What makes flesh-eating infection dangerous is that it’s rare and people are not aware of this phenomena. How to distinguish the first signs of the disease, and what can be done to prevent and treat it?
What is flesh-eating infection?
Also called as ‘necrotizing soft tissue infection’, this is a skin disease caused by rare bacteria that gets into human body via wounds and insect bites. It affects skin, muscles, and organs quickly spreading and destroying tissues.
In fact, these bacteria do not eat flesh — they emit toxins that destroy live cells. Typically, such infection starts with a minor injury, but can be lethal without proper treatment.
What causes it?
The causative agents of necrotizing soft tissue infection are usually aerobic and anaerobic microorganisms (in combination), causing necrosis of the subcutaneous fat, usually affecting the fascia. This infectious disease most often affects the limbs and perineum. Affected tissues become red, inflamed, and swollen, resembling severe phlegmon, and pain develops disproportionately to the clinical results.
According to CDC, it is caused by wounds, punctures, burns, and insect bites.
Without timely treatment, the affected area may develop a gangrene. The patient becomes acutely ill. The diagnosis is made during medical history and examination and is confirmed by evidence of a massive infectious process. Treatment includes antibiotic therapy and surgical treatment of the wound. Without an early initiation intense therapy, the prognosis is poor.
The infection causes tissue ischemia through extensive occlusion of small vessels of subcutaneous fat. Vascular occlusion leads to heart attack and tissue necrosis, which promotes the growth of obligate anaerobes (e.g. Bacteroides) and stimulates the anaerobic metabolism of facultative microorganisms (e.g. Escherichia coli), leading to the development of gangrene. Anaerobic metabolism produces hydrogen and nitrogen, relatively insoluble gases that can accumulate in the tissues of subcutaneous fat.
Pain — the first signal
The primary symptom is intense pain. In patients with normal sensitivity, pain disproportionate to clinical data may be an early clue. Nevertheless, in decayed areas, pain can be minimally expressed or completely absent as a result of peripheral neuropathy. As indicated by RareDieases.org, the pain becomes constant and piercing, way more severe than usually caused by injuries.
Redness of the skin
Affected tissues are red, hot to the touch and swollen and quickly lose color. Blisters, crepitus (due to gas in soft tissues) and gangrene can occur. Subcutaneous fatty tissue (including the adjacent fascia) is necrotic, the process quickly spreads to surrounding tissues. Muscles are not initially affected. Sometimes, the skin simply acquires a different color. Other skin symptoms are described here.
Serious side effects and symptoms
Patients are acutely ill, fever up to febrile numbers, tachycardia, a change in mental status, ranging from confusion to stunning and a drop in blood pressure. Patients may develop bacteremia or sepsis and may require aggressive hemodynamic support. Streptococcal toxic shock syndrome may develop, as well.
Pretty often, seriously infected patients suffer from fever — it’s a normal reaction of the immune system.
Other symptoms include:
- Blisters and ulcers on the reddened area;
- Palpitations, tachycardia, tachypnea, hypotension and dizziness;
- Tiredness, nausea, diarrhea, confusion.
Cultural examination of blood and diseased tissue
The diagnosis established on the basis of the history and clinical examination is confirmed by the detection of leukocytosis, gas in the soft tissues during an X-ray examination, obtaining positive results from a blood culture test and the detection of metabolic and hemodynamic status disorders.
BAT should be differentiated from clostridial soft tissue infection, in which phlegmon, myositis, and myonecrosis often develop. These are anaerobic infections. With anaerobic phlegmon, a large amount of gas is formed, but pain, swelling, or changes in the skin are mild; muscle damage is very rare. Necrotic myositis is manifested by fever, pain and muscle swelling without early skin changes; redness, inflammation, purpura, and blisters may develop on the skin later.
According to the research published in International Journal of Emergency Medicine, doctors should also analyze such health indicators as the level of C-reactive protein, sodium, creatinine, and glucose.
The death rate for this type of infection is about 30%. Yet, recent studies show that the mortality rate is below 25%. Elderly age, concomitant diseases, late diagnosis and initiation of therapy, as well as insufficient surgical treatment of wounds worsen the prognosis. If you have symptoms that it is a parasitic infection, then you can try to take Ivermectin. For more information on this medicine, go to this page.
The treatment for the early stages of BAT is mostly surgical, which should not be delayed due to diagnostic tests. In addition, intravenous infusions of antibiotics are prescribed, usually 2 or more drugs are prescribed, but the prescription schedule varies depending on the results of Gram stain and culture studies (for example, 4 million units of benzylpenicillin every 4 hours in combination with clindamycin at a dose of 600–900 mg every 8 hours or ceftriaxone in a dose of 2 g every 12 hours).
Signs of blistering, ecchymosis, fluctuation, crepitus and systemic spread of infection require immediate surgical examination and surgical treatment of the wound.
The initial incision should be lengthened until the skin with subcutaneous fatty tissue from the deep fascia can be separated with a tool or finger. The most common mistake is not extensive surgery; the operation should be repeated every 1–2 days, extending the incision with surgical treatment of the wound, which should become a routine procedure. Amputation of the limb may be necessary.