Flesh-eating bacteria: Is it safe to go in the water?

Infectious disease physician explains necrotizing fasciitis (spoiler: it’s not actually flesh-eating)

What are the causes?
What are the risk factors?
What are the symptoms?
What are treatment options?
Is it safe to go in the water?

Do news reports and social media posts about flesh-eating bacteria have you scared to go in the water?

That’s probably an overreaction. There are a lot of misconceptions about flesh-eating bacteria, beginning with the name.

Necrotizing fasciitis is often referred to as flesh-eating bacteria but that is inaccurate, says Dr. Ana María Concepción, infectious disease physician and current chief of staff at Candler Hospital.

“People sometimes call necrotizing fasciitis a flesh-eating bacteria, and it is a disease process that can be caused by different types of organisms,” Dr. Concepción says. “Necrotizing fasciitis can be polymicrobial and what I mean by that is it is caused by several bacteria at the same time, or it can be caused by a single bacteria.”

Necrotizing fasciitis is an infection of the skin and the deeper tissue, including fat and connective tissue, sometimes going down to muscle, Dr. Concepción explains. Necrotizing means death of the tissue. Fasciitis means inflammation of the fascia tissue. The skin and the tissue are not literally eaten away, but the bacteria that cause necrotizing fasciitis leads to the death of the fascia.

Causes of necrotizing fasciitis

The most common cause of necrotizing fasciitis is believed to be group A streptococcus, which are the same bacteria that can cause strep throat or scarlet fever. There are several other bacteria known to cause necrotizing fasciitis such as Staphylococcus aureus, of which MRSA is a strain, and even E. coli.

Bacteria most commonly enter the body through a break in the skin including cuts and scrapes, insect bites, puncture wounds or surgical wounds.

Necrotizing fasciitis is fairly rare, but should be taken seriously, Dr. Concepción says. It spreads quickly in the body and can lead to sepsis, shock and organ failure. It also can cause the loss of limbs, most commonly the leg, and even death.

Related Article: What is sepsis?

Since 2010, the Centers for Disease Control and Prevention reports approximately 700 to 1,200 cases of necrotizing fasciitis occur each year in the United States just due to group A strep. Even with treatment, up to 1 in 3 people die from the infection, according to the CDC.

“Necrotizing fasciitis is a rare occurrence,” Dr. Concepción says. “But it’s a very serious infection.”

Who can get necrotizing fasciitis?

Some cases of necrotizing fasciitis occur randomly. Some people are at an increased risk for necrotizing fasciitis including those with diabetes and cirrhosis of the liver, Dr. Concepción says. Necrotizing fasciitis is not contagious.

Those who recently had surgery or have a wound should take proper care to ensure the area does not get infected.

Symptoms of necrotizing fasciitis

Symptoms of necrotizing fasciitis usually appear quickly, over just a couple of days as opposed to weeks, Dr. Concepción says. Symptoms may include:

• An area of the skin of discoloration, maybe red or sometimes gray, that spreads quickly
• Severe pain, including pain beyond the area of the skin that is infected
• Fever
• Fatigue

If you experience any of these symptoms, especially if you recently had an injury or surgery, Dr. Concepción says see your doctor immediately or go to the emergency department.

How is necrotizing fasciitis treated?

Necrotizing fasciitis is a surgical emergency and antibiotics are needed as well.

So is it safe to go in the water?

Yes, it’s safe to go in the water but do pay attention to water advisories, Dr. Concepción says. Bacteria can live in water. It can enter the body through a wound or by swallowing or accidentally inhaling the water, says Dr. Concepción.

In Georgia, the Coastal Health Department and the Coastal Resources Division of the Georgia Department of Natural Resources routinely test coastal beach waters for the presence of potentially harmful bacteria. If bacteria levels are elevated, an advisory sign will be placed on the beach and notification sent through local media and social media.

That doesn’t always mean the beach will be closed, so it’s important to pay attention to these water advisories and consider avoiding the area, especially if you have a recent wound.

Dr. Concepción adds that bacteria found in bodies of water don’t typically lead to necrotizing fasciitis. Most often it leads to a gastrointestinal illness.