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Necrotizing soft tissue infection

Necrotizing soft tissue infection is a rare but very severe type of bacterial infection. It can destroy the muscles, skin, and underlying tissue. The word "necrotizing" refers to something that causes body tissue to die.

Alternative Names

Necrotizing fasciitis; Fasciitis - necrotizing; Flesh-eating bacteria; Soft tissue gangrene; Gangrene - soft tissue

Causes

Many different types of bacteria can cause this infection. A very severe and usually deadly form of necrotizing soft tissue infection is due to Streptococcus pyogenes, which is sometimes called "flesh-eating bacteria."

Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape. The bacteria begins to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. As the tissue dies, the bacteria enters the blood and rapidly spreads throughout the body.

Symptoms

Symptoms include:

  • Small, red, painful lump or bump on the skin
  • Changes to a very painful bruise-like area and grows rapidly, sometimes in less than an hour
  • The center may become black and die
  • The skin may break open and ooze fluid

Other symptoms can include:

  • Feeling ill
  • Fever
  • Sweating
  • Chills
  • Nausea
  • Dizziness
  • Weakness
  • Shock

Exams and Tests

Your doctor or nurse may diagnose this condition by looking at your skin. You may be diagnosed in an operating room by a surgeon.

Tests that may be done include:

  • CT scan
  • Blood tests
  • Skin tissue biopsy

Treatment

Immediate treatment is needed to prevent death. Treatment includes:

  • Powerful, broad-spectrum antibiotics given immediately through a vein (IV)
  • Surgery to drain the sore and remove dead tissue
  • Special medicines called donor immunoglobulins (antibodies) to help fight the infection in some cases

Other treatments may include:

  • Skin grafts after the infection goes away to help your skin heal and look better
  • Amputation if the disease spreads through an arm or leg
  • 100% oxygen at high pressure (hyperbaric oxygen therapy) for certain types of bacterial infections

Outlook (Prognosis)

How well you do depends on:

  • Your overall health (especially if you have diabetes)
  • How fast you were diagnosed and how quickly you received treatment
  • The type of bacteria causing the infection
  • How quickly the infection spreads
  • How well treatment works

This disease commonly causes scarring and skin deformity.

Death can occur rapidly without proper treatment.

Possible Complications

  • Infection spreads throughout body, causing a blood infection (sepsis), which can be deadly
  • Scarring and disfigurement
  • Loss of your ability to use an arm or leg
  • Death

When to Contact a Medical Professional

This disorder is severe and may be life-threatening, so contact your health care provider immediately if symptoms of infection occur around a skin injury, including:

  • Drainage of pus or blood
  • Fever
  • Pain
  • Redness
  • Swelling

Prevention

Always clean the skin thoroughly after a cut, scrape, or other skin injury.

References

Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections. Clin Infect Dis. 2005;41(10):1373-1406.

Updated: 12/3/2013

Daniel Levy, MD, PhD, Infectious Diseases, Lutherville Personal Physicians, Lutherville, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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