By Laura Shin
Posting in Education
Learn answers to common questions about necrotizing fasciitis, the infection that has taken Aimee Copeland's leg and may claim her life.
The eco-psychology grad student caught the gruesome affliction last week after falling from a homemade zipline into Georgia's Little Tallapoosa River May 1st and sustaining a deep gash to her left calf that required 22 staples to stitch up.
Within three days, a bacteria called Aeromonas hydrophila, common in warm climates and fresh water, had caused an infection called necrotizing fasciitis in the leg. In order to prevent the infection from spreading further, doctors have amputated most of her left leg, part of her abdomen and may amputate her other foot and part of her hands, though they hope to save her palms so she can someday use prosthetic fingers.
Below are answers to some common questions about her condition and how it can be prevented and cured.
What is necrotizing fasciitis and what causes it?
Necrotizing fasciitis is a rare but severe bacterial infection of soft tissues that causes them to die. It attacks muscles, the connective tissue covering muscle, and skin.
The way such an infection starts is when certain types of bacteria enter the body, usually through a cut or scrape. That bacteria begins to grow inside the body, releasing toxins that kill tissue. The bacteria then enters the blood, spreading throughout the body.
Several types of bacteria can cause necrotizing fasciitis. While Copeland's was caused by Aeromonas hydrophila, that's one of the rarer causes of necrotizing fasciitis. The bacteria that most commonly causes the infection is Streptococcus pyogenes, known in lay terms as “flesh-eating bacteria." Staph and combinations of different bacteria can also cause it.
However, these bacteria are not deadly all the time. What makes them dangerous is an oxygen-free environment. “If I went swimming in the same water and dunked my head, nothing would happen to me,” William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville, told The Daily Beast. "This is not a bug that can get on the surface and burrow in. Something has to give it access to those deep tissues and that was the problem here. She had that injury into which the water was splashed. This is a bug that is essentially harmless except when it finds itself in the wrong place.”
And when it does find itself in that "wrong place," it "can switch its metabolism so that it can also function in an oxygen-poor environment," Schaffner told USA Today.
Why does it take time to detect?
Because the infection takes root so deep, a victim and his/her doctors may not realize that necrotizing fasciitis is there until it has already spread.
The patient may feel pain in the early stages, but the wound will display no visible clues such as redness, swelling or discharge. Even more deceptively, there will be no fever, which typically indicates infection. So until the diagnosis is made, the infection can spread.
“It’s one of the few true infectious-disease emergencies where an hour can make a huge difference,” Otto Yang, an infectious-diseases physician at UCLA’s David Geffen School of Medicine, told The Daily Beast.
How is it cured and prevented?
Because of necrotizing fasciitis's high mortality rate (upward of 60% for infections caused by Aeromonas hydrophila, according to a 2010 report in Clinical Microbiology Reviews), immediate and drastic measures are necessary.
They include treating the wound, powerful antibiotics, and surgery to drain the sore and remove dead and infected tissue. If the disease has spread, aggressive surgery, including amputation, is often necessary, to take out not just the dead tissue but also healthy tissue where the infection may already be working microscopically. This type of approach goes against conventional surgical training, which teaches that viable tissue must be preserved. "It’s not unusual for surgeons to have to go back a second or third time to keep up with and get ahead of the infection,” Schaffner told The Daily Beast.
Often, patients need skin grafts after the infection goes away, in order to help heal the skin.
Dr. Amy Horneman, a specialist in Aeromonas hydrophila who is chief of microbiology and molecular diagnostics at the Baltimore Medical Center of the Veterans Affairs Maryland Health Care System, has not treated Copeland but has been studying the bacteria for 30 years.
To prevent necrotizing fasciitis infections caused by the bacteria, she has been waging a campaign to get doctors and the general public to remember to think of the bacteria whenever they are dealing with a water-related wound.
As with many diseases, the best cure is prevention, and the key to prevention is education. She told The Los Angeles Times that common antibiotics such as Ciprofloxacin, Bactrim, SXT and Septra can easily take care of the bacteria before the infection sets in -- as long as they are administered in time.
