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December 2005, a woman, Donna, developed a limp on what had always been her “bad knee.” She didn't think much of it until she noticed a bubbling rash near her hips. She was admitted to the hospital December 28 with low blood pressure. The hospital discharged her, diagnosing her with shingles. At that time, the rash had developed into puss-filled blisters that oozed with a terrible stench. At around 5 AM on January 2, 2006, she passed out, the infection gushing from her sores. Donna was rushed to the hospital where her left leg was amputated that night; the right leg was amputated the next day. Her condition worsened, and a second major surgery was performed, which removed the skin and surface tissue on the left side of Donna's abdomen. Less than a week after the initial infection, lying in her hospital bed, immense gaping wounds covering her lower body, the sappy stumps where her legs once were still dissolving, Donna began the painful process of planning her own funeral. She was sixty years old. Within the next few weeks, her body developed seeping wounds and infections. With her organs failing, Donna was unable to fight the swift and injurious infection. On January 21, she died, the flesh literally having been eaten from her body. When I read of Donna's death, it seemed surreal. I don't know what to make of news headlines and pithy articles that matter-of-factly indicate that individuals have died from Necrotizing Fasciitis—more commonly known as flesh-eating bacteria. A flesh-consuming infection seems so fantastic—images of sticky, red zombie-like figures staggering through plagued, abandoned streets come to mind. Even Hollywood recognized and exploited such a horrific and extraordinary idea in the 2002 film Cabin Fever— a group of attractive teens head to the woods for a weekend of fun, only to contract a flesh-eating virus, and die looking as though their bodies had been turned inside out. But the reality is that Donna was one of 500 to1,500 real Americans who will contract the flesh-dissolving infection in a given year. The BBC estimates that out of the individuals who fall ill, twenty to thirty percent of them will die; the rest of the victims will likely suffer from disfigurement. How common is such an infection? While becoming severely infected with the sickness is rare—the actual flesh-eating infection is likened to being struck by lightning or being bitten by a shark—carrying the catalyst for the infection is not. Audiences saw Cabin Fever and were giddily frightened by the production— Did you see the way her skin fell apart in his hands! How gross! How exciting! Leaving the theatre, thrilled and relieved, they would have no idea that they probably came into contact with the infection-causing bacteria, strep A, that had them anxiously squirming in their seats just moments before. In fact, according to the National Necrotizing Fasciitis Foundation (NNFF), fifteen to thirty percent of the population carries strep A with no symptoms. Strep is carried in respiratory droplets of the lungs. When those carrying the bug (in America that would be up to 900,000 people at any given time) sneeze or cough, the bacteria are dispersed. People can pick strep up anywhere—grocery stores, schools, theatres. And people do indeed pick it up. The BBC estimates that there are ten million cases of strep infections every year. Strep A is a system of bacterium that work together for a common purpose. Usually, the common purpose is a throat infection, but strep A also commonly develops into pneumonia, meningitis, or various types of fever. Strep is not, by any means, a new threat; the BBC estimates that it has been active in “modern” society since the 5 th century BC when Hippocrates, a Greek physician, describes a scarlet fever epidemic. And in some rare cases, strep A work together to produce Necrotizing Fasciitis. The BBC reports that the first documented case of the flesh-eating infection was related to a war wound of a soldier in the French army in 1783. Most accounts of the infection reflect that the individuals look as though they've been eaten from the inside out; but strep doesn't eat the flesh exactly. The faculty of the department of Bacteriology (University of Madison-Wisconsin) notes that in cases when strep develops into the flesh-eating form, it is because the strep bacteria itself is in fact infected with a clever virus that prompts the bacteria to produce toxic chemicals called pyrogenic exotoxins—these toxins are the