CONFRONTING NECROTIZING FASCIITIS
A historical study of flesh eating bacteria shows an increase in facial infection.
by Christopher Tedeschi
In the past three years, physicians at LAC+USC Medical Center have treated three cases of necrotizing fasciitis of the face, which turns out to be three of the four total cases they have seen in a 15-year span.
An uncommon condition seemed to be happening more frequently, leaving researchers puzzled.
Necrotizing fasciitis, a bacterial infection that leads to rapid tissue death, confronts physicians at the Medical Center relatively often-sometimes several times a month. But such infections hardly ever attack the face, since the head and neck's excellent blood supply help the immune system to work quickly when dangerous bacteria threaten.
Most patients with necrotizing fasciitis have either diabetes or alcoholism, two common problems that can lead to compromised immunity.
The seemingly high incidence of facial necrotizing infections intrigued Vincent Nalbone, M.D., former chief resident of otolaryngology, along with colleagues Maisie Shindo, M.D., assistant professor of otolaryngology, and William Dougherty, M.D., assistant professor of surgery. Nalbone decided to take a historical look at occurrences of the disease. He searched the medical records of every patient diagnosed with necrotizing fasciitis at LAC+USC Medical Center in the last 15 years. After reviewing hundreds of cases, the researchers identified only four patients whose infections had struck the face.
The group then conducted a world-wide search of medical literature and found only 35 reported cases of facial necrotizing fasciitis.
Among the cases, the group found that in recent years, necrotizing infections of the face have become more common, and that patients tend to be infected with several different kinds of bacteria, including anaerobes-bacteria that carry out their metabolism in the absence of oxygen. At least part of the trend can be attributed to more sensitive lab techniques that can detect many kinds of bacteria.
Streptococcus bacteria most frequently cause the disease. Infection usually starts when the bacteria infect a facial cut, or even a small break in the skin like a bee sting.
Bacterial infection of the face usually starts as a reddish inflammation called cellulitis, which is commonly treated with antibiotics. If left unchecked the infection can worsen, leading to extensive loss of facial skin and even death.
Shindo stressed that physician education is critical in identifying early signs of infection, since the problem can progress from cellulitis to potentially fatal fasciitis "in days or even hours. It's important for physicians to keep a close eye out for that change, and to catch these cases early." Patients with serious infections are often rushed to surgery to remove dead tissue, and may need extensive reconstructive surgery to replace lost tissue.
