Necrotising fasciitis is a severe and rapidly progressing skin and soft tissue infection that leads to necrosis of the muscle fascia and subcutaneous tissue. It is a life-threatening infection with high mortality, ranging between 20% to 80%. 

Numerous factors contribute to unfavourable outcomes, including delayed onset, older age, resistant strains of microbes, delayed treatment initiation, multiorgan failure, and the site of the anatomic infection. If you are appearing for NEET PG, it is crucial to have a comprehensive understanding of the causes, symptoms, diagnosis, and treatment of necrotising fasciitis.

This not only helps in achieving quality exam preparation but also provides a strong platform for making appropriate diagnoses and clinical judgments in real-life practice afterwards. Keep reading to gain a complete understanding of this life-threatening condition.

What is Necrotising Fasciitis?

Necrotising fasciitis is a severe and rapidly progressing bacterial infection that can be fatal unless treated promptly. “Necrotising” is the killing of tissue, and “fasciitis” is inflammation of the fascia, the layer of connective tissue underlying the skin that covers and supports muscles, nerves, blood vessels, and fat.

It is a type of necrotising soft tissue infection (NSTI) and is also known as a “flesh-eating disease.” Other such infections in this group are necrotising cellulitis and necrotising myositis.

What Causes Necrotising Fasciitis?

This infection typically develops when bacteria enter the body with an entry point through the skin. It may be a small cut, scrape, surgery incision, or even needle puncture. These injuries need not be deep for infection to develop.

The most prevalent cause is Group A Streptococcus, although many other bacteria can cause necrotising fasciitis, such as:

• Aeromonas hydrophila
• Clostridium species
• Escherichia coli (E. coli)
• Klebsiella
• Staphylococcus aureus

What are Necrotising Fasciitis Symptoms?

Necrotising fasciitis symptoms often develop within the first 24 hours of infection and can be similar to the flu or a common skin infection. This renders early detection challenging, particularly after surgery. The signs exhibited early are:

• Segmented pain that extends beyond the immediately visible site
• Redness and swelling
• Fever
• Nausea or discomfort
• Increased pain in the area of a small wound or injury
• Discolouration and warmth in the infected area
• Flu-like symptoms such as dizziness, diarrhoea, and weakness
• Excessive thirst from dehydration

After the third or fourth day, the symptoms may become worse:

• Purple rashes with swelling
• Black-coloured, putrid-smelling blisters
• Dryness or peeling of skin from tissue death
• Prolonged weakness, dizziness, or nausea

By four or five days, there can be more severe symptoms like:

• Sudden decline in blood pressure
• Toxic shock signs
• Loss of consciousness

How is Necrotising Fasciitis Bacteria Diagnosed?

Due to the rapid development of the infection, timely diagnosis is crucial to ensure survival. A doctor will diagnose necrotising fasciitis symptoms and conduct diagnostic tests, typically in a hospital environment.

The following diagnostic tests can be applied to make a diagnosis:

• Blood Tests: To detect elevated white blood cell counts, indicating infection
• Tissue Biopsy: A surgical procedure may be required to collect tissue for lab analysis to identify the bacteria
• CT (computed tomography) Scan: Helps locate pockets of fluid or gas under the skin, which supports diagnosis

Family members or individuals who are close to a necrotising fasciitis patient need to seek medical help if they exhibit symptoms.

What is the Treatment for Necrotising Fasciitis?

Treatment must begin as soon as possible. The specific interventions depend on the severity and the stage at which the infection is identified. Common treatments include:

• IV antibiotics against the bacteria
• Surgical removal of infected or dead tissue to avoid the spread
• Blood pressure drug support
• Severe infection, limb amputation
• Hyperbaric oxygen therapy to aid the survival of healthy tissue
• Heart monitoring and respiratory care
• Blood transfusion, if necessary
• IV delivery of immunoglobulin to aid the immune system

Prompt diagnosis combined with immediate antibiotics and surgery offers the best chance of survival. Even with proper treatment, one in three patients does not survive necrotising fasciitis.

Multiple surgeries may be required, and survivors often experience permanent scarring or other long-term effects.

FAQs About Necrotising Fasciitis

1. How fast does necrotising fasciitis spread?

This infection can spread within hours. Severe pain that seems disproportionate to the wound should raise immediate suspicion of necrotising fasciitis.

2. Who is at risk for necrotising fasciitis?

While it is uncommon in healthy patients, individuals with weakened immune systems are more likely to develop it. Risk factors include diabetes, cancer, chronic kidney disease, and liver cirrhosis. While the disease is not infectious, colonisation with some bacteria, like Group A Streptococcus, can happen and result in infection.

3. How is necrotising fasciitis prevented?

The disease is rare, especially among healthy individuals with strong immune systems. However, good hygiene and wound care are always essential. Clean cuts, burns, or open wounds always with soap and water. Carefully dress wounds and seek medical treatment immediately if signs of infection appear.

4. Can necrotising fasciitis return?

While the disease is severe, recurrence is infrequent. If the patient has recovered from necrotising fasciitis, follow-up and proper wound care are recommended.

5. How long does it take to recover from necrotising fasciitis?

Since there is so much tissue damage and big wounds, recovery can take months. Patients can be hospitalised for a few days in intensive care for wound care in the operating room and close monitoring after treatment.

Conclusion

If you have any wound, whether it be by cut, burn, or surgery, wash it with soap and water to minimise infection. Watch for redness, bruising, swelling, peeling of the skin from the tissue beneath it, fever, much pain out of proportion to the wound, or spreading redness and heat on the skin. 

These are signs that require prompt medical attention because the sooner necrotising fasciitis is treated, the more likely you will survive. For NEET PG aspirants, understanding critical conditions like necrotising fasciitis is essential for both academic success and clinical competence. 

DocTutorials provides expertly crafted video lectures, high-yield revision programs, and detailed notes tailored to help you excel in your exam and future practice. Enrol in DocTutorials’ NEET PG course today and enhance your preparation for a successful medical career.