What is Necrotizing Fasciitis?

Necrotizing fasciitis is described as a rare illness with severely damaging effects to the deep tissue and skin layers, it is a very swift spreading infection of the soft tissues and connectives tissues that cause the affected areas to just waste away and undergo tissue necrosis. Any part of the body may be affected by this condition and has no particular risk factors. Studies on the occurrence of this disease have found out that the most common pathogen causing necrotizing fasciitis is a particular species of bacteria under the so called, group A beta hemolytic streptococci, which is the streptococcus pyogenes,anf for some time, this was the only recognized causative agent of this particular condition. But recent studies have completely shattered this notion, because now we know that a host of other microorganisms can cause this debilitating sickness, such as other bacteria and some species of fungi. Bacteria are the most common pathogens bringing about this condition and some of the bacterial toxins also have the ability to activate the T-cells or T lymphocytes of the body, releasing excessive amounts of immune modulating substances called cytokines and causing a condition called toxic shock syndrome.

Although the disease might have been present since the earliest days of our ancestors, it was not until the middle 1800s that physicians started to describe this condition, there were lots of other names for it then but in 1952, it was officially named necrotizing fasciitis. This disease has also been called “flesh-eating bacterial infection” or simply, “flesh eating disease” among other things, because the progress of the condition through the tissues is so fast that you would believe that the skin is being eaten right before your eyes. But as opposed to the “flesh eating bacterial disease” notion, the bacteria do not actually eat the tissues, they release a variety of substances and toxins that “dissolve” the soft tissues and skin, causing necrosis at an extremely fast rate Any infection with this disease is treated as an ongoing emergency situation, therefore, a quick and effective response is imperative to the survival of the patient.

Necrotizing Fasciitis Causes

It was first thought that group A beta hemolytic streptococci were the only organisms able to cause necrotizing fasciitis but as more studies were done on a variety of cases, it has been found out that a variety of other organisms can cause the condition.

The causative microorganisms were found out through the different tissue cultures that were done from cases of necrotizing fasciitis and it was found out that more often than not, different strains of bacteria and other microorganisms are found on the tissue, leading to the theory that these microorganisms are inadvertently working together and complimenting each other’s virulence factors, also called coninfection. For example, one type of aerobic bacteria can cause tissue destruction on the upper layers of the skin, another strain releases toxins to stop the immune cells’ functions and cause tissue destruction or necrosis, the resulting necrotic tissue on the deeper layers become anoxic or without oxygen, this is where opportunistic anaerobic bacteria move in and multiply, releasing even more toxic substances to eat away at the different connective tissues.

Some of the most common microorganisms found in cultures of necrotizing fasciitis patients are;

• S. pyogenes
• Group A Streptococci
• Group A Staphylococci
• Clostridium spp
• Peptostreptococcus
• Klebsiella
• E. Coli
• Pseudomonas
• Vibrio vulnificus.

Necrotizing Fasciitis Symptoms

Signs and symptoms of necrotizing fasciitis include a variety of visible skin conditions but the disease often begins with cases of immunosuppresion, an existing infection, or an open lesion or wound. Immunosuppressive cases include unregulated drug use, alcoholism, diabetes, and other chronic systemic diseases, once the immune system is compromised by these conditions, necrotizing fasciitis causing micro fauna are able to establish themselves in the tissue before the immune system can detect and counteract them.

Some of the symptoms of necrotizing fasciitis are:

• Delayed healing with the lesions becoming tender, swollen, and reddened.
• Diarrhea
• Nausea, and vomiting coupled with fever and chills,
• Increased redness in the affected area
• Flaking of skin
• Blisters or bullae
• Darkening of the skin from pinkish to red, to dark red and violet
• Black areas of necrotic tissue or eschars become apparent
• Leaking fluid from the deeper parts of the skin
• Gas formation in the tissues giving off a pungent and foul odor
• Septic infection

Three subtypes of the disease causes include;

• Type 1 – the condition stems from supposedly “sterile” means of trauma like surgical wounds
• Type 2 – skin trauma is simple and small like insect bites, abrasions, and small cutes
• Type 3 – skin trauma is more extensive and the wounds come in contact with things harboring the causative organisms themselves, this is the type with the fastest progress of the disease and gangrene or tissue death often occur within a few days.

