Jacqueline Roemmele
Watchung, New Jersey

Necrotizing fasciitis (NF) is a severe and progressive infection of the tissues situated between the skin and underlying muscle. As the process spreads along tissue planes, blood supply is lost and gangrene en­sues, leading to loss of limbs or, all too frequently, to death. A particu­larly vicious form of NF is that caused by the group A streptococcus, the same bacterium responsible for common “strep throat” and scarlet fever. Because of the highly destructive and rapidly progressive nature of streptococcal NF, the organism has been dubbed in the lay press as the “flesh-eating bug.”
NF due to the group A streptococcus is not a new disease. Descrip­tions of what was more than likely streptococcal NF are found in the writings of Hippocrates (circa 400 B.C.), and the disease was first re­ported in the modern medical literature by Dr. Frank Meleney in 1924. In the intervening years, however, such cases have been extremely rare. Indeed, until a decade ago, neither I, a physician specializing for many years in infectious diseases and with an investigative interest in the group A streptococcus, nor my colleagues had more than a rare en­counter with cases of “flesh-eating disease” Since that time, however, and for reasons not yet entirely understood, the incidence of group A streptococcal NF has increased both in the United States and abroad, and clusters of the disease have appeared in many communities. Moreover, strep NF is often accompanied by a toxic shock syndrome similar to the tampon-associated shock syndrome caused by staphylococcus. Unfortu­nately, when NF is accompanied by toxic shock, the mortality rate ranges between 30 and 70 percent.

Although the risk of strep NF and toxic shock is highest at the ex­tremes of life and in patients with certain chronic diseases, the disease may also strike perfectly normal individuals who may progress from good health to deaths door in only a few days. Such cases occur unpredictably, and there is no way of preventing them. Thus this disease un­derstandably strikes fear in family members and associates of stricken patients as well as in communities where it is occurring in increased numbers. In such circumstances, people search for information and for comfort and reassurance from persons who have suffered from the illness and survived.

As survivors, Jacqueline and Donna have devoted themselves to disseminating information about the so-called flesh-eating disease by co­founding the National Necrotizing Fasciitis Foundation and establishing a web site that serves as an information resource and support group for victims and family members. By involving authoritative medical experts, the foundation has dispelled rumor and misinformation and served as a valuable data collection center for researchers studying strep NF. Through this forum, it has been possible to inform the public that strep NF remains a rare disease and that, promptly recognized and treated, the chances of survival are greatly improved.

This book serves as a valuable distillation of information for those who have experienced strep NF themselves or in loved ones, as well as for the general public. It is written with a minimum of the technical jar­gon we doctors often use (and overuse!), so the message is readily un­derstandable to the nonprofessional. The true-life case histories are heart wrenching, often sad, and sometimes inspiring.

The earliest symptoms of strep NF often simulate other and much more common illnesses. Diagnosis can thus be difficult, even for expe­rienced physicians. In addition, some physicians may not yet be entirely familiar with the illness, which is still quite uncommon in everyday med­ical practice. Thus, it is important for the lay public to recognize the warning signs that should alert them to seek medical advice, to question their physicians about the possibility of NF, and if necessary, to seek sec­ond opinions from qualified infectious disease specialists. This informa­tion is lucidly presented in the following pages. Finally, the reader will be glad to know about encouraging research into prevention of NF and other group A streptococcal diseases by development of a safe and ef­fective vaccine.
Let’s hope that a future second edition of this book will be able to detail great progress in diagnosis and treatment of the “flesh-eating dis­ease” or even a vaccine to make it largely of historic interest.
—Alan L. Bisno, M.D.
Chief, Medical Service Miami Veterans Affairs Medical Center Professor and Vice-Chairman University of Miami School of Medicine