Pathology Associates Of Lexington, P.A.

"Flesh eating bacteria!"

There are several entities caused by bacteria which cause local, spreading skin & deep tissue necrosis, and they go by various names. These are extremely life threatening. We have seen a number of these cases in my career at one community hospital since 1975. When a lesion has "gas", the clinical implication should be that it is an anaerobic infection...but one should not automatically presume that it is a clostridial infection. Bacteria can be morphologically demonstrated in a significant percentage of these cases...but not in all cases (we have had at least one case in which we were unable to identify any bacteria on slide sections...although cultures became positive).

Clostridial:
- "Simple contamination": This denotes growth of clostridia in an untidy wound, negative for true tissue invasion...connoting the saprophytic growth of clostridia in already devitalized tissues.
- Clostridial cellulitis/gas abscess/local gas gangrene/brown form of gas gangrene/epifascial gas gangrene: A heavier infection primarily involving already-necrotic tissue and usually not "invasive". Little or no local pain, adenia, or toxemia.
- Clostridial anaerobic myonecrosis: includes very deep necrosis.
Non-clostridial:
- Necrotizing fasciitis: a rapidly spreading skin and soft-tissue necrosis which must be emergency-style surgically treated...plus antibiotics, etc.
  The NF foundation has numerous survivor stories, some with dramatic photos.
- Fournier's scrotal gangrene: The above, when a disease of the male scrotum...though it commonly begins as a perirectal abscess which spreads through the perineum to the scrotum.
- Balanitis gangrenosa (Corbus' disease): A mixed and necrosing process of the penile glans and foreskin involving a mixed growth of anaerobes, spirochetes, and fusobacteria.

References:

Dellinger EP "Severe necrotizing soft-tissue infections. Multiple disease entities requiring a common approach" JAMA 1981; 246(15):1717-21.

(posted 25 March 2004)