Necrotizing Fasciitis on the Rise

 

"We've all had some tough cases. 'Nec fasc' [necrotizing fasciitis] isn't just among the scariest diagnoses for emergency physicians. [The life-and-limb threatening infections] scare the daylights out of everyone."

"[Most doctors will see a handful, if that, in their entire career] and yet there's this huge pressure to make the diagnosis quick. [The infections progress fast], like, right in front of  you."

"[Most urgently require cutting away layers of dead skin and tissues, big surgeries people don't want to get wrong], because the consequences of getting it wrong are huge. I think that strikes fear in everyone's hearts."

Dr. Stephanie Mason, general and burn surgeon, Sunnybrook Hospital, Toronto

"[The challenge is that people often show up in emergency] not super obviously sick, until they're very late into their course [of infection]."

"You're talking higher mortality with every organ that fails [by the time the necrosis -- dead tissue -- has spread extensively, vital organs can shut down]."

"But otherwise, they don't necessarily have classic signs of infection [like fever, or an elevated white blood cell count].

Dr. Shannon Fernando, critical care doctor, Lakeridge Health, Oshawa

"There's likely some level of reduced immunity on a population level due to lack of exposure and that would translate into more infections."

Dr. John McCormick, biomedical researcher, Western University

Doctors say they’re seeing significantly more invasive strep A infections, caused by a bacteria that usually leads to milder illnesses. But in some cases it can enter the bloodstream and quickly become deadly.     Still from video/CBC

 

Flesh-eating disease infections are frequently caused by invasive group A streptococcus, a bacterium increasing globally, including Canada, the reason for which is as yet unknown. For those who survive an infection which has a frightening 50 percent mortality rate -- the still-rare infection is a growing cause of concern for doctors in the medical community. Response to the infections -- diagnosis and surgery -- must be quick to prolong life. The urgency is to cut away layers of dead skin and tissues to stop the spread.

Strep A, a normally relatively harmless bacterium causing throat infections like strep throat or tonsillitis has the potential to enter the skin through a wound; alternately it can occur at sites of "non-penetrating trauma" according to researchers; even a minor muscle sprain. IGAS -- Invasive group A streptococcus has caused a resurgence of cases in recent years. Cases in the United States reached a 2-year high in 2023. Canada too has seen a rise in cases from province to province.

 

Group A strep is a major cause of the flesh-destroying disease, a bacteria that becomes life threatening when the blood is invaded, or when it spreads along the tissues surrounding muscle. Known risk factors include diabetes or other chronic diseases, along with a weakened immune system, adults past age 60 and the  use of  injection drugs. On the other hand, roughly 30 percent of cases occur in people who tend to be otherwise healthy.

 

A rough in appearance and exquisitely tender rash is one of the symptoms of the presence of he bacterium, "But otherwise, they don't necessarily have classic signs of infection." Numerous body areas can be affected; arm, legs, chest wall, neck. Group A strep is exclusively a human infection transmitted person-to-person  through direct contact with, or inhalation of, droplets from a person's nose or mouth in the winter months and early spring -- December through April.

 

Doctors used black marker to track the infection's route

As people grow older they tend to get fewer strep infections due to natural immunity built over the years. Up to ten percent of children carry strep in their throats harmlessly, with no disease resulting. And then there's the fact that a new strain of strep -- M1UK -- surfaced in 2019 in Britain, that is now taking the lead from the older strain. M1UK is more aggressive, dangerous, and produces nine times more of a toxin that can overstimulate the immune system, potentially causing streptococcus toxic shock syndrome and multi-organ failure.

 

It is this hyper-toxic strain that has staged a prevalence in Canada, causing greater numbers of cases of invasive group A strep. Once inside the body from perhaps a scrape on a knee, the bacteria can enter the bloodstream causing blood supply to tissue to become compromised, so the tissue dies, and dead tissue acts as fuel to the fire, according to Dr. Mason, since dead tissue helps bacteria to thrive.

 

People generally, said Dr. Mason, "have enough things to worry about and this doesn't need to be one of them. But if you are very unwell, you should seek medical attention, especially if you notice a new wound or a new change in your skin that wasn't there before."

 

Doctors are seeing an increase in the number of patients experiencing an invasive form of group A strep. The illness is common but can be serious when bacteria spreads to the blood or deep tissue, and needs to be treated quickly.     CBC