Necrotizing Fasciitis Pictures

Picture 1 :  Necrotizing Fasciitis photo

 

Picture 2 : Necrotizing Fasciitis on leg

 

 

Picture 3: Necrotizing Fasciitis (diagram)

Image source: MedicineNet

 

Necrotizing Fasciitis Statistics

Because this disease spreads so fast within the body yet so rare in terms of occurrence, varying statistics are available about it. It is generally known that more than 1000 people are affected each year, with the numbers rising slightly every year, and more than 20 percent of these cases become mortalities even with complete access to treatment. 70 percent have predisposing immunosuppressive conditions and there is a more than 70 percent mortality rate for cases with little or no access to treatment.

Necrotizing Fasciitis Treatment

Because this disease progresses at a terrifying speed, all cases are treated as emergency situations, and early antibiotic treatment is often employed to try and slow the progress of the disease. Both intravenous and oral antibiotics with wide spectrums are employed to counteract the disease progress, and once the exact microorganisms are determined through tissue cultures, more specific acting antibiotics are given to the patient. Surgery is often an unavoidable part of the treatment in order to halt the spread of the infection, debridement, or manual removal of dead and infected tissue is often done on the lesions of patients to determine the extent of the disease. Amputation is often necessary to save the healthy tissue and make sure that the infection does not reach other parts of the body, and the wound is closely monitored for signs of reappearing infection.

What is Fetal Alcohol Syndrome?

FAS or fetal alcohol syndrome is a series of conditions and defects of the mental and physical aspects of a person who has been subjected to alcohol exposure when he or she was still a fetus in the womb of the mother, the alcohol exposure of the growing fetus is attributed to the intake of alcoholic beverages by the pregnant woman. The amount and frequency of alcohol intake during the trimesters of pregnancy plays an important part in the development of fetal alcohol syndrome in a baby. Although drinking alcoholic beverages during pregnancy does not guarantee that the child will subsequently develop FAS or fetal alcohol syndrome, and there are no extensive studies and statistics as to what exactly is the amount of alcohol that can cause fetal alcohol syndrome, it is better to play is safe and have the pregnant woman avoid any intake of alcohol at any time during the whole pregnancy.

Fetal Alcohol syndrome was first officially described by French physicians in 1968, when they studied more than 100 children with alcoholic mothers. The report was made public through a pediatric journal but was not given much attention until 1973, when a group of Americans studied 8 children whose mothers were chronic alcoholics and published their report in a British medical journal.

Alcohol is a known teratogen, or a substance that can cause abnormalities in a developing fetus, in fact it is the most common teratogen to which developing fetuses are exposed. Alcohol can cross the placental barrier easily and get absorbed into the system of the developing fetus, causing a number of abnormalities in growth and development.

 

Fetal alcohol syndrome in Children

Children with fetal alcohol syndrome exhibit a number of physical signs and symptoms as well as different mental development problems. A child with fetal alcohol syndrome may have problems in socialization and can exhibit exaggerated tantrums that are normally experienced by children during this stage. Some behavioral problems like a decreased attention span, inability to concentrate, unpredictable tantrums and mood swings, decreased intellectual capacity, impulsivity, irresponsibility, and an overall difficulty in discipline, may be exhibited by a child affected by fetal alcohol syndrome.

The physical features of children with fetal alcohol syndrome are more noticeable and are usually the first clues to the child’s condition. Children with FAS usually have problems in their sense organs like the eyes and ears, with some difficulties in eyesight like myopia and some hearing problems. Abnormalities in dentition are also common, like discolored and malaligned teeth.

 

Fetal alcohol syndrome in Adults

As the children with fetal alcohol syndrome grow and become adults, they can still carry with them the mental and behavioral problems exhibited during their childhood. The problems in mental development can cause them to perform poorly at school and at work, often causing a degree of frustration. Conforming with the social rules of society may also be hard for adults with FAS, since their behavioral problems are interfering with how they conduct themselves, young adults with fetal alcohol syndrome have been found to have increased tendencies to become violent, use illicit, and become alcoholics. These behaviors are still attributed to the abnormal mental development of people with FAS.

 

Fetal alcohol syndrome causes

As we all know, the primary culprit for the occurrence of fetal alcohol syndrome is a woman consuming alcoholic beverages during pregnancy. The alcohol taken in by the pregnant woman gets absorbed into her system and easily bypasses the placental barrier to the system of the developing fetus. While taking in excessive amounts of alcohol or binge drinking is more dangerous, even small amounts of alcohol in the system of a pregnant may still cause fetal alcohol syndrome because there is no such thing as a “safe” dose of alcohol for a pregnant female. Although taking in of alcohol at any time during the pregnancy is dangerous, the time where the most abnormalities occur is during the first trimester of a pregnancy, as the fetus is developing most major functions during this time.

