Symptoms and Signs of Necrotizing Fasciitis (Flesh-Eating Disease)

Medical Author:
Medically Reviewed on 9/13/2022

Doctor's Notes on Necrotizing Fasciitis (Flesh-Eating Disease)

Necrotizing fasciitis (NF), also called flesh-eating disease (bacteria), is a rapidly progressive infection that primarily affects the connective tissue planes (fascia) just under the skin, where it can spread rapidly and involve adjacent soft tissue, leading to widespread tissue death (necrosis). It is a rare condition but can be life-threatening.

Early on, there may be few symptoms of necrotizing fasciitis (flesh-eating disease) other than pain or soreness, similar to that of a "pulled muscle." As the infection rapidly spreads, the symptoms of necrotizing fasciitis include

  • an area of localized redness,
  • warmth,
  • swelling, and
  • pain, often resembling a superficial skin infection (cellulitis). The pain and tenderness are often out of proportion to the visible findings on the skin.

Other symptoms of necrotizing fasciitis include 

Within hours to days, the skin redness rapidly spreads and skin may become dusky, purplish, or dark in color. Blisters, black scabs, hardening of the skin, skin breakdown, and wound drainage may develop. A fine crackling sensation due to gas within the tissues may sometimes be felt under the skin (crepitus). Nerve damage progresses and localized numbness of the affected area may occur. If untreated, the infection spreads throughout the body, often leading to sepsis (infection in the bloodstream) and often death.

What is the treatment for necrotizing fasciitis (NF)?

Treatment of NF should begin in a hospital as quickly as possible and consists of both surgery and IV broad-spectrum antibiotics:

  • IV antibiotics are given immediately (for example, penicillin, vancomycin, cilastatin/imipenem); antibiotics may need to be changed quickly if the infecting bacteria are resistant to antibiotics in use. 
  • Surgery – aggressive surgical removal of dead and infected tissue from the infected site (extensive debridement); some patients may require reconstructive surgery and/or amputation. 

Death rates range from about 11 to 33%; rapid diagnosis and aggressive treatments may reduce the chance of complications or death from NF.

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Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.