If you were asked to describe necrotizing fasciitis in three words, you might choose: rapid, deadly, and rare. The third of those adjectives may provide some comfort, but the first two are the clear inspiration for this infection’s more lurid nickname: flesh-eating bacteria. In this episode, we get up close and personal with necrotizing fasciitis and its causative agents. We start off by examining step by step how these infections wreak so much havoc and why doctors still struggle with its treatment. Then we take a tour through its grisly history, featuring maritime misadventures and wicked war wounds. We wrap up the story with a look at the global trends in these infections as well as some promising new research. This episode may not be for the faint of heart, but it is for the endlessly curious.
| History | Biology |
| Bishop, E. J., et al. “Necrotizing fasciitis in captive juvenile Crocodylus porosus caused by Streptococcus agalactiae: an outbreak and review of the animal and human literature.” Epidemiology & Infection 135.8 (2007): 1248-1255. | Bonne, S. and Kadri, S.S., 2017. Evaluation and management of necrotizing soft tissue infections. Infectious disease clinics of North America, 31(3), p.497. |
| Blackadder, H. Home. Observations on phagedæna gangrænosa. 1818. | Stevens, D.L. and Bryant, A.E., 2017. Necrotizing soft-tissue infections. New England Journal of Medicine, 377(23), pp.2253-2265. |
| Brewer, George Emerson, and Frank Lamont Meleney. “PROGRESSIVE GANGRENOUS INFECTION OF THE SKIN AND SUBCUTANEOUS TISSUES, FOLLOWING OPERATION FOR ACUTE PERFORATIVE APPENDICITIS*: A STUDY IN SYMBIOSIS.” Annals of Surgery 84.3 (1926): 438-450. | May, A.K., 2009. Skin and soft tissue infections. Surgical Clinics of North America, 89(2), pp.403-420. |
| CRUICKSHANK, ROBERT. “Hospital infection: a historical review.” British Medical Bulletin 2.12 (1944): 272-276. | Seal, D.V., 2001. Necrotizing fasciitis. Current opinion in infectious diseases, 14(2), pp.127-132. |
| Dean, Malcolm. “Flesh-eating bugs scare.” The Lancet 343.8910 (1994): 1418-1418. | Allaw, F., Wehbe, S. and Kanj, S.S., 2024. Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment. Current Opinion in Infectious Diseases, 37(2), pp.105-111. |
| Descamps, Vincent, James Aitken, and MartinG Lee. “Hippocrates on necrotising fasciitis.” The Lancet 344.8921 (1994): 556. | Chen, Y., Huang, Y., Shou, J., Song, R., Tan, J. and Deng, J., 2025. Epidemiology and prognostic factors of necrotizing fasciitis in resource-limited regions based on 119 cases. Scientific Reports, 15(1), p.27458. |
| Gorbach, Sherwood L. “Flesh-Eating Bacteria: A New Disease or an Old Story?.” Infectious Diseases in Clinical Practice 4.3 (1995): 177-179. | Stevens, D.L., Bisno, A.L., Chambers, H.F., Dellinger, E.P., Goldstein, E.J., Gorbach, S.L., Hirschmann, J.V., Kaplan, S.L., Montoya, J.G. and Wade, J.C., 2014. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clinical infectious diseases, 59(2), pp.e10-e52. |
| Jackson, Robert, and Michael Bell. “Phagedena: gangrenous and necrotic ulcerations of skin and subcutaneous tissue.” Canadian Medical Association Journal 126.4 (1982): 363. | Oruç, E., Turunç, T., Beyaz, S., Demiroğlu, Y.Z. and Arslan, H., 2022. Necrotizing fasciitis: evaluation of 85 cases and usage of LRINEC score. Infectious Diseases & Clinical Microbiology, 4(2), p.81. |
| Jones, Joseph., and M. LX. “Hospital gangrene.” Nashville Med. and Surge] 1 (1866): 329-432. | Bechar, J., Sepehripour, S., Hardwicke, J. and Filobbos, G., 2017. Laboratory risk indicator for necrotising fasciitis (LRINEC) score for the assessment of early necrotising fasciitis: a systematic review of the literature. The Annals of The Royal College of Surgeons of England, 99(5), pp.341-346. |
