Necrotizing fasciitis is a serious but rare infection of the deeper layers of skin and subcutaneous tissues (fascia). While many other types of bacteria can cause necrotizing fasciitis, most cases result from Group A streptococcus.
The infection occasionally starts with a sore throat, but more often begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor or even non-apparent. The affected skin is very painful, red, hot and swollen. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the death rate is high. The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue. Early medical treatment is critical. Treatment often includes intravenous penicillin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). Limb amputation may be necessary.
This disease is one of the fastest spreading infections known, and tissue may be consumed at a rate of three centimeters per hour. For this reason, it is popularly called "flesh-eating disease" and, although rare, became well-known to the public in the 1990s. Possibly its most famous victim is former Quebec premier Lucien Bouchard, who became infected while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.
Even under world best care practices today, necrotizing fasciitis has a mortality rate of around 20%. Mortality is nearly 100% if not properly treated. Correct diagnosis and early treatment of this disease is therefore of paramount importance.
