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Necrotizing fasciitis

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Flesh-Eating Disease

Flesh-Eating Disease


Flesh-eating disease is more properly called necrotizing fasciitis, a rare condition in which bacteria destroy tissues underlying the skin. This tissue death, called necrosis or gangrene, spreads rapidly. This disease can be fatal in as little as 12 to 24 hours.


Although the term is technically incorrect, flesh-eating disease is an apt descriptor: the infection appears to devour body tissue. Media reports increased in the middle and late 1990s, but the disease is not new. Hippocrates described it more than three millennia ago and thousands of reports exist from the Civil War. Approximately 500 to 1,500 cases of necrotizing fasciitis occur in the United States each year.

Flesh-eating disease is divided into two types. Type I is caused by anaerobic bacteria, with or without the presence of aerobic bacteria. Type II, also called hemolytic streptococcal gangrene, is caused by group A streptococci; other bacteria may or may not be present. The disease may also be called synergistic gangrene.

Type I fasciitis typically affects the trunk, abdomen, and genital area. For example, Fournier's gangrene is a "flesh-eating" disease in which the infection encompasses the external genitalia. The arms and legs are most often affected in type II fasciitis, but the infection may appear anywhere.

Causes and symptoms

The two most important factors in determining whether or not a person will develop flesh-eating disease are: the virulence (ability to cause disease) of the bacteria and the susceptibility (ability of a person's immune system to respond to infection) of the person who becomes infected with this bacteria.

In nearly every case of flesh-eating disease, a skin injury precedes the disease. As bacteria grow beneath the skin's surface, they produce toxins. These toxins destroy superficial fascia, subcutaneous fat, and deep fascia. In some cases, the overlying dermis and the underlying muscle are also affected.

Initially, the infected area appears red and swollen and feels hot. The area is extremely painful, which is a prominent feature of the disease. Over the course of hours or days, the skin may become blue-gray, and fluid-filled blisters may form. As nerves are destroyed the area becomes numb. An individual may go into shock and develop dangerously low blood pressure. Multiple organ failure may occur, quickly followed by death.


The appearance of the skin, paired with pain and fever raises the possibility of flesh-eating disease. An x ray, magnetic resonance imaging (MRI), or computed tomography scans (CT scans) of the area reveals a feathery pattern in the tissue, caused by accumulating gas in the dying tissue. Necrosis is evident during exploratory surgery, during which samples are collected for bacterial identification.


Rapid, aggressive medical treatment, specifically, antibiotic therapy and surgical debridement, is imperative. Antibiotics may include penicillin, an aminoglycoside or third-generation cephalosporin, and clindamycin or metronidazole. Analgesics are employed for pain control. During surgical debridement, dead tissue is stripped away. After surgery, patients are rigorously monitored for continued infection, shock, or other complications. If available, hyperbaric oxygen therapy has also be used.


Flesh-eating disease has a fatality rate of about 30%. Diabetes, arteriosclerosis, immunosuppression, kidney disease, malnutrition, and obesity are connected with a poor prognosis. Older individuals and intravenous drug users may also be at higher risk. The infection site also has a role. Survivors may require plastic surgery and may have to contend with permanent physical disability and psychological adjustment.


Flesh-eating disease, which occurs very rarely, cannot be definitively prevented. The best ways to lower the risk of contracting flesh-eating disease are:

  • take care to avoid any injury to the skin that may give the bacteria a place of entry
  • when skin injuries do occur, they should be promptly washed and treated with an antibiotic ointment or spray
  • people who have any skin injury should rigorously attempt to avoid people who are infected with streptococci bacteria, a bacteria that causes a simple strep throat in one person may cause flesh-eating disease in another
  • have any areas of unexplained redness, pain, or swelling examined by a doctor, particularly if the affected area seems to be expanding



Roemmele, Jacqueline A., Donna Batdorff, and Alan L. Bisno. Surviving the 'Flesh-Eating Bacteria': Understanding, Preventing, Treating, and Living With the Effects of Necrotizing Fascitis. New York: Avery Penguin Putnam, 2000.


National Necrotizing Fascitis Foundation. PO Box 145, Niantic, CT 06357. (616) 261-2538.


Aerobic bacteria Bacteria that require oxygen to live and grow.

Anaerobic bacteria Bacteria that require the absence of oxygen to live and grow.

CT scan (computed tomography scan) Cross-sectional x rays of the body are compiled to create a three-dimensional image of the body's internal structures.

Debridement Surgical procedure in which dead or dying tissue is removed.

Dermis The deepest layer of skin.

Fascia, deep A fibrous layer of tissue that envelopes muscles.

Fascia, superficial A fibrous layer of tissue that lies between the deepest layer of skin and the subcutaneous fat.

Gangrene An extensive area of dead tissue.

