a bacterial infection. These bacteria attack the soft tissue, usually in an extremity following minor trauma. There are also many cases of this occurring after surgery, and most often abdominal surgery.

It can be contracted after a c-section, after abdominal surgery, after scratching a rash, after giving birth vaginally, from a 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.

The bacteria are introduced from a person carrying Strep Type A or from an area where Strep Type A is present. These bacteria are the same as those that cause "Strep throat." However, there are various strains of the bacteria, some of which are more powerful than others (with stronger m-protein serotypes).

The name "flesh-eating-bacteria" is a little sensational, but essentially, the bacteria do "eat flesh." They attack the subcutaneous (soft) tissue, which then becomes gangrenous. Infection moves swiftly, usually under the skin, where it is unobservable. Once tissue becomes necrotic (dead), it has to be removed.

Few people who come in contact with a virulent strain of GAS will develop invasive GAS disease; many will have a routine throat or skin infection, and most will have no symptoms whatsoever. Although healthy people can get invasive GAS disease, those with chronic illnesses like cancer, diabetes, and kidney disease requiring dialysis and those who use medications such as steroids are at higher risk. In addition, breaks in the skin, like cuts, wounds, or chickenpox may provide an opportunity for the bacteria to enter the body.

If diagnosed very early, tissue loss can be "relatively" small, and surgery would be less severe, with removal of flesh, subcutaneous tissue, and fat only. The bacteria usually will not attack muscle or bone. In more advanced cases, 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 system 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.

Prompt treatment is essential due to the speed with which the infection spreads.

Unfortunately, symptoms of Necrotizing fasciitis resemble influenza ("the flu"), and most people delay treatment. No major trauma is necessary. In fact, the condition often occurs following minor trauma, or even a bruise or abrasion. As mentioned above, it can occur after surgery. In any case, the symptoms are the same.

Often after treatment is sought, misdiagnosis or delayed diagnosis occurs. Even in the hospital following surgery many cases have gone unrecognized until it was too late to save the patient. In the early stages, Necrotizing fasciitis may be indistinguishable from typical acute cellulitis, yet prompt diagnosis is essential because it correlates strongly with a more favorable outcome.
Here are some of the symptoms to look for in the general order in which they occur as the condition advances:

1. Trauma of some type (however slight)
2. Discomfort in the general region of the trauma
3. Increased pain/tenderness; the pain is out of proportion in relation to the injury
4. Flu-like symptoms: vomiting, diarrhea, dehydration, general malaise, weakness, muscle pain, and fever
5. Swollen tissue and/or redness; affected area feels hot and very painful
6. Condition worsens without any improvement of the above conditions
7. Less frequent urination
8. Potential appearance of a sunburn-type rash
9. Large, dark boil-like blister(s) may or may not form
10. Possibility of shock

When seeking medical help, be sure to call these symptoms to the attention of medical personnel. This minimizes the risk of a delayed diagnosis if indeed the symptoms are those of Necrotizing fasciitis.

The single, most important preventative measure is keeping the skin intact!

Next is cleanliness. Always wash even the smallest opening in the skin and apply an antibiotic ointment. Buy tubes of antibiotic ointment and keep one in your car, your desk, your exercise bag, and at home.

The spread of all types of GAS infections may be reduced by good handwashing, especially after coughing and sneezing, before preparing foods and before eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether it is "strep throat"; if so, the person should stay home from work, school, or day care until 24 hours or more after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection: increasing redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever develops, should seek medical care.

Be respectful to protect others from infection if you suspect that you may have a Strep infection, such as Strep throat, or have been exposed to someone with a known Strep infection. Carriers of the disease will not necessarily exhibit symptoms.

SOURCE: The national Necrotising Fascilitis Foundation and Center for Disease Control

[Sanju]

People with increased risk of developing Necrotising Fascilitis * Have a weakened immune system or lack the proper antibodies to fight off the infection.
* Have chronic health problems such as diabetes, cancer, or liver or kidney disease.
* Have cuts or surgical wounds, including episiotomy.
* Recently had chickenpox or other viral infections that cause a rash.
* Use steroid medications, which can lower the body's resistance to infection.

[Angel]

I couldn't resist myself to share my experience. Well, I was posted in the surgery and got a case of Fournier Gangrene. He was a 53 years old male, diabetic, admitted when we were about to complete our internship he underwnet surgical debridement. I did dressing for couple of time after a week I left the department as I completed my posting and the internship as well and didnt' get the chance to follow up the patient.


Click to Enlarge it

After a month when I went to the department to know the whereabout of the patient I was told the he improved, split skin graft was done and discharged. But all patients are not fortunate enough to get the prompt surgical and early antibiotics treatment which is the mainstay of management.

I don't want to go into the detail of the literature as most of the things have been discussed however you can visit the following links for more info:

• Fournier Gangrene - eMedicine
• Fournier's Gangrene - Evidence Base Review
• Fournier Gangrene - Case Study 1
• Fournier Gangrene - Case Study 2

Nice discussion, Keep it up guys.

[Ramri]

Originally Posted by ujnas

m a junior member too, so i thought it would be helpful.

unjnas I find it helpful.

Originally Posted by Angel

I couldn't resist myself to share my experience. Well, I was posted in the surgery and got a case of Fournier Gangrene. He was a 53 years old male, diabetic, admitted when we were about to complete our internship he underwnet surgical debridement. I did dressing for couple of time after a week I left the department as I completed my posting and the internship as well and didnt' get the chance to follow up the patient.


Click to Enlarge it

After a month when I went to the department to know the whereabout of the patient I was told the he improved, split skin graft was done and discharged. But all patients are not fortunate enough to get the prompt surgical and early antibiotics treatment which is the mainstay of management.

I don't want to go into the detail of the literature as most of the things have been discussed however you can visit the following links for more info:

• Fournier Gangrene - eMedicine
• Fournier's Gangrene - Evidence Base Review
• Fournier Gangrene - Case Study 1
• Fournier Gangrene - Case Study 2

Nice discussion, Keep it up guys.

it must have been the most painful moment of his life for thie patient, i have never seen this case or seen any picuturs of fournier gangrene now i can imagine how terrible is this disease.

thank you Angel for sharing your experience.

[Vishal]

Originally Posted by Hero

... During my MBBS, I encountered 2 cases of Fournier's gangrene--in the scrotal region. It really looks deadly, actually it is. Fortunately it is rare.

Great,, u seem an experienced doc. Ur posts are really informative, interesting, as well as tough also . Thank you hero

[Vishal]

Originally Posted by Angel

Well, I was posted in the surgery and got a case of Fournier Gangrene. He was a 53 years old male, diabetic, admitted when we were about to complete our internship he underwnet surgical debridement. I did dressing for couple of time after a week I left the department as I completed my posting and the internship as well and didnt' get the chance to follow up the patient.

Thank you Angel for sharing ur experince, especially for the picture.