byproduct of the bacteria. The writers of Scientific American liken the toxin to snake venom; it cannot simply be treated medically. It is this toxin that dissolves the flesh, tissues and fat. It will usually “eat” the body at a rate of one inch an hour. Gruesome narratives of individuals who survived the bacteria speak of this toxin; it creates painful deposits of gas within the tissues, which accounts for the bloating of limbs, as well as the putrid stench that often accompanies the boils and blisters that erupt on the dissolving flesh. The bacteria's destruction of the flesh causes unbearable pain for the victim, which leads to an ironic twist of the affliction. When an individual, such as Vance Salisbury in May 1998, has an infection, white blood cells trigger the brain with a chemical, called tumor necrosis factor, to cause a fever in the body. The fever, in turn, shuts down the production of this chemical, which is necessary, otherwise the immune system continues attack cells. In Vance's case, his ankle was kicked during a game of soccer. Soon after, he felt tremendous pain and experienced flu-like symptoms. Vance took aspirin to combat the pain. Individuals who use non-steroidal anti-inflammatories—Tylenol, ibuprofen, aspirin—to fight the pain block the fever that regulates the immune system. The infection can continue to spread, producing the pyrogenic exotoxin. A New Zealand Medical Journal found that in five out of the seven cases seen of Necrotizing Fasciitis that resulted in deaths, the individuals had been taking such pills. Here in lies the irony of it all: individuals, like Lance, rush to the emergency room with great pain and doctors send them home with no diagnosis, or the wrong diagnosis, prescribing them Tylenol, ibuprofen, and aspirin. Vance's doctor told him his pain was a routine sport injury and sent him home with prescription pain killer. When he returned to the ER the next morning, the doctor doubled his pain medication. By the afternoon, his condition had worsened. By the time Vance was correctly diagnosed, he required five operations to remove most of the tissue of his left leg. His doctor likened removing the infection via surgery to stopping a fright train with tissue paper. Vance spent ten days in a coma, going into toxic shock. He slowly recovered, requiring eight skin grafts to cover his skinned leg. More than three months after he was first sent home with pain killer for his “routine sport injury,” Vance was discharged from the hospital. For surviving, he was labeled a miracle of medicine. This infection has a high rate of death compared to other strep infections because it is highly misdiagnosed. Many individuals are like Donna and have visible wounds to indicate how they picked up the bug. In a recent head line worthy case, an eighteen-year-old woman developed the sickness after having her nipple pierced. Within days, she was forced to have her breast removed. In other cases, such as Vance's experience, the infection develops simply after impacts that only leave bruises. March 2006, a nurse accidentally jammed her thumb on a wheelchair; she died three days later after doctors' grisly and fruitless attempt to hack the infected flesh off of her body. The infection can occur after the most innocent of experiences. In June 2001, James Sheer was slightly burnt by the sun on an overcast day. A few days later, on June 10, a terrible flu sent him to the hospital. He died ten hours after being admitted. Frighteningly, in fifty percent of the cases, no entry point for the infection is ever discovered. The infection is often misdiagnosed because the initial symptoms reflect that of other ailments. In Donna's case, her doctors thought she had shingles. Vance was thought to have a sports injury. In January 2001, Tiana Tippett was taken to the hospital after feeling ill. She was sent home with a flu diagnosis and was prescribed to alternate Tylenol and Motrin ever four hours for the pain and fever. Six days later, 65% of her tissues and fat were removed from her body. She died on day seven. She was five years old. Like Tiana, in the first 24 hours, most individuals experience cold and flu symptoms. Individuals will begin to feel discomfort and severe pain. This is the point at which doctors send patients home to take pain killers. After returning home, the effects of Necrotizing Fasciitis begin to set in. These are suffererings most people would not wish on their worst enemies. If an entry point, such as a cut, is visible, this area will begin to