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The day after Christmas last year, 52-year-old Everett Evans accidentally hit his shin while climbing into the semi-trailer tractor he drives for a living.
At first, he hardly noticed the minor injury. As the hours passed, however, his condition worsened with severe headache, fever, and uncontrollable pain.
"My leg was throbbing," he says. "It was swollen—huge—with oozing blisters."
Fortunately, after visiting the emergency room at Mercy Iowa City, Evans was quickly referred to the Burn Treatment Center at University of Iowa Hospitals and Clinics. There he received life-saving treatment for necrotizing fasciitis, the so-called "flesh-eating" bacteria (it doesn't actually eat flesh but rather releases toxins that destroy tissue).
Today, after receiving expert care that included two surgical procedures to remove infected tissue, he is recovering well.
While necrotizing fasciitis infections like Evans' are unusual—about 1,500 cases nationally per year—the UI burn service has seen a growing number: 129 total cases last year.
"We don't really know why the numbers are increasing," says Barbara Latenser, MD, UI professor of surgery and medical director of the UI Burn Treatment Center. "We think obesity and diabetes may be linked to the problem, but we have a study going to investigate some of those questions and hopefully get some answers."
Even though necrotizing fasciitis is one of the fastest-spreading infections known to humankind, and is sometimes lethal, favorable outcomes are possible with early diagnosis and treatment.
On that score, the UI burn service gets high marks. While the national mortality rate for necrotizing fasciitis hovers around 30 percent, the burn unit's mortality rate has been about 6 percent.
"Our outcomes are high above the norm," Latenser says. "That's because our staff is well-trained to quickly recognize the symptoms and act immediately. In addition, our Burn Treatment Center specializes in treating patients with complex wounds so we already have the appropriate resources to care for these high-acuity patients."
Unfortunately, she adds, some patients in the region aren't so lucky. Because infections are not commonly seen, the symptoms often go recognized for too long, resulting in patients who are critically ill or even die because of delayed treatment.
Rapid diagnosis—through physical examination, laboratory studies, and sometimes suctioning pus from infected tissue—is the first step to successful treatment.
"Antibiotics must be administered quickly, with initial treatments often involving a combination of intravenous antibiotics," Latenser says.
Surgery is almost always performed to remove infected tissue, and amputation is sometimes necessary. Among survivors, disfigurement is a common consequence. One patient at UI had 40 pounds of diseased tissue removed during surgery.
"Repeat surgical explorations are usually needed to remove additional necrotic tissue," she says. "Often, this leaves a large open wound that requires skin grafting."
For more information about the UI's services for patients with necrotizing fasciitis, patients and family members should:
For consultation or referral, physicians should call 319-356-1616 and ask for the trauma surgeon on call.
—Michael Sondergard
Necrotizing fasciitis
Pronunced neck-row-tize-ing fash-e-i-tis, the term literally means "decaying infection of the fascia" (fascia being the soft tissue that extends from head to toe and gives the body structural integrity). It is often caused by a strong variety of the same bacteria that causes common strep throat, but can also result from other bacteria.
How it spreads
The potentially lethal bacteria can be spread in various ways, including a cough or sneeze. Points of entry into the body include paper cuts, staple punctures, pin pricks, bruises, or blisters. Infections sometimes mysteriously occur after surgery. |
