By Antra Sood, Arnav Sood

1. Necrotizing Fasciitis :
“Life After Flesh-Eating
Bacteria”
Name – Antra Sood
Class – M.Sc.(microbiology)
Semester- 4th
Reg. No.- 11701161

2. “
Necrotizing fasciitis :
(NECK-re-tie-zing FASH-e-i-tis) is a rare
bacterial infection that spreads quickly in
the body and can cause death.
2

3. Most Common Cause
▸ Public health experts believe group
A Streptococcus (group A strep) are the most
common cause of necrotizing fasciitis.
▸ These bacteria are found on the skin or in the
nose and throat of healthy people. Many people
carry these bacteria but don¡¦t get sick.
3

4. Symptoms
Most often there is
sudden onset of
pain and swelling
with redness at the
site of a wound.
Fever may also
occur.
A red or swollen
area of skin that
spreads quickly.
High Fever and
Inflammation in
body.
4

5. Prevention and Diagnostics
Prevention
• An important clue to this disease is
very severe pain at the site of a
wound.
• Always take good care of minor cuts
to reduce the chance of the tissues
under the skin getting infected.
• If you have a small cut or wound,
wash it well in warm soapy water, and
keep it clean and dry with a bandage.
Diagnostics
• Antibiotics and surgery are typically the
first lines of defence if a doctor
suspects a patient has necrotizing
fasciitis.
• Sometimes, however, antibiotics cannot
reach all of the infected areas because
the bacteria have killed too much tissue
and reduced blood flow.
• When this happens, doctors have to
surgically remove the dead tissue.
It is not unusual for someone with necrotizing fasciitis to end up needing multiple
surgeries. In serious cases, the patient may need a blood transfusion.
5

6. TYPES OF Necrotizing Fasciitis
Necrotizing
Cellulitis
▸Necrotizing cellulitis, or
haemolytic streptococcal
gangrene.
▸Patients have findings
consistent with cellulitis,
including erythema,
warmth, and swelling.
Streptococcal
Myositis
▸The hallmarks of
streptococcal myositis are
severe local pain and
toxaemia.
▸ Wounds have a foul
odour, discoloration, and
edema.
▸Patients might develop
blebs and gangrene of the
overlying skin, although
disease progression is
characteristically slow.
Clostridial
Cellulitis
▸In cellulitis is severe pain
occurring days after local
tissue injury.
▸Patients subsequently
develop skin blebs that
contain a reddish-brown,
foul-smelling fluid.
▸There is rapid progression
of cellulitis over hours and
patient is toxic.
6

7. TYPES OF Necrotizing Fasciitis
Meleney’s Gangrene
▸Progressive bacterial synergistic gangrene
(PBSG) and Meleney’s ulcer represent
variants of the same disease process, but
Lewis describes them as two separate
entities.
▸Patients have findings consistent with
cellulitis, including erythema, warmth, and
swelling.
▸It is most commonly found following
abdominal surgeries with infected wound.
▸Clinical presentation is notable for a wound
with a central necrotic area that is
surrounded by purple, erythematous zones of
skin.
Fournier’s
Gangrene
▸Fournier’s gangrene is an
acute, rapidly progressive,
and potentially fatal,
infective necrotizing
fasciitis affecting the
external genitalia,
perineal, or perianal
regions,
▸The clinical features of
Fournier’s gangrene
include sudden pain in the
scrotum, prostration,
pallor, and pyrexia.
7

8. Mechanism
▸ When GAS adheres and infects the host's cells, it delivers
into these cells two streptolysin toxins.
▸ These toxins impair the body's mechanism for quality
control of protein synthesis.
▸ This in turn triggers a defensive stress response which,
among other things, also increases the production of the
amino acid asparagine.
▸ GAS senses the increased asparagine level and alters its
gene expression profile -- and its rate of proliferation,
which can be deadly in the host.
8

9. Mechanism Cont. : Molecular
genetic approach
▸ “Lacking this single protease, the mutant Strep strain
was easily killed by human neutrophils,”
▸ The critical role of the Strep protease was confirmed by
cloning the corresponding gene into a normally non-
pathogenic bacterial strain, which then became resistant
to neutrophil killing.
▸ By inactivating IL-8, Spy-CEP blocked neutrophil
migration across blood vessels as well as neutrophil
production of "extracellular traps" used to ensnare
bacteria.
9

10. Mechanism Cont. : Immune-
blocking effects and Infections
▸ The immune-blocking effects of Spy-CEP produced by Strep
were strong enough to allow other bacterial species to survive
at the site of infection, which may contribute to mixed
infections that require complex antibiotic regimens.
▸ Streptococcus iniae, produces its own version of Spy-CEP that
may contribute to recent reports of severe skin infections
caused by this bacterium in fish handlers.
10

11. Case Study
Experimental
11
48 Cases of necrotizing fasciitis were
examined.

12. Materials and
Methods
• Forty-eight cases of necrotizing
fasciitis were examined and treated
between April 2007 and March 2009.
Institutional ethical committee
approval was obtained to carry out
this study.
• Each patient’s history was recorded
to determine any pre-existing illness,
triggering factors, presenting
symptoms with duration, relevant
personal history, and predisposing
factors.
12

