Recently, an Edmonton lady was diagnosed with flesh-eating disease while on a holiday in Mexico. Media reports say the lady underwent three surgeries to remove the dead tissues secondary to the infection. The good news is she survived and is now back in Canada.
Medically speaking, this condition is known as necrotizing fasciitis. It is not a new disease. It is often called flesh-eating disease because it kills muscle and skin as it spreads through the tissue.
In Canada, in 1954, the famous case of flesh-eating disease was Loucien Bouchard, the former premier of Quebec. He luckily survived and had to have one leg amputated.
It is an uncommon, rapidly progressive and life-threatening infection that requires urgent diagnosis and medical and surgical treatment. Fortunately, the disease is not that common. In Canada, it is estimated 90 to 200 cases of necrotizing fasciitis occur each year. And, unfortunately, approximately 20 to 30 per cent of these cases lead to death. From time to time the disease hits the headlines. Then there is a long silence before another case is reported. This leaves people wondering what is this all about.
The term flesh-eating refers to the toxins produced by a bacterial infection that can destroy muscles, skin and fatty tissues. The infection spreads rapidly. It progressively destroys fat, fascia and muscles. Shock and multi-organ failure are common.
The flesh-eating infections have been described as early as the fifth century B.C. during the time of Hippocrates. More than 2,000 cases of this condition were reported among soldiers during the Civil War.
In 1871, the same disease was recorded by Dr. Joseph Jones, who was an army surgeon for the Confederate Army (in the American Civil War). He called it ‘hospital gangrene’, and 46 per cent of his patients who suffered the condition died.
Who is susceptible to the infection?
Certain illnesses can make people prone to this infection: diabetes mellitus, intravenous drug users and those who are immunocompromised. However, these infections can arise in people who are healthy.
What kind of organisms are involved?
Streptococci (invasive group A hemolytic streptococci) may act alone or in combination with other bacteria.
The most common sites of infection are perineal and groin areas and post-surgical wounds. Infection around the umbilicus in a new born can be life-threatening. Infection can occur in the trunk and the limbs.
What are the signs and symptoms?
Pain, warmth, skin redness, or swelling at a wound, especially if the redness is spreading rapidly. Skin blisters, sometimes with a “crackling” sensation under the skin. Pain from a skin wound that also has signs of a more severe infection, such as chills and fever. Grayish, smelly liquid draining from the wound would suggest the diagnosis.
Diagnosis
For diagnosis, it is important to be clinically alert to the condition. Early expert advice when necrotizing fasciitis is suspected should be considered. But early diagnosis of this condition is not always easy. If the diagnosis is in doubt, then surgical exploration is the best way to go.
Here are four key points from the Canadian Medical Association Journal (CMAJ May 23, 2017):
- Necrotizing fasciitis can occur in otherwise healthy individuals.
- Treatment involves emergency debridement in the operating theatre, broad spectrum antimicrobial drugs, local wound care and eventual free flap reconstruction.
- If the diagnosis is not clear, it is important to reassess the patient frequently and seek early expert advice in suspected cases.
- Imaging examination is ancillary and should never delay surgical treatment of necrotizing fasciitis.
(Ref: Necrotizing fasciitis after scalpel injury sustained during postmortem examination. Michal Brichacek, Robert Strazar, Kenneth A Murray and Avinash Islur CMAJ May 23, 2017 189 (20))
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