Cases Of Flesh-Eating
Strep On the Rise
By PATRICIA GUTHRIE, The Albuquerque Tribune
Copyright © 1997
ALBUQUERQUE, N.M. (September 3, 1997 01:15 a.m. EDT) - The deadly infection known as "flesh-eating bacteria" is ravaging more and more people in New Mexico, say University Hospital doctors who are diagnosing "frightening" cases from all over the state.
About 400 people in New Mexico have been afflicted in the past seven years, estimates Dr. Donald Fry, chairman of the surgery department at the University of New Mexico School of Medicine.
In the past decade, 34 people in New Mexico have died from the infection, according to records from the state Office of the Medical Investigator.
The deaths hold steady with the national rate, but the cases themselves have risen in the last two or three years, New Mexico researchers say.
About half of those infected had conditions that lowered their immune system, such as diabetes, obesity or blood-vessel disease.
But some of the fatalities involved 3-year-olds with chickenpox and healthy adults just stung by a bee.
"We're seeing a catastrophic case every three to four weeks at University Hospital," said Fry, who has been compiling data on the infections.
Known in the medical world as necrotizing fasciitis, the infection is caused by bacteria that usually enters through a cut, scrape or other break in the skin. The infection attacks the fascia, the deepest layer of skin, and irreparably destroys tissue as it marches through a victim's arms, legs, stomach or back.
It can spread as fast as 1 inch per hour.
So rapidly does the infection move, doctors must remove skin, large muscle groups or amputate limbs to save a person's life.
"The kinds of cases we've seen are really kind of frightening," Fry said. "With some people, we've been forced to remove their entire leg."
The last New Mexico death occurred in June. A 33-year-old man stumbled while mowing his lawn, bruising his shoulder. Thirty-six hours later, he was dead after the bacteria devoured his back.
The Centers for Disease Control and Prevention in Atlanta estimate about 1,000 Americans annually contract necrotizing fasciitis and 350 die from it, said Dion Gallant, a third-year UNM medical student who researched the disease after seeing its damage during an autopsy this summer at OMI.
The infections are caused by a common bacteria, group A streptococcus. This is the same bug associated with strep throat and chickenpox.
"This is not a new bacteria," Fry said. "But this is a new strain of strep. It seems to have a special gene that makes it a very special kind of toxin, and that makes it unusually virulent."
Researchers cannot fully answer why the strep is attacking now and why just a few unlucky individuals. After all, we all get scratches, bites, bumps and bruises.
"Practically all of us are walking around with strep A, but it doesn't make us sick," said Dr. Fred Koster, professor of medicine at UNM. "Most of us get rid of it in a week without even knowing we had it.
"Why this relatively rare infection occurs in relatively healthy people is a mystery that nobody understands."
New Mexico's climate may be one factor, Fry said.
"There seems to be a higher frequency in higher-altitude climates and within arid climates," Fry said. "Other Rocky Mountain states have also seen increased cases."
Patients of all ages from all over New Mexico have landed at University Hospital's emergency room with the symptoms of flesh-eating bacteria: excruciating pain in an area of a fresh small cut or insect bite. Fever is also common, as is shock and sometimes delirium, Koster said.
The bacteria can kill perfectly healthy people within two days.
In the cases that Fry said he attended in recent years, 11 were children with chickenpox. Some were as young as 3 and 4 years old.
"Three of them died," he said.
To save a person's life, doctors must immediately operate, peeling away a person's skin to get at the infection just below the surface.
The skin and tissue removal is called debridement. If a patient survives the operation, the body resembles a huge wound. Doctors must then graft skin from other areas of the body, much like the technique for burn victims.
If milder cases are successfully halted, a good recovery is predicted, although it may involve a five-week hospital stay to heal the skin.
"Most of the cases we see are luckily more mild cases," Koster said.

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