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The Undead? Flesh-Eating What? You Can’t Be Serious!

All this season’s lurid headlines, tweets, texts and postings notwithstanding, we are not in the midst of a flesh-eating bacteria pandemic.  Why people want to dress up as the undead and play zombie pranks on each other is something else again – who knows?  How that passes for entertainment is truly beyond us.  But the two things do seem to be dominating headlines lately.

Anyway, the CDC has some seriously effective, state-of-the-art tracking systems and methods for real medical and health emergencies, including Active Bacterial Core surveillance (ABCs).  The good news is that these show no rise in annual cases of flesh-eating bugs.  This doesn’t mean no cases, however – there are some 650-800 cases in the US each year, and this is thought to be somewhat of an underestimation.   ABCs are a very important part of the CDC’s Emerging Infections Programs network (EIP), a collaboration among state health departments, universities and the CDC.  Information is shared in a timely and thorough fashion so that public health professionals across the country stay connected and recognize and report trends.

The scary disease we keep hearing about, necrotizing fasciitis, is a very serious bacterial infection that spreads with terrifying speed, destroying the body’s soft tissue as it progresses.  The name alone is creepy enough.  This  is the media’s ‘flesh-eating infection’.  Despite the news reports, however, it remains extremely rare and is caused by more than one type of bacteria, including group A Streptococcus (group A strep),  Klebsiella, Clostridium, E. coli, Staphylococcus aureus, and Aeromonas hydrophila, among others.  Group A strep is thought to be the most common cause of the infection.  ‘Necrotizing’, by the way, means ‘causing the death of tissues’.

Nearly all infections from group A strep are mild or moderate and easily treated.  Sometimes, however, toxins made by this invading bacteria destroy the very tissue they infect, causing it to die.  This is why accurate diagnosis and swift treatment with antibiotics through a vein and surgery are so important.

Your first line of defense in the prevention of a bacterial skin infection is common sense and proper wound care:

  • Do not delay first aid for even very minor, non-infected wounds such as blisters, scrapes or any other break in the skin.
  • Keep draining or open wounds covered with clean, dry bandages until healed.
  • If you have an open wound or an active infection, stay clear of common-use sites (whirlpools, hot tubs, swimming pools and so on) until the infections are completely healed.
  • Wash your hands often with soap and water, or use an alcohol-based hand rub should washing up not be possible.

According to the CDC, if you are healthy, have a strong immune system, and observe and practice good hygiene and proper wound care, your chances of getting necrotizing fasciitis are extremely low.

What causes necrotizing fasciitis?  Most cases occur randomly and are not linked to similar infections in others.  The most common way of getting the infection involves the bacteria entering the body through a break in the skin (a cut, scrape, burn, insect bite or a puncture wound).  Nearly all those people who get necrotizing fasciitis appear to have other health problems that lower their  ability to resist infection.  These conditions include, among others, diabetes, cancer, kidney disease or other chronic health conditions that compromise the body’s immune system.

The bacteria spread very rapidly once they enter the body in cases of necrotizing fasciitis, infecting the flat layers of a membrane known as the fascia.  These are connective bands of tissue that surround muscles, fat, blood vessels and nerves.  The infection also damages the tissues next to the fascia.

Telltale symptoms often start within hours of an injury, but it may seem like any other illness at first.  Some victims notice a pain or soreness that is similar to that of a pulled muscle.  The skin may feel warm, with red or purple areas of swelling that spread quickly.   There may also be black spots, blisters or ulcers on the skin.  Fever, chills, tiredness or vomiting may follow the initial wound or soreness.  Often, patients describe their pain as really severe, all out of proportion to how the injured area looks when first examined.  The confusing or conflicting nature of the symptoms may delay someone from seeking medical attention promptly.  If you or anyone in your care seems to have these symptoms following an injury or wound, get to a doctor right away.

We already noted that the number one, best treatment is strong antibiotics given through a needle directly into a vein.  But even this is not enough, as the bacterial toxin can destroy soft tissue and reduce blood flow.  The antibiotics alone may not be able to get to all the infected areas.  Prompt surgical removal of all dead tissue in addition to the antibiotics is often critical to stopping the spread of the infection.

So there you have it.  We are not being invaded.  Necrotizing fasciitis is real but really rare.  It deserves our vigilance and respect but should not rob us of our sanity or perspective.  People dressing up as zombies and staging attacks on their neighbors and co-workers?  We have no idea what to do with that one.

Special thanks Centers for Disease Control and Prevention, Division of News and Electronic Media, June 2012.

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