Hyperbaric oxygen therapy A treatment in which the patient is placed in a chamber and breathes oxygen at higher-than-atmospheric pressure. This high-pressure oxygen stops bacteria from growing and, at high enough pressure, kills them.

Magnetic resonance imaging (MRI) An imaging technique that uses a large circular magnet and radio waves to generate signals from atoms in the body. These signals are used to construct images of internal structures.

Necrosis Abnormal death of cells, potentially caused by disease or infection.

Subcutaneous Referring to the area beneath the skin.

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Flesh-Eating Disease



Flesh-eating disease is more properly called necrotizing fasciitis (pronounced nek-ro-TIZE-ing FASS-ee-i-tiss). The disease is caused by a rare bacterium that destroys tissues lying beneath the skin. The tissue death is called necrosis, or gangrene. It spreads very rapidly and can be fatal.


The term flesh-eating disease is not really correct. However, it does describe what seems to happen in the disease. An infection occurs that seems to consume body tissue. Reports about flesh-eating disease increased during the 1990s. But the disease has been known for a very long time. The Greek physician Hippocrates (c. 460c. 377b.c.) described the condition more than two thousand years ago. The disease was also common during the Civil War (186165).

Flesh-eating disease affects the arms and legs most often, but the infection can occur anywhere on the body.

Flesh-Eating Disease: Words to Know

Computed tomography (CT) scan:
X rays taken of a portion of the body from various angles in order to obtain a three-dimensional picture of that region of the body.
Computerized axial tomography (CAT) scan:
Another name for a computed tomography (CT) scan.
An extensive area of dead tissue.
Abnormal death of tissues.


In nearly every case, flesh-eating disease begins with a skin infection. Bacteria begin to grow in the infected area. They release toxins (poisons) that destroy tissue under the skin.


Initially, the infected area appears red and swollen and feels hot. The area is extremely painful. After a few hours or days, the skin may become bluish-gray in color. Blisters filled with fluid may also form. The infected area becomes numb. An individual may go into shock and develop dangerously low blood pressure. The heart, kidneys, liver, and other organs may fail, leading to the patient's death.


Flesh-eating disease can often be diagnosed based on the way the skin looks, along with pain in the area and a fever. This diagnosis can be confirmed by a variety of tests, such as an X ray or a computed tomography (CT) scan. A CT scan is a procedure by which X rays are directed at a patient's body from various angles and the set of photographs thus obtained assembled by a computer program. This procedure is sometimes called a computerized axial tomography (CAT) scan. Samples of tissue under the skin can also be taken. Analysis of these samples will tell if the flesh-eating bacteria are present.


Two treatments are used with flesh-eating disease. One is the use of antibiotics. Antibiotics such as penicillin, a family of drugs known as aminoglycosides (pronounced uh-MEE-no-gly-ko-sides), or cephalosporins (pronounced seff-a-lo-SPORE-inz) are used to kill the flesh-eating bacteria. The second method of treatment is surgery on the infected area. During surgery, dead tissue is cut away so that healthy tissue can grow back. The patient is observed carefully after surgery to make sure that the infection does not return.


About 30 percent of those who are affected by flesh-eating disease eventually die of the infection. People with other disorders, such as diabetes (see diabetes mellitus entry), kidney disease, malnutrition, and obesity (see obesity entry), are at especially high risk for the disease. The elderly and intravenous drug users (those who inject drugs) are also at higher risk for the disease.

One consequence of the disease can be permanent scarring where the dead skin was cut away. Plastic surgery can sometimes be used to cover or reduce the amount of scarring.


There is no known method of preventing flesh-eating disease.



Kotrappa, Kavitha S., Radhey S. Bansal, and Navin M. Amin. "Necrotizing Fasciitis." American Family Physician (May 1996): p. 1691.

Rth-Sahd, Lisa A., and Mary Pirrung. "The Infection that Eats Patients Alive." RN 1997 (March 1997): p. 28.

Web sites

"The Flesh-eating Bacteria." Microbiology Home Page: Queen Mary Hospital. [Online] (accessed on October 19, 1999).

National Necrotizing Fasciitis Foundation Home Page. [Online] (accessed on October 19, 1999).

Grant, Amy. "Streptococcus ANecrotizing Fascitis." Bacterial Infections and Mycoses. [Online] (accessed on October 19, 1999).

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necrotizing fasciitis

necrotizing fasciitis n. a life-threatening bacterial infection of the layer of fascia beneath the skin, usually by Streptococcus. Tissue necrosis and toxin production can result in shock and multi-organ failure. It is often associated with vascular disease, especially in diabetics, and the elderly and those who have recently undergone surgery are also vulnerable to the infection, which requires prompt treatment with intravenous antibiotics and excision of the involved tissue.

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