With 2,000 to 3,000 patients killed by necrotizing fasciitis each year, early diagnosis of the flesh-eating bacteria is of the utmost importance. That's what Russell Russo, an orthopedic surgeon at LSU Health Sciences Center New Orleans, and his team are stressing in the September 2012 issue of Orthopedics Today.
While the flesh-eating bacteria is relatively rare in comparison to the incidence rates of other diseases and disorders, the ratio of deaths -- at best, 2,000 out of the 10,000 to 15,000 cases diagnosed each year -- is high enough to warrant the call for earlier diagnosis.
"The infection can rapidly spread at a rate of one centimeter per hour," Russo told Orthopedics Today. "People who have their surgery and debridement within 10 to 24 hours once they hit the door, do much better than the patients for whom the diagnosis is not made for days."
Russo recommends that doctors maintain a high suspicion of the flesh-eating bacteria when treating patients with symptoms that fall in line with the infection. A physical examination is also necessary, since imaging scans such as X-rays may not detect the infection and can be quite time-consuming.
"Nowadays, people tend to rely on X-rays, CT scans and labs," Amr Abdelgawad, an orthopedist at Texas Tech University Sciences Center in El Paso, said. "We are getting farther away from going to see patients and putting hands on them — the human touch, the human effect. With [recognizing] necrotizing fasciitis, it is all physical examination."
Though the bacteria often enters the body through a cut or wound like in the case of 24-year-old graduate student Aimee Copeland, Russo said 45 percent of patients do not recall apparent injuries, making early diagnosis even more difficult.
"I have seen it in people with closed fractures or in patients with just hematomas under the skin who never had a penetrating injury, but then developed an infection that progressed to necrotizing fasciitis,” Abdelgawad said, adding that football players hit on the field have contracted the flesh-eating infection.
In 2006, 21-year-old University of Tulsa football player Devin Adair died after spending a week in the hospital. Though he had no open wounds, his autopsy later revealed that necrotizing fasciitis was the cause of death.
Since misdiagnosis or failing to diagnose the flesh-eating bacteria usually results in amputation or death, any and all symptoms that signal necrotizing fasciitis, including fever, nausea and skin discoloration, should be addressed immediately.
"If you have a red, warm arm, address it, and do not wait," Russo said.