| Loudon, Irvine. “Necrotising fasciitis, hospital gangrene, and phagedena.” The Lancet 344.8934 (1994): 1416-1419. | Wong, C.H., Khin, L.W., Heng, K.S., Tan, K.C. and Low, C.O., 2004. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Critical care medicine, 32(7), pp.1535-1541. |
| Meleney, Frank L. “Hemolytic streptococcus gangrene.” Archives of Surgery 9.2 (1924): 317-364. | May, A.K., Talisa, V.B., Wilfret, D.A., Bulger, E., Dankner, W., Bernard, A. and Yende, S., 2021. Estimating the impact of necrotizing soft tissue infections in the United States: incidence and re-admissions. Surgical Infections, 22(5), pp.509-515. |
| Nasser, Waleed, et al. “Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences.” Proceedings of the National Academy of Sciences 111.17 (2014): E1768-E1776. | Choi, H.K., Seo, G.H. and Han, E., 2020. The incidence and seasonal variation of necrotizing fasciitis in Korea: a nationwide cross-sectional study. Clinical Microbiology and Infection, 26(8), pp.1090-e1. |
| Patiño, José Félix, and Daniel Castro. “Necrotizing lesions of soft tissues: a review.” World journal of surgery 15.2 (1991): 235-239. | Tam, P.C.K., Kennedy, B. and Ashokan, A., 2023, April. Necrotizing soft tissue infections in South Australia: a 15-year review. Open Forum Infectious Diseases (Vol. 10, No. 4, p. ofad117). US: Oxford University Press. |
| Pini, Pia. “Superbug stars in media-made epidemic.” The Lancet 343.8910 (1994): 1376-1377. | Tantirat, P., Rattanathumsakul, T., Praekunatham, H., Pachanee, K. and Suphanchaimat, R., 2020. Epidemiological situation of necrotizing fasciitis and factors in Thailand and factors associated with its morbidity and mortality, 2014–2018. Risk Management and Healthcare Policy, pp.1613-1624. |
| Quirk Jr, William F., and George Sternbach. “Joseph Jones: infection with flesh eating bacteria.” The Journal of emergency medicine 14.6 (1996): 747-753. | Khan, S., Ahmad, R., Munir, A., Nasir, S., Adnan, M., Naveed, F., Idrees, U., Fatima, S.M. and Iqbal, J., 2025. Trends in Necrotizing Fasciitis‐Associated Mortality in the United States 2003–2020: A CDC WONDER Database Population‐Based Study. World Journal of Surgery, 49(5), pp.1210-1218. |
| de Reijke, Theo M., and Karl H. Kurth. “Fournier’s gangrene.” Current Opinion in Urology 5.1 (1995): 60. | Archer, E.J., Baker-Austin, C., Osborn, T.J., Jones, N.R., Martínez-Urtaza, J., Trinanes, J., Oliver, J.D., González, F.J.C. and Lake, I.R., 2023. Climate warming and increasing Vibrio vulnificus infections in North America. Scientific reports, 13(1), p.3893. |
| Sarani, Babak, et al. “Necrotizing fasciitis: current concepts and review of the literature.” Journal of the American College of Surgeons 208.2 (2009): 279-288. | |
| Seal, D. V., and Barbara Leppard. “Necrotizing fasciitis—a disease of temperate and warm climates.” Transactions of the Royal Society of Tropical Medicine and Hygiene 76.3 (1982): 392-395. | |
| Stevens, Dennis L. “The flesh-eating bacterium: what’s next?.” The Journal of infectious diseases 179.Supplement_2 (1999): S366-S374. | |
| Suijker, Jaco, et al. “The impact of necrotizing soft tissue infections on the lives of survivors: a qualitative study.” Quality of Life Research 32.7 (2023): 2013-2024. | |
| Trotter, Thomas. Medicina Nautica... Vol. 3. 1803. | |
| United States Sanitary Commission, and Frank Hastings Hamilton. Surgical Memoirs of the War of the Rebellion. [New York: U.S. sanitary commission, 187071. | |
| Wilson, B. “Necrotizing faciitis.” Am J Surg 18 (1952): 416-431. |
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One thought on “Episode 193 Necrotizing Fasciitis: A strange beast”
A good friend of ours just died from this a few months ago. It happened so fast… it was hard to wrap our heads around. But we couldn’t ask the bereaved family too many questions…they were understandably shellshocked. Thankyou SO MUCH for helping me better understand what happened.
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