necrotizing fasciitis

Necrotizing fasciitis (NECK-ro-tie-zing fash-ee-EYE-tiss) is the dread "flesh eating virus" of supermarket tabloid fame. Unfortunately, while it really isn't a virus, but a bacterial infection, the fear is justified. While rare, this syndrome is devastating, disfiguring, and potentially lethal.

This syndrome can be caused by a variety of organisms, and often is actually a combined infection of several germs attacking at once. In adults, the majority of infections are caused by several bacteria acting in concert. Necrotizing refers to the fact that there is extensive tissue death (necrosis). Fasciitis means that the infection spreads along the planes of specialized tissue that surround and lie between muscle bodies called the fascia. The fascia binds the muscle body into a unit - hence the name. The spaces between the fascia surrounding the muscles act as a freeway for bacteria to spread deep and wide through the body once they get a foothold and overwhelm local defences.

In children, the syndrome, while rare, is most often caused by Group A streptococcus infecting chickenpox sores. There is first a spreading cellulitis around an infected chickenpox sore, followed by swelling and then the onset of gangrene (tissue death). Initially, the infection may not appear to be very severe, but can progress rapidly to sepsis, shock and death.

Treatment involves early detection, agressive surgical debridement (cleaning out) of the infected tissue spaces, and high dose antibiotics along with life support. The very extensive wounds that result usually require later plastic surgical reconstruction.

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