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Necrotizing Fasciitis Definition
A rare but serious bacterial INFECTION of the fascia, the layer of connective tissue that covers, separates, and connects the muscles and other musculoskeletal structures. In necrotizing fasciitis a combination of aerobic and anaerobic bacterial activity produces an abundance of nitrogen, hydrogen, and methane gases. These gases act to suppress the activity of white blood cells that ordinarily would move in to fight the infection. Necrotizing fasciitis is most commonly an OPPORTUNISTIC INFECTION that develops in people who have DIABETES, HIV/AIDS, and other circumstances of immunocompromise.
Diagnosis and Symptoms of Necrotizing fasciitis
Nearly always the infection arises at or near the site of a wound, either accidental (more common) or surgical. Symptoms include sudden, severe PAIN at the site along with redness and slight swelling. The person generally feels and looks well in the early stages of the infection, then suddenly becomes critically ill. The redness of the rash becomes purple, and the skin is odd to the touch. Often there is loss of sensation (traumatic ANESTHESIA) in the area.
Necrotizing fasciitis moves very rapidly along the fascia into the deep tissues; the farther into the body it goes, the faster its progression because the anaerobic conditions (lack of oxygen) support its growth. Diagnosis is difficult in the early stages but unmistakable in the later stages. Blood cultures and cultures of tissue samples from the innermost edges of the infection generally reveal the causative BACTERIA, which allows doctors to choose effective ANTIBIOTIC MEDICATIONS.
Treatment Necrotizing Fasciitis
Treatment is multifocused and includes intravenous antibiotics, usually multiple drugs, to attack the various types of bacteria involved in the infection as well as surgery to expose the infection to air (which reduces the ability of anaerobic bacteria to flourish) and remove dead and infected tissue so only healthy tissue remains. The surgical wounds are often significantly larger than the surface appearance of the infection would suggest because so much of the infection is deep within the body. Multiple operations are often necessary. Treatment with hyperbaric oxygen speeds improvement in some people.
With early detection and aggressive treatment that keeps necrotizing fasciitis fairly localized, the likelihood for recovery is good. When infection is extensive and other health conditions exist that challenge the IMMUNE RESPONSE, about 20 percent of people survive necrotizing fasciitis. Because researchers do not understand the complexity of circumstances that allows necrotizing fasciitis to develop, there are no methods for preventing infection. People who have any degree of immunocompromise should carefully monitor any wounds and seek prompt medical care for those that do not seem to follow a normal path of HEALING.