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Necrotizing fasciitis is more commonly known as "flesh-eating disease." It is a rare illness that causes extensive tissue destruction and can lead to death. In Canada, there are 90 - 200 cases of necrotizing fasciitis each year. Some of the Symptoms that can be noticeable or just from the inside of necrotizing fasciitis include fever, severe pain, and a red, painful swelling which spreads rapidly. Death can occur in 12 to 24 hours. When the disease spreads along the layers of tissue that surround muscle (the fascia), it is called necrotizing fasciitis. When the disease spreads into the muscle tissue, it is called necrotizing myositis.
Necrotizing fasciitis can be caused by a number of different bacteria, one of them being the group A streptococcus. This is a common bacteria which causes infections, such as sore or strep throat, in children and young adults. Ten to 15 per cent of school age children may carry group A streptococcus in their throat and have no symptoms. It is normally spread through close, personal contact with an infected person, for example, through kissing or sharing cutlery. This same bacteria also causes scarlet fever, impetigo and rheumatic fever. Sometimes group A streptococcus causes serious diseases such as pneumonia, streptococcal toxic-shock syndrome, and necrotizing fasciitis and myositis.
In instances where serious disease develops, the presence of sore throat is very unusual. While group A streptococcus is passed from person to person, necrotizing fasciitis is not. The disease was first discovered in 1783, in France. Doctors noted that it occurred sporadically throughout the 19 th and 20 th centuries. The disease was usually restricted to military hospitals, especially in war times.
However, there have been some outbreaks in civilian populations. The disease appeared to markedly decrease in frequency during the 1940 s, and reemerged worldwide in the 1980 s. In October 1998, serious streptococcal infections, such as necrotizing fasciitis, were reportable to public health officials in Newfoundland, Prince Edward Island, Quebec, Ontario, and Saskatchewan only. However, it was agreed that serious streptococcal infections would be under national surveillance from January 2000.
In 1996, Health Canada's Laboratory Centre for Disease Control studied serious group A streptococcal infections in nine Canadian health units across the country. These health units, called the Sentinel Health Unit Surveillance System (SHUSS), were used to periodically monitor rare diseases in selected populations. The SHUSS study and some provincial data showed that necrotizing fasciitis from group A streptococcus occurred in roughly 3 to 7 persons per 1, 000, 000 population per year. The study also confirmed that, while rare, necrotizing fasciitis is fatal in approximately 20 - 30 % of cases.
The fatality rate may be higher if it occurs with the toxic shock syndrome. Treatment for necrotizing fasciitis usually involves surgically removing infected tissue - including amputation if necessary - and giving antibiotics such as penicillin and other drugs. Researchers do not know why the normally mild group A streptococcus bacteria sometimes becomes a more serious threat. They are unsure exactly why group A streptococcus may cause minor infections, such as strep throat, in some people, and very serious infections, such as toxic shock syndrome or necrotizing fasciitis, in others. Bacteria have many different characteristics that can change over generations, keeping in mind that a generation for bacteria can be as short as 20 minutes. An apparent change in the level of disease activity (number of cases of infection) can be due to changes in one or several of these bacterial characteristics, a change in the type of person (s) exposed to the bacteria or a greater awareness of these infections.
It is likely that all of these possibilities have played a role in our perception of serious group A streptococcal infections. Many scientists believe the bacteria makes proteins that cause the body's immune system to destroy both the bacteria and body, in addition to proteins that destroy tissue directly. There is no vaccine available to prevent group A streptococcal infections. Since there are many types of group A streptococci, one of the biggest problems facing researchers has been how to make one vaccine against all the different types. Canadian researchers are working on a new strategy that could help in the treatment of flesh-eating disease. Health Canada works with provincial and local public health officials to monitor infectious diseases.
If requested, the Department will assist in the investigation of clusters of these infectious diseases using our human and technical resources. The Department's Health Protection Branch through its Laboratory Centre for Disease Control works with the National Streptococcus Centre in Edmonton and other public health officials to develop new strategies and treatments to combat these diseases. Bibliography:
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