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By: Biuce Ruben, N.B., Neuical Biiectoi of Encompass BealthCaie anu Wounu
Neuicine

Befoie you can uelve into the vicious anu ueauly woilu of neciotizing fasciitis, the
ghastly "flesh-eating uisease" that's been wiuely iepoiteu by the meuia, you have to
unueistanu something about the bacteiia that causes it anu who is most susceptible
to this iaie conuition.

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Beie, the main culpiit is a veiy common bacteiium that may be haimlessly
colonizing on youi skin iight now calleu uioup A stieptococcus (uAS). 0ften,
though, neciotizing fasciitis is a combination of bacteiia incluuing klebsiella,
clostiiuium, E. coli, staphylococcus auieus, anu aeiomonas hyuiophila.

0n fiist ieauing that uAS is colonizing on youi skin, one might wonuei why
neciotizing fasciitis is so iaie a conuition. The answei is that youi bouy has been
manufactuiing antibouies since uay one to piotect you fiom any pioblem uioup A
Stieptococcus can cause.

Essentially, uAS is a benign colonizei that can occasionally cause milu skin
infections such as impetigo oi thioat infections such as stiep anu phaiyngitis. The
bacteiia spieau anu multiply quickly, but with conseivative antibiotic theiapy, the
infection is iesolveu quickly.

Bowevei, when the host's immune system is compiomiseu anuoi the stiain of uAS
(plus any of the othei bacteiia mentioneu above) is paiticulaily viiulent, moie
intensive meuical inteivention is iequiieu.

In these iaie cases, the uAS bacteiia can tiavel to the ueepei layeis of skin anu
subcutaneous tissues wheie it spieaus quickly along the fascia, which aie the
connective tissues that covei muscles. Theie, they ielease toxins that speeu up the
iate of infection uiamatically, leaving ueau, neciotic tissue in theii wake. That's
neciotizing fasciitis, aka, the "flesh-eating uisease."


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But "flesh-eating" is a misnomei, as the bacteiia uo not actually "eat" the tissue, but
ielease toxins incluuing stieptococcal pyogenic exotoxins that hypei-acceleiate the
spieau of the infection.

0ntil iecently, scientists hau no iuea what tuineu the haimless bug, uAS, into ueauly
neciotizing fasciitis. But in iecently publisheu ieseaich (}anuaiy 2u14) conuucteu
jointly by the Bebiew 0niveisity of }eiusalem anu the National 0niveisity of
Singapoie, a new mechanism has been uiscoveieu that ieveals how neciotizing
fasciitis opeiates in eaily stages of the infection.

Reseaicheis founu that when uAS sticks to anu infects the host's cells, it ueliveis
into these cells two stieptolysin toxins. These poisons impaii the bouy's mechanism
foi quality contiol of piotein synthesis, allowing the invasive uAS to piolifeiate
uiamatically, much fastei than the host can manufactuie antibouies to fight them.

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At that point, the main tieatments incluue intensive intiavenous antibiotics anu
suigical iemoval of infecteu tissues. Still, even aftei those moualities aie piomptly
implementeu, bacteiia can still succeeu in piolifeiating anu cause ueath in
appioximately 2S-Su peicent of patients.

That's why neciotizing fasciitis is one of the moie vicious anu ueauly uiseases. Anu,
what makes it so ghastly aie the uisfiguiing suigical excisions, amputations anu
scaiiing patients aie left with if they suivive.

Theie is optimism, though, in the iecently publisheu ieseaich. The team that uiu the
stuuies uiscoveieu that aspaiaginase, a populai chemotheiapeutic agent FBA-
appioveu foi lymphoblastic leukemia, stops uAS giowth in human bloou anu in an
animal mouel of human bacteiemia. That may mean that it's possible that
aspaiaginase may also be applieu to tieat uAS infections iesulting in neciotizing
fasciitis.

Bypeibaiic oxygen theiapy is also an FBA- anu Neuicaie-appioveu mouality to
combat the uisease.

In auuition, a piouuct calleu NeutioPhase, a u.u1% puie hypochloious aciu saline
solution with no bleach impuiities, has been shown in extensive in vitio testing to
kill bacteiia in seconus anu has the ability to neutialize toxins geneiateu by uAS.

The key to all the possibilities in tieating neciotizing fasciitis is eaily uetection
because patients uiagnoseu with the conuition have an ongoing emeigency that
uoesn't enu until all the toxins ieleaseu by the bacteiia aie gone.

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