Flesh-Eating Bacteria
Flesh-Eating Bacteria
The Centers for Disease Control and Prevention estimates there are about 10,000
annual cases of invasive GAS in the U.S. About six or seven percent of such cases
are NF and one quarter of those NF patients will die. Not even early and
aggressive treatment can always save a patient suffering from necrotizing
fasciitis.
Last month, the Tahoe Daily Tribune published a story about a 34-year-old
woman named Tanya Gludau. She cut her finger with a kitchen knife. The small
cut became infected with GAS and the highly invasive bacteria quickly spread
from finger to hand to arm to chest. In order to save her life, surgeons cut away
massive amounts of infected skin and tissue. The woman emerged from an
induced six-week coma to find that most of her right upper body was gone. (The
woman, and the newspaper, should be commended for their mutual courage in
publishing a photograph of the damage inflicted by strep and scalpel. It is a
startling image that conveys the horror of NF in a way the newspaper's long
article and my own few words cannot.)
How does this microbial ''Army of One'' do some much damage so quickly? As
with any good army, this one is equipped with a huge array of clever weapons
designed to produce ''shock and awe.'' Literally. Enzymes are released to digest
connective tissue, allowing the bacteria to quickly spread. Other enzymes kill the
patient's white cells, break up red blood cells and degrade DNA.
But the worst weapons are toxins called Streptococcal Pyrogenic Exotoxins. There
are seven known pyrogenic toxins produced by different strains of GAS: A, B, C,
F, G, H and J, which was recently discovered by Pat Schlievert at the University of
Minnesota. In addition to being toxic and producing a skin rash characteristic of
scarlet fever, they are also ''superantigens.''
Patients with NF and streptococcal toxic shock may have fatality rates as high as
67 percent. The high death rate likely is due to an unfortunate combination of
invasive, toxigenic strains of strep and certain genetic patterns that make some
patients highly susceptible to superantigens. Bad genes meet bad bugs with bad
toxins.
Don Low at the University of Toronto has done a few studies using IVIG on
patients with life-threatening GAS infections. He wrote at the conclusion of one
small study, "The fact that seven patients with severe group A streptococcal soft
tissue infections survived with this approach definitely warrants further studies …
on the use of IVIG in these severe infections."
Not surprisingly, there is serious debate among physicians about the merits of
delayed surgery and IVIG versus traditional surgical approaches. Remembering
Tanya Gludau and the other cases before her, however, I would rather take my
chances with Don Low's limited data than the awful certainty of a surgeon's
scalpel.