Sunday, May 5, 2013

Getting hit by a soccer ball gave her the flesh-eating disease

Necrotizing fasciitis is a nasty and deadly disease commonly known as the flesh-eating bacteria syndrome or simply the flesh-eating disease. Notable survivors include the Canadian science fiction writer Peter Watts, who described the experience in detail on his blog (with lots of gory photos).

We're talking about a bacterial infection of the deeper layers of skin and subcutaneous tissues which spreads swiftly (as fast as 1 inch per hour!) across the fascial plane (the fasciae are those whitish membranes that cover the muscles and need to be removed when you're preparing meat for cooking). In Peter Watts's own words, the bug spread across his leg "as fast as a Star Trek space disease in time-lapse"). As they multiply, the bacteria don't actually eat your flesh - they produce toxins that cause tissues to die. The initial symptoms can be subtle, often involving only intense pain at the site, but quickly become dramatic - skin swells and turns purple, black blisters appear, you're feverish and extremely ill, and soon your organs begin to shut down. Necrotizing fasciitis can occur after a surgical operation or trauma (even something as minor as a tiny scratch or bruise). Peter Watts had had a skin biopsy performed shortly before on an ugly sore on his calf that leaked pus and blood - possibly a spider bite. Frequently, however, no precipitating cause can be identified.  

Around two in three cases of necrotizing fasciitis occur in people with one or more obvious risk factors - impaired immunity, chronic illness, alcoholism, smoking or diabetes - but even being a young, healthy non-smoker doesn't guarantee you're safe. Oh, and if you don't get diagnosed and treated properly very soon, you can expect to die - the mortality for untreated cases is said to be around 73%. Treatment involves high doses of intravenous antibiotics and surgical removal of all the affected tissues. In other words, this means that all the skin and subcutaneous tissue need to be cut out, right down to the muscle - and if this is not enough, doctors need to amputate the limb(s). Peter Watts had a large hole carved out of his calf and was extremely lucky not to lose his leg.

This disease has two clinical types, depending on the bacteria that cause it. Type I is caused by a mixture of bacteria and type II by a single bacterium - usually either Streptococcus type A or methicillin-resistant Staphylococcus aureus.

Necrotizing fasciitis is rarely seen in children. Physicians from a hospital in San José, Costa Rica have reported a case which occurred in a 6-year old girl who got struck on the left side of the chest by a soccer ball and fell down, hitting the ground. Two days later she was taken to the emergency department, reporting chest pain and difficulty in breathing; an X-ray showed that she had a fractured rib, but no other disturbing symptoms, and she was discharged home.

Two days later she was admitted to the hospital again, with a high fever (39°C) and very high pulse rate, pale and with no pulse on her arms or legs. The left upper part of her chest was swollen and purple.

Laboratory tests showed en extremely high white cell count - clear evidence of an infection - and blood cultures revealed the presence of bacteria. Despite immediate treatment, the girl underwent septic shock and her organs began to fail. Within 24 hours, her condition deteriorated further and the lesions worsened - the swelling and purple discoloration increased and bloody blisters appeared down the side of her chest. Surgical debridement was on hold because her general condition was too unstable to allow an operation. She died 32 hours after admission to the hospital.

 And all because of getting hit by a soccer ball!

Source: Ocaña Y, Ulloa-Gutierrez R, Yock-Corrales A. (2013) Fatal Necrotizing Fasciitis in a Child following a Blunt Chest Trauma. Case Rep Pediatr. doi: 10.1155/2013/373712. Epub 2013 Mar 27.

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