Last week a Singaporean man pricked his finger while cleaning some prawns at home. The man had been pricked by prawns many times previously, and thought nothing much of it.
The next day, the man woke up to find his finger had turned black and he was running a mild fever. He made a quick visit to a local health clinic in Toa Payoh and was told to immediately go to a hospital.
At the hospital, the man was diagnosed with necrotising fasciitis, and was scheduled for emergency surgery. The man survived NF, but part of his finger was amputated. He was hospitalized for seven days, two of which were spent in the intensive care unit.
Doctors told the man if he had waited another day, he could have lost his arm or even died, as the bacterial infection had spread to his armpit. This man survived NF, and he has warned others to be careful when handling raw seafood.
The Centers for Disease Control and Prevention (CDC), states necrotizing fasciitis (NF) is a bacterial infection that spreads rapidly. NF eats away the tissue in your skin, muscles, as well as subcutaneous tissue (tissue beneath your skin). It is aggressive and spreads very quickly in an infected person.
The Group A streptococcus bacteria is the most common cause of NF. Other bacteria such as staphylococcus, are also known to be linked to NF infections, but these infections typically do not progress as quickly and are not as dangerous.
The NF bacteria can enter humans through skin openings such as:
- insect bites
- puncture wounds
- surgical wounds
- other injuries where the skin’s surface is broken
Early symptoms of NF appear within 24 hours of infection. Early symptoms of NF may be similar to a skin infection or common post-surgical complaints, making it difficult to correctly diagnose.
Early symptoms often appear in a combination of:
- flu like symptoms, e.g., fever, weakness, diarrhea, dizziness
- severe and increasing pain at the infected site
- redness and feeling of warmth around the infected site
- intense thirst caused by dehydration
Advanced symptoms which emerge within 3 – 4 days of being infected include:
- swelling, possibly with a purplish rash
- purplish (violet) coloured lesions which turn into large blisters with dark foul-smelling fluid
- skin discoloration, flaking or peeling around the infected site – indication of gangrene (tissue death)
If still left untreated, NF quickly progresses to the critical and often fatal stage within 4 – 5 days of being infected, where symptoms include:
- toxic shock
- drastic drop in blood pressure
- loss of consciousness
Complications arising from NF will include:
- organ failure
- severe scarring
- and possibly death
Early diagnosis and immediate intensive treatment are therefore critical for survival.The doctor will carry out the following tests for NF:
- blood tests – a high level of white blood cells indicate the presence of NF
- tissue biopsy with samples taken from the infected area
- CY scan to indicate the location of fluid and pus in your body, or gas bubbles under the skin
Those who have had close contact with a NF patient should also be tested.
Treatment of NF
The doctor will provide treatment according to which stage of NF the patient is in, and this includes:
- Antibiotics and immunoglobulin administered intravenously
- Surgical removal of dead/damaged tissue, or amputation where necessary, to halt the infection from spreading
- Hyperbaric oxygen therapy
- Blood transfusions
Note: there is no vaccine to prevent necrotizing fasciitis infections.
This article provides a general insight into necrotizing fasciitis, and is in no way to be taken as medical advice. Always treat open cuts and wounds immediately, or seek medical treatment without delay.
22nd July 16:00 2020