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Posted on: July 8, 2019 at 8:19 am
Last updated: August 3, 2019 at 12:50 pm

A new report from researchers at the Cooper University Hospital in New Jersey suggests that necrotizing fasciitis may no longer be as rare as previously assumed, no thanks to climate change and global warming [1]

Necrotizing fasciitis (NF) is a rapid-spreading, life-threatening bacterial disease that destroys the fascia, the tissue under the skin surrounding muscles, fats, and blood vessels. It is caused by a species of bacteria known as Group A streptococcus, also called “flesh-eating bacteria”, and Vibrio vulnificus. These bacteria thrive in warm salt and brackish waters, alternatively entering the body through open wounds or oral ingestion. 

Recent statistics show that necrotizing fasciitis affects about 1 in every 250,000 people in the United States per year [2]. In some other parts of the world where the climate is warmer, it may affect as much as 1 in every 100,000 per year. NF has been termed a “very rare” disease due to these low frequencies of occurrence, but global warming may be causing the increase. 

This recent report published in the Annals of Internal Medicine suggests that those statistics may be on the verge of going higher as world waters are getting warmer [3]. Flesh-eating bacteria species (especially Vibrio) thrive in unusually warm waters, and according to the report from the CUH, the few cases of necrotizing fasciitis studied have mostly arisen from the Southeastern U.S coast, the Chesapeake Bay, Delaware Bay, and the Gulf of Mexico. 

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Warm waters are a potential breeding ground

With climate changes rapidly occurring and more waters becoming warmer than before, the bacteria may be moving farther north and thriving in areas that were previously termed safe and nonendemic. They thrive in brackish waters that have an approximate temperature of 55 degrees Fahrenheit (13 degrees Celsius). The CUH report studied the cases of five patients who were exposed to NF by either eating seafood or fishing with open wounds in Delaware Bay. The vibrio is aquatic microbes and thrive only in water.

In one of the cases, a 46-year-old man had to have the skin on his right leg scraped and grafted following the removal of necrotic tissue to prevent the bacteria from spreading to other parts of his body. He had sustained an open cut wound during a crabbing trip, creating an inlet for the bacteria. He suffered swelling, blistering, and severe pain in his right leg. The infection was caught relatively early and the man’s life was saved.

A couple of the others were not so lucky. A 60-year-old man who consumed several crabs from the Delaware Bay had to have all four limbs amputated when the infection took over his flesh, starting from his right leg. A 64-year-old man died from the infection which he got from eating carrier crabs. He spiraled into tachycardia following an emergency procedure and passed away in the hospital. 

How does a person get NF?

There are two channels through which the flesh-eating bacteria could get into the bloodstream [4]. (1) By oral ingestion. A person who eats contaminated raw or undercooked seafood may begin to develop symptoms a day or two later. (2) Through an open wound. The bacteria can penetrate the body when an open wound comes in direct contact with infected water. 

A higher mortality rate is seen in patients who have underlying medical conditions such as cirrhosis, diabetes, heart conditions, and HIV, all of which may lead to partial or complete immunosuppression [5]

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The authors of the report are calling on medical personnel all over the country and in other parts of the world to keep a watchful eye for this infection formerly termed “very rare”. Many doctors wouldn’t think to diagnose a patient with NF in their regions, but it may no longer be as rare as was originally assumed. The bacteria have been noticed to thrive in areas that were previously noted as NF-safe zones and may begin to infiltrate imported seafood and local aquatic animals in warmer parts of the country. 

As a result of our experience, we believe clinicians should be aware of the possibility that V. vulnificus infections are occurring more frequently outside traditional geographic areas,” says Dr. Katherine Doktor, one of the authors of the report and an infectious disease specialist at CUH.

The CDC advises people to be extra-vigilant when getting in the water. The condition is still quite rare, but the planet has become highly unpredictable in recent times. Avoid eating raw or uncooked shellfish and other seafood. Ensure to wash them properly and cook adequately before eating. People with open wounds (even openings as tiny as needle pricks) must avoid salty or brackish warm water, and if they must get into the water, the wounds must be covered with waterproof material.

Symptoms and treatment of necrotizing fasciitis [6]

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The infection spreads very quickly, therefore fast action is crucial when the first signs are noticed. The symptoms may not begin until a day or two after the bacteria has penetrated, but once noticed, medical attention should be sought as soon as possible.

Early signs include:

  • Fever
  • Quick-spreading redness and swollen skin
  • Severe pain beyond the affected area

Later symptoms include:

  • Discoloration of the skin to a purplish or reddish color
  • Ulcers and fluid-filled blisters on the skin
  • Pus-filled lesions on the skin
  • Pus in the injury
  • Dizziness
  • Diarrhea or nausea

Presiding physicians must act quickly and certainly. The bacteria consume tissue with every passing second. The first course of treatment is the administration of intravenous antibiotics to stop the action of the bacteria. This treatment will only be fully effective if the infection is caught at a very early stage. Otherwise, doctors would also have to surgically remove or scrape off destroyed necrotic tissue in addition to the antibiotics. 

The patient may require more than one surgical procedure, and if the limb has been severely destroyed, amputation and blood transfusion may the safest courses of action.

  1. Lasker, Alex. Experts warn ‘flesh-eating’ bacteria may be spreading to seafood, beaches due to climate change. AOL. https://www.aol.com/article/news/2019/06/20/flesh-eating-bacteria-vibrio-vulnificus-seafood-beaches-climate-change/23752922/. Retrieved 03-07-19
  2. Wallace & Perera. Necrotizing Fasciitis. NCBI. https://www.ncbi.nlm.nih.gov/books/NBK430756/. Retrieved 03-07-19
  3. King et al. Vibrio vulnificus Infections from a Previously Nonendemic Area. Annals of Internal Medicine.  https://annals.org/aim/article-abstract/2736101/vibrio-vulnificus-infections-from-previously-nonendemic-area. Retrieved 03-07-19
  4. Sparks, Hannah. ‘Flesh-eating’ bacteria may be spreading to beach waters, seafood. New York Post. https://nypost.com/2019/06/18/flesh-eating-bacteria-may-be-spreading-to-beach-waters-seafood/. Retrieved 03-07-19
  5. Biggers, Alana. Necrotizing Fasciitis (Soft Tissue Inflammation). Health Line. https://www.healthline.com/health/necrotizing-soft-tissue-infection. Retrieved 03-07-19
  6. Admin. Diseases Caused by Group A Strep. CDC. https://www.cdc.gov/groupastrep/diseases-public/index.html. Retrieved 03-07-19 
  7. Admin. Management of Vibrio vulnificus Wound Infections After a Disaster. CDC. https://www.cdc.gov/disasters/disease/vibriofaq.html. Retrieved 03-07-19
  8. Admin. Necrotizing Fasciitis (Flesh-Eating Bacteria). Web MD. https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria. Retrieved 03-07-19
  9. Admin. Management of Vibrio vulnificus Wound Infections After a Disaster. CDC. https://www.cdc.gov/disasters/disease/vibriofaq.html. Retrieved 03-07-19
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