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Necrotizing soft tissue infection

Necrotizing fasciitis; Fasciitis - necrotizing; Flesh-eating bacteria; Soft tissue gangrene; Gangrene - soft tissue

Necrotizing soft tissue infection is a rare but very severe type of bacterial infection. It can destroy the muscles, skin, and underlying tissue. The word "necrotizing" refers to something that causes body tissue to die.

Causes

Many different types of bacteria can cause this infection. A very severe and usually deadly form of necrotizing soft tissue infection is due to the bacteria Streptococcus pyogenes, which is sometimes called "flesh-eating bacteria" or strep.

Necrotizing soft tissue infection develops when the bacteria enters the body, usually through a minor cut or scrape. The bacteria begin to grow and release harmful substances (toxins) that kill tissue and affect blood flow to the area. With flesh-eating strep, the bacteria also make chemicals that block the body's ability to respond to the organism. As the tissue dies, the bacteria enters the blood and rapidly spreads throughout the body.

Symptoms

Symptoms may include:

Other symptoms may include:

Exams and Tests

Your health care provider may be able to diagnose this condition by looking at your skin. Or, the condition may be diagnosed in an operating room by a surgeon.

Tests that may be done include:

Treatment

Treatment is needed right away to prevent death. You'll likely need to stay in the hospital. Treatment includes:

Other treatments may include:

Outlook (Prognosis)

How well you do depends on:

This disease commonly causes scarring and skin deformity.

Death can occur rapidly without proper treatment.

Possible Complications

Complications that may result from this condition include:

When to Contact a Medical Professional

This disorder is severe and may be life threatening. Contact your provider right away if symptoms of infection occur around a skin injury, including:

Prevention

Always clean the skin thoroughly after a cut, scrape, or other skin injury.

Related Information

Subcutaneous
Systemic
Aerobic
Anaerobic
Toxins
Shock
Necrosis
Sepsis

References

Abbas M, Uçkay I, Ferry T, Hakko E, Pittet D. Severe soft-tissue infections. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 72.

Fitzpatrick JE, High WA, Kyle WL. Necrotic and ulcerative skin disorders. In: Fitzpatrick JE, High WA, Kyle WL, eds. Urgent Care Dermatology: Symptom-Based Diagnosis. Philadelphia, PA: Elsevier; 2018:chap 14.

Pasternack MS, Swartz MN. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 93.

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Review Date: 10/11/2023  

Reviewed By: Elika Hoss, MD, Assistant Professor of Dermatology, Mayo Clinic, Scottsdale, AZ. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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