Necrotizing fasciitis is a rare flesh-eating infection that can be caused when common bacteria such as streptococcus and clostridia produce and release rogue toxins in a person's body.

The toxins can cause small clots to form in blood vessels. Skin and muscle tissues fed by those vessels then die from lack of blood.

If enough toxins are released and enough tissue dies, the body goes into shock, and basic functions like breathing, blood pressure and heart rate can falter.

Nebraska State Epidemiologist Tom Safranek said the toxins that cause necrotizing fasciitis are rare and sporadic. Common bacteria only rarely develop the ability to produce the toxins. And the same toxic strain may have far less serious consequences in one person than in another.

The only type of flesh-eating infections Nebraska tracks are those caused by streptococcus, which is different from what Ashley Munson has.

Safranek said the state has had one reported case so far this year, and one case last year. Both were caused by a group A streptococcus bacteria, one of the most common causes of strep throat and minor infections.

Exactly why one Nebraskan becomes deathly ill from a type of bacteria that in most causes only a sore throat is unclear.

"It's a combination of something going on in the patient and something going on in the bug," Safranek said. "If the bug doesn't have the ability to produce the toxin, it's not going to cause necrotizing fasciitis. And, even if the toxin's present in the bug, there are what we call host factors in the patient. Maybe a patient has a greater immunity or got antibiotics early or cleaned the wound more quickly. They are not a good host for whatever reason."

According to the Merck Manual of Medical Information, about one in three people who develop necrotizing fasciitis die from it, even with appropriate care. Treatment includes intravenous antibiotics, surgical removal of dead tissue (including limb amputation) and supportive care.

But if the infection is advanced, even those measures don't always work.

"Antibiotic resistance isn't usually the problem," Safranek said. "The issue is by the time they get medical attention, the patients are generally so sick, the antibiotics won't work."

Safranek said the best way to lower your risk of developing necrotizing fasciitis or other invasive infections is good wound hygiene: Clean even minor cuts, scrapes and skin injuries with soap and water. Apply an antibiotic cream or ointment. And cover the wound until it heals.