 

Signs of Fetal Alcohol Syndrome

You can most probably tell if a child suffers from fetal alcohol syndrome just by looking at the physical appearance of the person suffering from this disorder, some of the most common tell-tale physical signs of fetal alcohol syndrome are the following;

A small head or microcephalic appearance, this is primarily due to the stunted development of the brain, causing the skull to develop in a much smaller scale compared to that of a normal child’s head circumference, microcepaly in children with FAS can either be mild or moderate.

A person with FAS may also exhibit abnormalities in gait and posture because of the abnormal maturation of bones, this also least FAS patients to be smaller and with bone abnormalities in the fingers.

Simean crease, this is evident on the palms of people with fetal alcohol syndrome, it is describe as a straight crease beginning from one end of the palm, and all the way to the other end, unlike the normal palm creases where there usually are different creases lining the palm. The simian crease is a sign of developmental retardation.

Other birth defects may include deformities in the central nervous system like myelomeningocele, where the spine or backbone does not fully fuse before the child is born, it results in the protrusion of the spinal column and some brain matter outside the body. Other birth defects that may be present are, hydrocephalus, hear murmurs, coarctation of the aorta, and cleft palate or cleft lip

 

Fetal alcohol syndrome Symptoms

Fetal alcohol syndrome has a variety of symptoms that positively identifies the disease, although all these symptoms need not be completely present in order to diagnose a child with FAS, some of the symptoms may or may not appear in a child with FAS.

The most common symptoms of Fetal Alcohol Syndrome are the following;

Slowed or stunted physical growth and development, coupled with abnormalities in bone structure and body proportions.

Behavioral and social problems, a child with fetal alcohol syndrome may perform poorly in school and exhibit characteristics like that of children with ADHD or attention deficit and hyperactive disorder.

Impaired fine motor skills, tremors, and decreased eye and hand coordination. People suffering from FAS may also present with very low IQ, usually in the 60s, which is classified as mind mental retardation.

Fetal alcohol syndrome Facial features

The facial features of a person with FAS are very distinctive to this condition and often become the basis for its diagnosis. The facial features include; a sunken nasal bridge, short eye openings, flat cheekbones, short and flat nose, absence of the ridge between the nose and upper lip which is also called the philtrum, this area becomes smooth and widened, and a thin vermillion or thin upper lip.

These facial features are generally believed to have developed with the 10 and 12 week of pregnancy and it is said that patients who present with all the facial features attributed to fetal alcohol syndrome are more often than not, mentally retarded.

Fetal alcohol syndrome Pictures and Photos

Picture 1 : Fetal Alcohol Syndrome features

 

 

Picture 2 : Fetal Alcohol Syndrome Facial features

Image source: people.uwec.edu

 

 

Picture 3 : Simian crease

Image source : Adam Inc

 

Pictures 4: Fetal Alcohol Syndrome features in young child

Photo source: nsnet.org

 

 

Fetal alcohol syndrome Effects

The most common effect of fetal alcohol syndrome is the delay and permanent retardation of mental functioning because of the irreversible damage done to the central nervous system during development. Aside from the small size of the brain, there are also more evident mental impairments like poor attention span, poor cause and effect relation, irresponsibility and disregard for the consequences of an action, and a very poor memory recall. This condition is the single most common cause of mental or intellectual disability in most western countries.

Fetal alcohol syndrome Diagnosis

There are four criteria that must be present in a person for the physicians to be able to confirm a diagnosis of fetal alcohol syndrome, these are; the presence of fetal alcohol syndrome facial features, significant central nervous system abnormality or damage, growth and development retardation, and the presence of alcohol exposure during the fetal stage.

 

Fetal alcohol syndrome Treatment

Treatment for fetal alcohol syndrome is geared towards rehabilitation and preventing further damage to the brain through therapy and medication. Sadly, once the physical and mental effects of the disease have set in, there is nothing that can reverse it. This is one of those situations where the saying, “prevention is better than cure” is truly applicable, because the best thing that can be done is to avert its occurrence by preventing the intake of alcohol for pregnant women. Women with alcoholism problems should also seek counseling and substance abuse rehabilitation before even trying to get pregnant.

 

Fetal alcohol syndrome Facts

The facts about fetal alcohol syndrome remain the same, its effects on a child are irreversible and there is no known cure for it, not even the smallest amount of alcohol is safe to be taken for a woman who is pregnant, and most importantly, fetal alcohol syndrome is completely preventable.

 

Fetal alcohol syndrome Statistics

Recent statistics have shown that fetal alcohol syndrome is more widespread and occurs more frequently across the entire planet than diseases like AIDS. In the US and Europe, one in 100 babies being born has FAS and up to thirty percent of pregnant women have taken alcohol during pregnancy.