Some call it “horror” and some call it “the super germ”, but now, our always known “regular” bacteria, those one-celled creatures once considered under control with antibiotics, have invaded our hospitals and headlines with a vengeance. The vengeance used against us is caused by an existing organism called necrotizing fasciitis, the so-called flesh-eating bacteria, caused by Group A streptococcus. What this organism does is progressively destroy the human body tissue all the way to the bone. This organism has amazingly outsmarted us of even our most potent drugs.
In our community right now, medical researchers are testing antibiotics that may have chemicals to disable the resistance of this organism. But while research continues, it is vital to be aware of how these deadly germs spread and what we can do to prevent them.
Long before humans discovered antibiotics, they existed in nature. So naturally, after penicillin was introduced, some germs were already naturally resistant to the drug. As we used more and more of the antibiotics, we incidentally caused drug-resistant germs to progress. So, even if you’ve never misused antibiotics, you could still become infected by bacterium most drugs won’t kill. For each drug, there are germs genetically programmed to survive- some w/ outer walls tough for antibiotic to cross, others with ways to dump the drugs back out before they can work, and yet others can inactivate the antibiotic. Even worse, by passing tiny packets of genetic material to other bacteria, these survivor germs sometimes also pass the formula for resistance to the other bacteria. The best way you can protect yourself and your family against drug-resistant bacteria is by using antibiotics correctly. Taking them when they’re not needed encourages the takeover of drug-resistant strains in your body. (Redbook, pg.95) That’s because when antibiotics are given, the normal bacteria in your body are killed off, leaving lots of bacterial “parking spaces” open. And the germ left to fill them is the drug-resistant ones. (Redbook, pg.95) So far, antibiotic resistance has not been a big problem with streptococcus A, the germ familiar to all of us for causing millions of cases of strep throat and impetigo each year. However, a germ does not need to be drug-resistant to turn lethal. Each year one form of strep A invades the bodies of thousands of people and lets out toxins capable of causing shock and organ failure as you will read about later. Many others are infected by strep that destroys muscle and fat,
resulting in the dreaded flesh-eating disease. Those that it infects in this manner need surgery to cut out the infected tissue because drugs may not work fast enough to neutralize the toxins. This deadly strep is more likely to infect when surgery or wounds that go deep into the tissue are exposed to germs on the skin, or in people with weakened immune systems. But be aware that also recent cases found from the flesh-eating bacteria have included wounds as minor as pimples or razor nicks. This flesh-eating strep can actually happen to anybody. To be prepared and protect you and your family, be aware of some signs of the flesh-eating bacteria. Signs include: toxic shock, fever, dizziness, confusion, rash, and abdominal pain. As for children, keep these symptoms in mind and have a particularly close watch for these symptoms if the child has chicken pox. Time is of essence when this bacterial killer strikes, so it’s very important to know how to recognize it and provide the urgent care that you or your family need. If pain that is out of proportion to the size or type of wound occurs that is also a major sign of necrotizing fasciitis.
After you have been infected, during the first 24 hours of the infection, the skin around the wound is typically red, shiny, and swollen. The skin soon turns bluish-purple and blisters containing yellow fluid appear. This is just the beginning. Beneath the skin, multiplying aerobic and anaerobic bacteria are burrowing through soft tissue. Once the tissue is destroyed, gas is accumulated in the muscle fibers and you may be able to smell a foul odor by the fourth or fifth day after infection (an x-ray usually reveals the buildup of gas before you can smell it).In early stages of infection, patients may have a low-grade fever, accompanying tachycardia, a little higher than usual, white blood cell count increases, hematocrit decreases and also arterial blood gas analysis usually shows metabolic acidosis.
If the infection can’t be stopped by either surgery or drugs-to neutralize the toxins, like mentioned before, then necrosis of subcutaneous fat and fascia sets off in about a week, producing a watery, foul-smelling fluid known as “dishwater pus”. The necrosis may spread to muscle, as signaled by a rising creatinine phosphokinase level. As subcutaneous nerves are destroyed, numbness replaces pain and the skin becomes gangrenous. Septic shock usually follows and then death.
