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.
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 may include:
- Small, red, painful lump or bump on the skin that spreads
- A very painful bruise-like area then develops and grows rapidly, sometimes in less than an hour
- The center becomes dark and dusky and then turns black and the tissue dies
- The skin may break open and ooze fluid
Other symptoms may include:
- Feeling ill
Exams and Tests
The 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 is needed right away to prevent death. You'll likely need to stay in the hospital. Treatment includes:
- Powerful antibiotics are given through a vein (IV)
- Surgery to drain the sore and remove dead tissue
- Special medicines called donor immunoglobulins (antibodies) to help fight the infection in some cases
Other treatments may include:
- Skin grafts after the infection goes away to help your skin heal and look better
- Amputation if the disease spreads through an arm or leg
- Hundred percent oxygen at high pressure (hyperbaric oxygen therapy) for certain types of bacterial infections
How well you do depends on:
- Your overall health (especially if you have diabetes)
- How fast you were diagnosed and how quickly you received treatment
- The type of bacteria causing the infection
- How quickly the infection spreads
- How well treatment works
This disease commonly causes scarring and skin deformity.
Death can occur rapidly without proper treatment.
Complications that may result from this condition include:
- Infection spreads throughout body, causing a blood infection (sepsis), which can be deadly
- Scarring and disfigurement
- Loss of your ability to use an arm or leg
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:
- Drainage of pus or blood
Always clean the skin thoroughly after a cut, scrape, or other skin injury.
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 Saunders; 2020:chap 93.
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015;60(9):1448. Dosage error in article text]. Clin Infect Dis. 2014;59(2):e10-e52. PMID: 24973422
Last reviewed on: 9/30/2019
Reviewed by: Michael Lehrer, MD, Clinical Associate Professor, Department of Dermatology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.