Danger in the Flesh
Jan.11, 2007 — -- A 44-year-old male maintenance worker scraped his left foot on the job and suffered a simple wound that would soon cost him his leg -- but thankfully not his life.
Two days later, the scrape was blue and swollen, and oozed gray pus. He had a fever of 102 degrees Fahrenheit.
Quickly, the wound turned purple, grew to the size of a credit card, and kept oozing. It hurt -- a lot. He showed up at the emergency department with a fever of 103 degrees. The wound was dusky and numb. The doctor suspected flesh-eating disease.
Doctors knew they had little time to save the man's life. If he did not have surgery immediately to remove the infected tissue, he would likely die. To save his life, they amputated his leg within hours, only three days after the scrape.
The surgery cost the man his leg, but his doctor's quick thinking saved his life.
The U.S. Centers for Disease Control and Prevention estimate that 600 people each year acquire flesh-eating disease in the United States. Up to 30 percent of those people will die from the infection. Rapid diagnosis and surgery are the only ways to improve patients' chances for survival.
What Is it?
Necrotizing fasciitis (pronounced: nek-ruh-tahyz-ing fash-ee-ahy-tis), also known as "flesh-eating disease" or "flesh-eating bacteria," is a life-threatening infection. It is caused by "Strep" germs that infect the deeper layers of skin.
Roughly 30 percent of people who get flesh-eating disease die from the infection.
Strep germs are usually associated with illnesses like strep throat, or skin infections like impetigo that are easily cured with antibiotics. Very rarely a person may develop a life-threatening, flesh-eating disease when Strep germs get into deeper layers of the skin through minor cuts or scrapes.
Certain types of Strep germs produce toxins that damage the skin and deeper tissues. The disease is then called "flesh-eating" because the Strep toxins kill the infected tissue and rapidly spread to nearby tissues.
These germs and toxins often spread throughout the body, and can cause breathing problems and kidney problems as well.
Dr. Jennifer Logan is an instructor in the division of infectious disease and international medicine at the University of South Florida. Dr. John Sinnot is a professor at the same division and is director of that division.
Who Is at Risk?
Most people will not get flesh-eating disease, even if they do have a cut infected with Strep germs. People who are healthy with good immune systems are the least likely to get this disease. People with poor immune systems from HIV, AIDS, hepatitis or cancer have an increased risk for flesh-eating disease.
Other people at risk include: diabetics, people with significant burned areas of skin, and people on certain medications. You can speak with your doctor to find out whether you take any medications that may increase your risk.
Symptoms
Flesh-eating disease can occur anywhere on the body and may look like a small, red, swollen area at first. The skin will turn gray or black if untreated. The area is painful but has numbness overlying the redness. This numbness is characteristic of the flesh-eating disease, because it reflects the damage to nerves deeper in the skin.
Unlike other skin infections, this disease can progress quickly over a few hours. If you have a fever with a red area on your skin that is numb or growing in size, you should contact your doctor immediately. If you cannot find your doctor, go to the emergency room.
How Do I Prevent Infection?
The best way to prevent flesh-eating disease is careful hand washing and thorough cleaning of any open wounds. If you have an injury with broken skin, keep the area clean and covered after washing and until crusted.
Patients with diabetes, HIV, hepatitis or cancer should inspect their skin daily for cuts and scrapes that might become infected. Flesh-eating disease is rarely contagious to other people, but you should wash your hands thoroughly if you come into contact with someone who has this disease.
Doing this will prevent spreading germs to yourself or others. Flesh-eating disease is very rare, and most people who come into contact with these patients do not become infected.
How Will My Doctor Know?
Doctors diagnose flesh-eating disease by its appearance, rapid progression and overlying numbness. There is no reliable laboratory test to check for this disease, but MRI radiology studies are often diagnostic. Management must start immediately -- there is no time to wait for laboratory tests -- to reduce the risk of death.
Dr. Jennifer Logan is an instructor in the division of infectious disease and international medicine at the University of South Florida. Dr. John Sinnot is a professor at the same division and is director of that division.
How Is It Treated?
A person who develops flesh-eating disease will require surgery to remove the infected tissue. This tissue removal can be very extensive, including removal of skin, fat and even muscle tissue. After the infection is cured, patients often need surgery to graft new skin.
If surgery is not performed quickly, the infection can continue to spread and the patient is more likely to die. Antibiotics are also given through the patient's veins to help kill Strep germs in the bloodstream and decrease the spread to other areas of the body.
Dr. Jennifer Logan is an instructor in the division of infectious disease and international medicine at the University of South Florida. Dr. John Sinnot is a professor at the same division and is director of that division.