Nacrotising Faciitis by a ''FLESH-EATING'' Bacteria...
This is the foot of a 57-year-old male with a past medical history of type 2 diabetes mellitus, hypertension, alcohol abuse, significant tobacco abuse, and depression. He said that he has been living in the woods and homeless and staying at friends places when he could. His foot started hurting about 4 months ago but he just thought it was his diabetes. He doesn’t have any extra clothes so he just keeps his socks on and really hasn't looked at his feet in 4 months according to him. He also was rendered immobile and unable to walk on it secondary to pain. At presentation he was septic with necrotizing fasciitis. His foot literally smelled so bad they had to put a fan outside his room to blow the smell back in his room with air fresheners all over. Necrotizing fasciitis is a life-threatening, rapidly progressive subcutaneous soft-tissue infection that may extend to the deep fascia, but is superficial to muscles, and is accompanied by secondary necrosis of subcutaneous tissue. It is referred to as the "flesh-eating infection/bacteria", commonly caused by anaerobic bacteria or group A streptococci (pyogenes), but it can be a polymicrobial infection with both aerobic and anaerobic organisms too. The infection typically enters the body through a break in the skin such as a cut or burn. Clinical manifestations include sepsis and fever with an area of erythema. When progressed, the tissue begins to turn necrotic and into gangrene, which appears gray/black. It spreads quickly and aggressively from the primary infected area and beyond and can result in amputation, shock, and death if not treated by a combination of surgical exploration, debridement (removing necrotic tissue), and appropriate antibiotic therapy.
