Posted by: Chris Maloney | August 14, 2013

Rare Flesh-Eating Infection: Necrotizing Fasciitis in Maine

English: 43-year-old Caucasian male with necro...

English: 43-year-old Caucasian male with necrotizing fasciitis. Preoperative photograph on the day of admission. Extensive erythema and necrosis of the left leg. (Photo credit: Wikipedia)

The Bangor Daily News has a terribly sad and somewhat terrifying story of a young mother who died of an extremely rare flesh-eating infection.  Our hearts go out to the family.

I had previously written about how to kill flesh-eating bacteria, which should be susceptible to antibiotics. So now I’d like to delve a bit deeper into this infection.

When we look at the description from WebMD, it really doesn’t give much more information than the news article. Any of a number of different bacteria, which normally cause infections that easily respond to antibiotics, suddenly go crazy and start eating everything in sight.

We can feel no more assured than if we were told that a small vicious dog can suddenly become an unstoppable grizzly. WebMD mentions some obvious things like not having a suppressed immune system and avoiding have a chronic illness as being helpful for avoiding getting this infection. For treatments, we have surgical removal, lots of antibiotics and hyperbaric oxygen, which brings to mind the old oxygen tents of the last century.

A very recent study from Taiwan mentions that 84% of the victims of  Streptococcus A were men, typically over sixty with diabetes and liver damage.

But here in Maine we had a healthy young mother. The News article cites the incidence at 1 in a 100,000 people, but a study from Ontario fifteen years ago put the incidence at 0.08 in 100,000. Even with rounding, that’s a ten-fold increase in fifteen years. Not very reassuring.

How can a normally infectious, but not necessarily terrifying bacteria that should respond to antibiotics suddenly become an unstoppable juggernaut where early recognition and amputation are essential parts of treatment?

Simple. It can’t be the bacteria. The bacteria cannot undergo that level of mutation in the time period involved. So the bacteria is interacting with the human body, and setting off a catastrophic response. A very recent study supports this idea, talking about how Streptococcus bacteria can modify the immune response, particularly phagocytic (flesh eating) cells. Normally these cells are part of the immune system’s clean-up squad, clearing out debris. But if the bacteria triggers a cascade event, the body’s janitorial squad runs amok.  Now we have the reason that some studies of children in Canada show a connection between recent chicken pox and flesh-eating, while another study from New Zealand shows a connection between flesh-eating and gout. What do these two diseases, one viral and one metabolic, have in common? They activate the phagocytic cells, raising them to a heightened state. All they need now is a minor invasion from the right bacteria to possibly send them into overdrive.

So, if it is the immune system, not the bacteria, we’d expect suppressing the immune system might be helpful even as we’re dumping the body full of antibiotic immune support. The classic immune suppressing agent is steroids. But no one has really tried steroids on what is seen as a bacterial infection. A Vanderbilt case report says steroids helped in two cases.

At the top of the page, it says alternative, so does the world of alternatives have anything to offer the discussion of flesh-eating bacteria?

There is a subgroup of flesh-eating disease that is so nasty that it makes male doctors flinch. Fournier gangrene is a flesh-eating disease of the genital area. But from this condition we have an interesting treatment study.

In Turkey they divided patients into two groups. One group got antibiotics, deep cleaning, surgery, and skin grafts. The second group got antibiotics, light cleaning and honey. Yes, honey, orally and topically on the wounds. Not something you are likely to see in a Maine hospital anytime soon. (Nurse! A pint of Skowhegan clover, STAT!)

At the end, the ones given honey did better. None of them died, and two of the conventionally treated group did. The researchers also noted that the honey group’s genitals looked better at the end.

To quote the researchers: “unprocessed honey might revolutionize the treatment of this dreadful disease by reducing its cost, morbidity, and mortality.”

So the next time you head down to the farmer’s market, pick up a pint as a gift for your doctor. Remind him or her that a single case of Fournier Gangrene costs hospitals twenty-five thousand Euro in Spain, and a pint runs in the five to ten dollar range.

If patients somewhere in the world get this information and it helps them look at a different treatment plan with their doctors, then the time I spent finding all of this on medline will be worth it. The links to the abstracts are peppered throughout.


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