Necrotizing fasciitis or flesh-eating disease

Please add people who have died from Necrotizing fasciitis or flesh-eating disease.

Necrotizing fasciitis (NF), (neck-roe-tie-zing fashee-eye-tis) commonly known as flesh-eating disease, is an infection that results in the death of the body's soft tissue (fascia & subcutaneous tissue). It is a severe disease of sudden onset that spreads rapidly through the tissue, or flesh surrounding the muscles. In some cases death can occur within 12 to 24 hours. Necrotizing fasciitis kills about 1 in 4 people infected with it. Symptoms include red or purple skin in the affected area, severe pain, fever, and vomiting. The most commonly affected areas are the limbs and perineum.

Typically the infection enters the body through a break in the skin such as a cut or burn. Risk factors include poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral vascular disease, pressure ulcer & perianal abscess. It is not typically spread between people. The disease is classified into four types, depending on the infecting organism. Between 55% and 80% of cases involve more than one type of bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is involved in up to a third of cases. Medical imaging is helpful to confirm the diagnosis.

"Flesh-eating bacteria" is a misnomer, as in truth, the bacteria do not "eat" the tissue. They destroy the tissue that makes up the skin and muscle by releasing toxins (virulence factors).

Cause & Risk factors

• Over 70% of cases are recorded in people with at least one of the following clinical situations: immunosuppression, diabetes, alcoholism, injectable drug abuse, malignancies, steroid usage, skin lesions and chronic systemic diseases, such as chronic heart or lung disease.
• For reasons that are unclear, it occasionally occurs in people with an apparently normal general condition.
• The infection begins locally at a site of trauma, which may be severe (such as the result of surgery or burns), minor, or even non-apparent.
• Common organisms include Group A Streptococcus, Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus, and Aeromonas hydrophila, and others. Group A strep is considered the most common cause of necrotizing fasciitis.
• The majority of infections are caused by organisms that normally reside on the individual's skin. These skin flora exist as commensals and infections reflect their anatomical distribution (e.g. perineal infections being caused by anaerobes).
• Sources of MRSA may include working at municipal waste water treatment plants, exposure to secondary waste water spray irrigation, exposure to run off from farm fields fertilized by human sewage sludge or septage, hospital settings, or sharing/using dirty needles.
• The risk of infection during regional anesthesia is considered to be very low, though reported.
• Vibrio vulnificus, a bacterium found in saltwater, is a rare cause.

Epidemiology

• Necrotizing fasciitis affects about 0.4 in every 100,000 people per year in the United States. In some areas of the world it is as common as 1 in every 100,000 people.
• Since 2010, approximately 700 to 1100 cases occur each year in the United States. This is likely an underestimate according to the CDC.
• Necrotizing fasciitis is extremely dangerous, and it has a high fatality rate, between 20 percent and 80 percent.
• It can spread through human tissue at a rate of 3 cm per hour, although the speed of spread is directly proportional to the thickness of the subcutaneous layer. Twenty-five percent of its victims die, and in severe cases, the patient is dead within 18 hours.

History

In 1871, a Confederate army surgeon named Joseph Jones first described the disease during the Civil War. In 1883, Fournier documented necrotizing fasciitis in the perineal and genital region. By 1918, the cause of the disease was identified as a bacterial infection. It was named "necrotizing fasciitis" in 1952, from necrosis, which means death of a portion of tissue, and fascia, which refers to the fibrous tissues that enclose and connect the muscles.

Throughout the 19th and 20th centuries, cases of NF occurred only sporadically and usually remained restricted to military hospitals during wartime, although some civilian population outbreaks have also occurred. The Centers for Disease Control and Prevention (CDC) reports that, worldwide, rates of NF increased from the mid-1980s to early 1990s. Increases in the rate and severity of NF are associated with increases in the prevalence of toxin-producing strains of S. pyogenes (M-1 and M-3 serotypes). In 1999, approximately 600 cases of NF were reported in the United States, according to the CDC.