13. 13
Hypotension with systolic
blood pressure less than
100 mmHg.
1.Temperature greater than
38 °C.
1.Heart rate greater than 110
beats/min.
1.Urine output less than
30 mL/h.
1.Mental confusion,
disorientation regarding time,
place, and person.
Systemic toxicity was defined
as presence of any three of the
following:

14. 14
By baseline haematological and biochemical
investigations, to identify the predisposing
conditions and indicators of poor prognosis.
1.Anaemia: haemoglobin level less than 10 mg/dL.
1.Leukocytosis: white blood cell count (WBC) greater than
10,000/mm3.
1.Hyperglycemia: random blood glucose level greater than
120 mg/dL.
1.Renal dysfunction: serum creatinine level greater than
2 mg/dL.
1.Adult respiratory distress syndrome: radiological evidence of
diffuse pulmonary edema.
1.Hepatic dysfunction: serum bilirubin greater than 3 mg/dL.
1.Blood urea nitrogen.
Parameters

15. Results
15

16. Most patients were in the age group of 40–
60 years, of whom 32 patients were males
16

17. 17
Necrotizing fasciitis of breast Necrotizing fasciitis of face
Healthy wound after three debridements and
regular dressings: ready for skin graft (day 20)

18. Predisposing factors
Predisposing
Factor
Percentage
(%)
Chronic
alcoholism 20
Diabetes 26
Vascular
disease
7
Peripheral
vascular
deficiency
12
Acquired
immune-
deficiency
syndrome
0
Age >50 years 29
Poor personal
hygiene 38
18
The most common predisposing factors included
age greater than 50 years (60.4 % cases) and
diabetes mellitus (54.16 % cases)

19. Infecting organisms
Bacteri
a
Number of
patients
Confidence
interval
Chroni
c
alcoho
lism
20
Diabet
es
26
Vascul
ar
diseas
e
7
Periph
eral
vascul
ar
deficie
ncy
12
19
Most infections were polymicrobial
(87.5 %). The most common organisms
isolated included Escherichia
coli (77.08 %), Streptococcus (72.9 %),
and Staphylococcus (50 %)
Streptococ
ci
35 59.11–
84.03 %
Staphyloco
cci
24 36.035–
63.9 %
Escherichia
coli
37 63.675–
87.32 %
Klebsiella 11 12.685–
36.33 %
Pseudomo
nas
10 11.1–
34.00 %
Proteus 3 1.615–
16.07 %

20. 20
Investigations Number of patients Confidence interval
Chronic
alcoholism 20
Diabetes 26
Vascular
disease
7
Anemia 32 52.15–78.86 %
Leukocytosis 48 93.95–100 %
Serum creatinine >2 mg/dl 9 9.555–31.63 %
Hyperglycemia 31 50.37–77.08 %
Histological confirmation of
presence of necrosis
48 93.95–100 %
AIDS (ELISA) 0 0
Investigations
The most common deranged laboratory finding
was leucocytosis (100 %) followed by anaemia
(66.7 %) and hyperglycaemia (66.10 %)

21. 21
• Necrotizing fasciitis is a lethal soft-tissue infection
mostly affecting males in middle-age group.
• Major predisposing factors include poor personal
hygiene, age more than 50 years, and diabetes mellitus.
• Early and aggressive debridement, often at repeated
sittings, are the mainstay in the treatment of necrotizing
fasciitis, supplemented by adequate antibiotics and
supportive measures.
Conclusion

22. 22
1. Necrotizing Fasciitis: A Study of 48 Cases
Gurjit Singh,Pragnesh Bharpoda, and Raghuveer Reddy.
2. Necrotizing Fasciitis (Flesh-Eating Disease)HealthLinkBC File Number:
60.
https://www.healthlinkbc.ca/healthlinkbc-files/flesh-eating-disease
3. CDC: Necrotizing Fasciitis: All You Need to Know
https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html
4. Medical News Today
https://www.medicalnewstoday.com/articles/7884.php
5. Hakkarainen, T. W., Kopari, N. M., Pham, T. N., & Evans, H. L. (2014). Necrotizing soft tissue infections: review and current concepts in
treatment, systems of care, and outcomes. Current problems in surgery, 51(8), 344. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4199388/
Krieg, A., Röhrborn, A., Am Esch, J. S., Schubert, D., Poll, L. W., Ohmann, C., ... Knoefel, W. T. (2009, January 28). Necrotizing fasciitis:
microbiological characteristics and predictors of postoperative outcome. European journal of medical research, 14(1), 30. Retrieved
from https://eurjmedres.biomedcentral.com/articles/10.1186/2047-783X-14-1-30
6. Wong, C. H., Khin, L. W., Heng, K. S., Tan, K. C., & Low, C. O. (2004). The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis)
score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Critical care medicine, 32(7), 1535-1541. Retrieved
from http://journals.lww.com/ccmjournal/Abstract/2004/07000/The_LRINEC__Laboratory_Risk_Indicator_for.11.aspx
References

23. THANKS!
Any questions?
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