blister; these blisters often hemorrhage. The bacteria spread from the entry point, often creating red lesions in a linear fashion as this infection of the blood, called sepsis, moves towards the heart. It is difficult to stomach images of those inflicted with the bacteria. The entry point melts away, the flesh turning a ghastly blackish-purple. The tissue bubbles, red and puss-filled. The integrity of the limb disbands, and the body begins to look as though it is covered in craters filled with rotting fruit. As the tissues liquefy, the body seeps away from itself; muscle and bone are exposed. If an entry point is not visible, as is in half the cases, the pain becomes unbearable for the victims. One doctor noted that a patient will feel the worst she has ever felt with no understanding as to why. The victims are incapacitated as the silent and hungry bacteria dissolve everything between bone and flesh—the skin remains intact, often turning black. As the toxins produce the gases, the body to bloats. At this point, it still may not be apparent that the individual is being eaten from the inside out. In the case of the nurse who jammed her thumb, it was only when her arm bloated and appeared as though it would burst that doctors knew that she was liquefying beneath her surface; it was too late. Individuals who suffer from Necrotizing Fasciitis have three methods of treatment suggested by the NNFF. The first most drastic, and generally most necessary, method is amputation. This is often fruitless because the infection is one of the blood, which, obviously, cannot be easily removed. The second method is the use of antibiotics. Again, this will often kill the bacteria, but the toxins produced by the initial bacteria remain in the body continuing to cause harmful effects. The third method involves placing victims into a hyperbaric oxygen chamber with the intent of keeping the organs alive by supplying oxygen. This third method of treatment is used to address the major reason why this infection kills individuals. The virus creates an immense amount of blood clots due to all of the bleeding it causes. These clots block oxygen flow to the vital organs; the organs begin to starve. What ensues is known as system toxic shock. Often, the vital organs fail, causing death. Fortunately, the majority of individuals who contract Necrotizing Fasciitis do live. Disfigurement often requires prosthetic limbs or plastic surgery. Testimonies of the survivors through the NNFF indicate that much emotional healing is required after recovery: people must cope with their disfigurements, must accept the fact that there is no way to prevent contracting the disease, and must acknowledge that they cannot use their experiences to help others. They cannot avoid the infection by staying healthy—the infection affects the healthiest of people. Survivors urge individuals who are feeling sick to seek treatment, but recognize how often the infection is misdiagnosed. Hollywood was right to exploit the flesh-eating bacteria—if only a bacterium with no prevention that consumed our bodies from the inside out was only a product of Hollywood. Unfortunately, Necrotizing Fasciitis is a stealthy, creative, and spontaneous infection with real, appalling results. Bibliography 1. Farlander. “Streptococcus Pyogenes - Killer Flesh-Eating Bacteria.” BBC. 26 February, 2003. http://www.bbc.co.uk/dna/h2g2/A907481 . (25 Oct. 2006). 2. “Flesh-eating Germ Kills Woman in Three Days.” Associated Press: MSNBC. 13 March, 2006. http://www.msnbc.msn.com/id/11752394/ . (25, Oct. 2006). 3. “Dedications.” The National Necrotizing Fascitiis Foundation. http://www.nnff.org/nnff_survivors.htm . (25, Oct. 2006). 4. Madigan, Kristy. “Necrotizing Fasciitis.” Department of Bacteriology: University of Wisconsin-Madison. 26 July, 1999 http://www.bact.wisc.edu/Microtextbook/index.php?name=Sections&req=viewarticle&ar tid=186&allpages=1&theme=Printer . (25 Oct. 2006). 5. Mirkin, Gabe. “Flesh Eating Bacteria.” 2006. http://www.drmirkin.com/morehealth/G233.html . (25 Oct. 2006). 6. “ Role of Flesh-Eating Bacteria's Toxin Identified.” Scientific American. 16 Oct. 2006. http://www.sciam.com/article.cfm?chanID=sa003&articleID=0007F5F9-F927-1533- B92783414B7F0000 . (25 Oct. 2006). 7. Salisbury, Vance. “Overcoming Necretizing Fascitiis.” http://www.flesheatingbacteria.net/ . (25, Oct. 2006). 8. “Survivor Stories.” The National Necrotizing Fascitiis Foundation. http://www.nnff.org/nnff_survivors.htm . (25, Oct. 2006).
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