Since 1883, more than 500 cases of necrotizing fasciitis have been reported in the literature. There may be an increased incidence in African and Asian countries; however, because of the lack of recorded cases, the true incidence is not known.

Notable cases

• In 1990, puppeteer Jim Henson (best known for creating the Muppets) died from NF.
• 1994 Lucien Bouchard, former premier of Québec, Canada, who became infected while leader of the federal official opposition Bloc Québécois party, lost a leg to the illness.
• 1994 A cluster of cases occurred in Gloucestershire, in the west of England. Of five confirmed and one probable infection, two died. The cases were believed to be connected. The first two had acquired the Streptococcus pyogenes bacteria during surgery, the remaining four were community-acquired. The cases generated much newspaper coverage, with lurid headlines such as "Flesh Eating Bug Ate My Face".
• 1997 Ken Kendrick, former agent and partial owner of the San Diego Padres and Arizona Diamondbacks, contracted the disease in 1997. He had seven surgeries in a little more than a week and later recovered fully.
• 2004 Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, lost his left arm and shoulder to the disease in 2004.
• 2005 Alexandru Marin, an experimental particle physicist, professor at MIT, Boston University and Harvard University, and researcher at CERN and JINR, died from the disease. (Wikipedia - Alexandru Marin)
• 2006 Alan Coren, British writer and satirist, announced in his Christmas 2006 column for The Times that his long absence as a columnist had been caused by his contracting the disease while on holiday in France.
• 2009 R. W. Johnson, South African journalist and historian, contracted the disease in March 2009 after injuring his foot while swimming. His leg was amputated above the knee.
• 2011 (January) Jeff Hanneman, guitarist for the thrash metal band Slayer, contracted the disease in 2011. He died of liver failure two years later, on May 2, 2013, and it was speculated his infection might be the cause of death. However, on May 9, 2013, the official cause of death was announced as alcohol-related cirrhosis. Hanneman and his family had apparently been unaware of the extent of the condition until shortly before his death.
• 2011 Peter Watts, Canadian science fiction author, contracted the disease in early 2011. On his blog, Watts reported, "I’m told I was a few hours away from being dead...If there was ever a disease fit for a science fiction writer, flesh-eating disease has got to be it. This...spread across my leg as fast as a Star Trek space disease in time-lapse."
• 2014 Daniel Gildenlöw, Swedish singer and songwriter for the band Pain of Salvation spent several months in hospital after being diagnosed with necrotizing fasciitis on his back in early 2014. After recovering he went to write the album 'In the Passing Light of Day',[36] a concept album about his experience during the hospitalization.
• 2014 Don Rickles (d. April 6, 2017), an American stand-up comedian, revealed on The Late Show with David Letterman on 2 May 2014 that he had contracted necrotizing fasciitis on his right leg. His doctor came over to his house for a visit and noticed a sore on Don's leg. After examining it he sent him straight to the hospital. Treatment was successful, though he now requires a cane for a short period of time. If it had progressed further, Don quipped, he would have wound up with Johnny Depp as a one legged pirate.
• 2015 (May) Edgar Savisaar, an Estonian politician. His right leg was amputated. He got the disease during a trip to Thailand

For Further reading:

• Wikipedia - Necrotizing fasciitis
• CDC - Necrotizing Fasciitis
• WebMD - Necrotizing Fasciitis (Flesh-Eating Bacteria) - Topic Overview
• Health Link BC - Necrotizing Fasciitis (Flesh-Eating Disease)
• Healthline - Necrotizing Fasciitis (Soft Tissue Inflammation)
• NORD (National Organization for Rare Disorders) - Necrotizing Fasciitis
• Wound Care Advisor by Lydia Meyers, BSN, RN, CWCN
• Journal of Young Investigators - When Bacteria Go Bad - the Case of necrotizing Fasciitis
• Medscape - Necrotizing Fasciitis

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