Horrifying manifestations of the Group A strep bacteria include: necrotizing fasciitis, which rapidly destroys the connective tissue between skin and muscle and two more deadly variants- STSS, which causes multi-organ failure, and even rarer necrotizing myositis which attacks the muscles themselves. (Macleans’s, pg.48) The American puppeteer Jim Henson died in 1990 from STSS, a disease that has claimed up to 80 percent of its victims. (Maclean’s, pg.48) Of the diseases caused by group A streptococcus, questions have risen such as: ” How can the same organism live fairly harmlessly in the throats and on the skin of up to 15 per cent of children and one percent of adults, but cause debilitating, life-threatening diseases in others?” Scientists now know that “flesh-eating” enzymes-which enable the organism to spread by dissolving surrounding tissue-and other toxins are released by the bacteria to trick the immune system to turn against itself. (Macleans, pg.49) Once enzymes are in the bloodstream, toxins destroy the tissue by breaking down protein. A chain reaction of biochemical signals from toxins results in the body being attacked by its own forces. “It’s like letting commandos into your house because there’s a burglar there, and everyone opens fire all at once,” says Dr. Allison McGeer, a medical microbiologist at Toronto’s Mount Sinai hospital. “The damage that results has very little to do with the burglar.” (Macleans, pg.49) Victims of this deadly bacterium usually lack sufficient defensive antibodies to fend off the attack and typically have predisposing factors such as diabetes, obesity, alcoholism, atherosclerosis, or IV drug abusers. However, in the past year studies also have shown that the infections have begun to occur in apparently healthy people also following surgery or even spontaneously without tissue injury.
Necrotizing fasciitis, the “flesh-eater”, caused by the strep bacteria accounts for up to 10 of the 15,000 cases of severe group A streptococcus infections that occur in the United States each year. New cases in the past year alone, one of them fatal, has kept its horror in the public eye. According to public health officials, out of the cases reported, none of the cases had any connection with each other.
After reading several articles and doing research on this deadly organisms, I found a very interesting story (based on a true story) I would like to share. This is a woman named “Katie”, as
we’ll call her, who was a 79-year old obese diabetic admitted to a hospital after falling on her right leg. She had a small, open wound above her right knee-the surrounding skin was swollen and inflamed-and the pain in the injured leg was severe. She was also running a fever, and her blood pressure had begun to drop. Antibiotic therapy and IV fluids were all started but the fever continued, and four days after admission to the hospital the inflammation began spreading to her upper leg, groin, and pelvis. . Rapidly spreading inflammation to the body followed. A surgical fasciotomy was performed on Katie. Culture and gram stain of necrotic fat obtained from the wound revealed group A streptococcus. That confirmed what doctors already suspected: necrotizing fasciitis- a flesh-eating disease. This disease as confirmed by her doctor deserves emphasis: The disease can consume up to an inch of flesh per hour. In Katie’s case the infection was precipitated by traumatic injury to her right leg. Because this is highly contagious, the patient was placed in strict contact isolation once she had been identified carrying this organism. She was placed in a private room with a precaution sign on the door. No one entered her room unless they were wearing gloves and a gown. Penicillin was the drug of choice and was given to her in high doses up to even 40 million units per day administered through IV’s. Since large amounts of extracellular fluid accumulated in Katie’s interstitial spaces, the nurses had to closely monitor her hemodynamic status, her urine output, peripheral pulses, and vital signs among many other tasks. This of course needed special attention because the patient could have had beginnings of shock. Until surgery is performed to try and save Katie, monitoring the progression of the disease was crucial.
Katie finally went through surgery to try to be saved from this deadly bacterium. The surgeon removed necrotic skin, subcutaneous tissue, and even muscle extending from her knee to the pelvis and lower abdomen. That left an enormous open wound. Sometimes it took two nurses to change the dressing- one to lift the folds of skin and the other to pack the wound. Continuing to mark the date and the margins of the wound, Katie’s nurses and doctors were hoping for a survival. Nutritional support at this point was entered via gastrointestinal tubing and by this time Katie was going through major psychological wounds that needed healing as well. Sadly the doctors were not able to prepare Katie to go home. Despite fasciotomy and the surgery, her infection continued aggressively. Her wound after surgery had a foul-smelling drainage, which increased in amount every day. Local cellulitis developed at the IV site on her arm. Just 10 days after the first surgery she underwent a second infection spreading around her hip area. Despite all efforts by Katie and the hospital staff, she died of septic shock and multisystem organ failure after 30 days in intensive treatment. Although flesh-eating disease is always life threatening and in most cases results in a fatality, it doesn’t have to have an unhappy ending if you use prompt recognition and go to clinical expertise within the first sign of the disease. Don’t let it get you!