What is Necrotising Fasciitis?
Necrotising Fasciitis (“NF”) is rare in healthy adults, and doctors may only see a single case in their whole career. However, the so-called “flesh eating bug” needs to be diagnosed and treated quickly to avoid life changing consequences.
NF is an infection of the deep layer of tissue between the skin and muscle (known as the fascia). It causes the death of tissue, which is what the “necrotising” part of the name refers to. It spreads quickly and will cause death if not diagnosed early and properly treated.
Even though it is rare, given the very serious consequences of even a short delay in diagnosis, clinical staff must be very alert. Most at risk are diabetics, cancer patients, drug users, and those who have suffered a recent skin injury such as a graze, cut, or insect bite.
The symptoms are swelling, redness, pain and tenderness. There may also be symptoms of fever and chills, rapid pulse and breathing, and nausea and vomiting. A key indicator of NF is pain which is out of proportion to the physical signs.
The difficulty for the doctor is that less serious infections have similar symptoms.
As the infection spreads, the developing symptoms include blistering, skin discoloration and breakdown, low blood pressure, septic shock, and confusion.
NF is diagnosed by taking a careful history, blood tests, radiology, and surgery. It is treated by high doses of anti-biotics and the removal of the affected tissue. This may need to be done repeatedly.
The risk of death is high. Survivors can be left with significant disabilities. Some will have amputations. Others may require skin grafting or other reconstructive surgery.
We see NF cases reasonably frequently. Typically, a patient will present with pain out of all proportion to the physical signs, an inadequate history is taken by an inexperienced doctor and the doctor fails to consider the possibility of NF. This leads to delay, which may only be a matter of hours, in starting treatment. The delay leads to a worse outcome for the patient. This can include avoidable long term disability.
Succeeding is about more than awards of money. People may be left disabled for life and needing care. Rehabilitation, paid for out of the settlement, can go a long way to helping people cope with disability and live a normal life.
A settlement can also mean life-long financial security. This is particularly important when someone is no longer able to go out to work to provide for their family.