Causative agent
Necrotising fasciitis (NF; commonly known as "flesh-eating infection") can be caused by different types of bacteria including Group A Streptococcus, Vibrio vulnificus, Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus and Aeromonas hydrophila. Group A Streptococcus is considered the most common cause of NF.
Clinical features
NF is a serious bacterial infection of the soft tissue and fascia (a sheet or band of fibrous connective tissue separating or binding muscles and organs together). The skin of the patient may be warm with a reddish swelling that spreads rapidly; there may be ulcers, blisters or black spots. The patient may experience intense and severe pain which is out of proportion to the visible skin changes, and may also have fever, chills, fatigue, diarrhoea, vomiting, or pus from the infected area. NF can progress rapidly, result in complications and death.
Mode of transmission
The bacteria that cause NF most commonly enter the body through a wound in the skin, such as a cut, scrape, burn, insect bite, or puncture/ surgical wound. However, blunt trauma may also cause necrotizing fasciitis. Besides, NF caused by Vibrio vulnificus can also be acquired through eating raw or undercooked seafood, such as oysters, harvested from warm waters, or exposure to seawater through an existing open wound.
NF rarely spreads from person to person.
High risk groups
All people are susceptible to infection with NF. People who frequently handle or have direct contact with raw seafood have a higher risk of acquiring NF associated with Vibrio vulnificus infection. People with underlying medical conditions that weaken their immune system, such as diabetes mellitus, cancer, kidney diseases and liver cirrhosis, are also at increased risk of acquiring the infection.
Incubation period
The symptoms often start within hours after an injury.
Management
NF is a severe illness that require hospitalisation, and some patients require intensive care. Prompt treatment with appropriate antibiotics is necessary to kill the bacteria. In order to stop the infection from spreading, surgery, e.g. removal of the dead tissues or amputation of the limb, may be required.
Prevention
To prevent the infection, members of the public should maintain good personal hygiene and practise good wound care; wear protective gloves when handling raw shellfish or other seafood.
Maintain good personal hygiene
Proper wound management
For details of NF caused by Vibrio vulnificus, please refer to the fact sheet of Vibrio vulnificus infection.