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May 15, 2012
Silverwater... or... Colloidal Silver water, the best natural bacteria killer in the world. http://silverwater-wonderful.blogspot.com/
When I was in Africa I ran into a girl who had a Flesh eating disease all over her right arm, the top of her chest, and half way down her back. I asked the villagers if she had seen a Doctor, and they said yes, she had gone to several Doctors but there was no cure for the disease. I asked what would happen to her? And they said that the disease would soon spread down her chest and eat through her stomach, and her guts would burst open and she would die. I said ???O my God we need to try to do something to help her!??? I had brought some medicine with me from the U.S. in case I got sick in the middle of nowhere. So I gave her some ???Bactrin??? which is an anti-biotic similar to Penicillin, and a bar of Ivory Soap. I told her that the Bactrin would help fight the disease on the inside, while the Soap would fight the disease on the outside. I explained to her that there were little tinny bugs inside the scabby disease that were eating through her skin, and that she needed to try to soak off in water as much of the scabby disease as possible. Then put a little bit of water on top of the bar of Ivory Soap and rub it to make a paste, and dab the paste on the raw open wounds. I told her that it would burn like hell for a minute or so, but then it would start to feel much better. I told her to leave the soap on the wounds all the time to keep them from getting infected, and to wash it off and apply new soap twice a day. I had to leave to work on a dam project, but 8 weeks later I returned to her village and it had killed the disease. You could see the new skin on her back and there was no ugly scaring or discoloration of skin.
Here's where the techies could step in and work on an expert system to diagnose and treat at an early stage. Type of injury -- deep cut -- water involved; first aid -- hydrogen peroxide solution, etc. A reader mentioned competent doctors; even incompetent ones could have come up with an acceptable first aid treatment for the injury.
My brother-in-law got a severe infection after sticking himself with a fork while loading the dish washer. He says he could have lost his hand. He said that using hydrogen peroxide would have prevented it.
Had this wound been irrigated with simple hydrogen peroxide initially, this very probably would never had happened. I never go anywhere without it. Had competent docs. looked at her blood early on this would likely not have happened because anti-biotics would have taken care of it in the early stages. From what I read it isn't only a water hazzard, but occurs in most warm environments - wet and dry. I had a friend that got a similar infection, probably a Staph - in Texas while hunting - from a barbed wire fence scratch. Lost a lot of abdomen skin.
Its an antiseptic , will it be all thats necessary to also take away the itch and infection? does anyone know?
Hospitals in Japan have used 2.5 pH Electrically Reduced Water (ERW) for years as a disinfectant to clean wounds, 3rd degree burns, the Surgery rooms and equipment and to Prewash before Surgery! Any Pure water that has been stripped of its hydrogen to the point of being below 2.7 pH is a scientifically recognized Disinfectant. Much research and peer reviewed articles have proven this for over 20 years. 2.5 pH water is readily available. It is not as severe as Hydrogen peroxide. It does not harm new skin, but it kills bacteria, virus, mold, etc within seconds. It also cauterizes the wound and sustains the healing process. Medical science in America has its collective head up where the sun doesn't shine, because someone else didn't do the thinking and no-one would consider trying to save this girl, just applying the same old solutions that never worked before. going through the motions. We can understand why doctors won't go to their own hospitals to deal with their own sickness! they go out of the country more often than not. My Humble opinion, of course
After severe fever and IV antibiotics, the antibiotic topical creams now prescribed one year later by 2 doctors aren`t helping it from spreading one year later on both lower legs now UGH
I have used 3% H2O2 regularly for many years very successfully. I inhale it and it improved my lung capacity (I am a smoker) substantially from 70% to 95%, not bad for someone in their 70's (for inhaling instructions check the net "inhaling H2O2") for cuts and abrasions and they heal really fast to clean my ears very effectively with a few drops I also clean my teeth with H2O2 and Sodium Bicarbonate (Baking Powder) Yes, it might destroy adjacent healthy tissue very very marginally. However it is so little, if any, that it is not worth worrying about and I have not noticed any alleged destruction of my gum tissue. Just one piece of advice: "Don't tell your GP" He will just think you are insane for not taking an antibiotic or some other much more expensive pharmaceutical drug with their well known side effects. They think because it is so cheap it can't possibly be any good. Oh yes, don't tell your friends either they are likely to have the same mindset.
I've heard that with deep cuts your not supposed to use hydrogen peroxide. I think it will kill healthy tissue or something like that....