Necrotizing fasciitis: What is the flesh-eating disease?

The nation has recently been captivated by the tragic story of Aimee Copeland and again by the similar case of new mother Lana Kuykendall, two young women from Georgia and South Carolina, respectively, who both contracted a flesh-eating bacteria within weeks of each other.

Copeland, 24, came into contact with the bacteria after a zip lining accident that split open her leg, while Kuykendall noticed a suspicious spot on her leg a few days after giving birth to twins at Emory University Hospital Midtown in Atlanta.  Both are showing signs of recovery, though Copeland has already lost a leg to the disease and will most likely have to have her fingers amputated as well.

This once little-known condition is called necrotizing fasciitis, a rare but extremely aggressive disease that has a mortality rate as high as 73 percent, according to Medscape Today.  The condition involves the infection and destruction of the fascia – a layer of tissue right underneath the skin.

“If you have eaten red meat, that white, tough gristle– that’s fascia,” Dr. Michael Lucchesi, chief medical officer for SUNY Downstate Medical Center in Brooklyn, told  “That’s underneath the skin and covers the muscle.  The infection spreads up underneath the skin, and it spreads through that area very rapidly and aggressively.  It also does better in a non-air environment where there’s no oxygen around.”

Numerous types of bacteria can cause this kind of infection, according to Lucchesi.  The bacteria typically enter the body through a puncture wound, so in Copeland’s case, it entered her body through the gash she received after falling from a homemade zip line by a creek in Carrolltown, Ga.  Lucchesi said that the creek environment in which Copeland cut herself is typically rife with bacteria.

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There is not much known yet about Kuykendall's case.  Emory University Hospital released a statement saying, "Due to privacy regulations, we are not able to discuss our patient's care and treatment."

“These bacteria are ubiquitous – they’re everywhere,” said Lucchesi.  “But when you have stagnant water, and you have animals defecating in the water, or you have other types of fish and wildlife that might have died in it – it can be teeming with various types of bacteria.”

According to the U.S. National Library of Medicine, once the bacterium enters the skin, it starts to release toxins that destroy tissue and shut down blood supply to the infected areas.  The lack of blood flow and the rate at which the disease spreads makes an infection of this kind extremely difficult to treat, Lucchesi said

“A lot of the antibiotics don’t work,” Lucchesi said.  “When you take antibiotics, you take them two ways – through the mouth or intravenously.  Antibiotics are delivered through the blood to particular areas where there is infection, but if you’re in an area without good blood supply, the antibiotics can’t get there very well.   And since it spreads so quickly, it’s just very hard to treat with antibiotics.”

If identified too late, treatment for necrotizing fasciitis often includes surgery and amputation to stop the disease from traveling further.  Also, just like with Copeland, patients often require full use of a ventilator to help increase their blood flow.

In order to try to avoid an episode of this kind, Lucchesi said it’s important for people to be very wary when they cut themselves, especially if they receive a puncture wound.

“Really be aggressive about washing any kind of cut, especially if it’s a puncture – such as stepping on a nail through your sneakers,” Lucchesi said. “Also, be extremely diligent to continue to follow it and observe it.”

It’s also important to observe any changes in the skin surrounding the original abrasion.

“This is not subtle at all,” Lucchesi said. “If the skin overlying the area is red, warm and extremely tender, or if someone feels pain surrounding the inoculation, that’s a very bad sign.  Sometimes if it’s a gas producing bacteria, the skin overlying the area can actually feel like Rice Crispies under the skin – almost crunchy.”

Whether or not a person contracts this kind of devastating disease ultimately relies on a host of different factors.

“It depends on the bacteria and the host,” said Lucchesi.  “A strong healthy athletic person with no medical issues has a better chance against this than someone with medical issues. Some bacteria are very aggressive, some aren’t; it really is a whole gambit of different types of bacteria.”

Necrotizing fasciitis is listed as a ‘rare disease’ by  the National Institute of Health, and according to the CDC’s Division of Bacterial and Mycotic Diseases, it only affects 600 people in the U.S. each year.  While the condition doesn’t happen often, Lucchesi said it’s important for people to remain vigilant.

“It’s not all that common, but it’s very traumatic when you do see it.” Lucchesi said.