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The dark side of strep throat: What is necrotizing faciitis?

A Winnipeg, Manitoba, Canada woman named Cari Kirkness, a 28-year-old mother of two had a sore throat that Canadian media describes, “quickly spiraled out of control”. The GoFundMe page set up on her behalf says the following:

Cari was diagnosed with strep throat… which later escalated voilently, she is currently at the Health Science Centre in the Intensive Surgical Care Unit in an induced medical coma, Cari has had two unfortunate amputations to remove her legs and one of her arms, doctors fear that she has flesh eating disease that it would spread to her internal organs

Group-A Streptococcus (GAS)/CDC

What is group A streptococcus?

Streptococcus pyogenes, or beta streptococcus group A is a very common pathogenic bacterium in humans. Historically, Streptococcus pyogenes got its notoriety as the cause of puerperal fever, a life-threatening disease that was seen in women after childbirth, until Ignaz Semmelweis discovered that it could be prevented by physicians just washing their hands before each vaginal examination. Today, physicians treat infections caused by Streptococcus pyogenes on a daily basis.

Streptococcus pyogenes produces numerous virulence factors that lend to its pathogenicity, or disease-causing capabilities including capsule production and production of several enzymes that give the bacteria the ability to destroy tissue and spread. Lastly, this bacterium also produces a wide variety of toxins that can produce generally mild symptoms like a rash, to toxins that can cause multi-organ failure.

Probably the most common disease caused by Streptococcus pyogenes is pharyngitis, or strep throat. Strep throat is very common in school-aged children, particularly in the winter and spring months. Untreated strep throat can lead to more serious complications like rheumatic fever; however, this is relatively uncommon.

It is also a cause of several skin infections such as impetigo and cellulitis. Impetigo is a characterized by a crusty lesion frequently found on the mouth area. Cellulitis typically occurs after a wound or burn where the bacteria enters and spread though the skin and lower tissues.

More serious, potentially life-threatening infections caused by Streptococcus pyogenes include necrotizing fasciitis (commonly called flesh-eating bacteria) and toxic shock syndrome. In addition, Streptococcus pyogenes can cause scarlet fever, septicemia and pneumonia. The death of Muppets creator Jim Henson was a result of an infection with Streptococcus pyogenes.

What is necrotizing fasciitis?

The “flesh eating bacteria” is actually a relatively rare bacterial infection technically known as necrotizing fasciitis.

The most common organism that causes this devastating disease is Streptococcus pyogenes (group A strep), however other bacteria have been implicated (Clostridia, Vibrio, and in the case of Aimee Copeland in 2012, Aeromonas.).

It’s called “flesh eating bacteria” because of how it destroys the skin and soft tissue.

This is the same bacteria that cause relatively mild infections like strep throat and impetigo. However, rarely a strain of the bacteria produce toxins and enzymes that make the infection spread quickly through the flesh.

Though rare, it is very serious with a fatality rate of approximately 30%.

So how does someone get infected? Usually the bacteria enter the body through an opening in the skin, quite often a very minor opening, like a paper cut.

It can also happen following a major trauma or surgery, and in some cases there appears to be no identifiable point of entry.

The bacteria is transmitted through respiratory droplets or contact with the secretions of from someone who has group A strep and this gets on a person’s hands or directly into a wound.

According to WebMD, the symptoms of necrotizing fasciitis start with pain from an injury that gets better over 24 to 36 hours and then suddenly gets worse. Often the pain is much worse than would be expected from the size of the wound or injury.

Other symptoms may include fever, chills, and nausea and vomiting or diarrhea. The skin usually becomes red, swollen, and hot to the touch. If the infection is deep in the tissue, these signs of inflammation may not develop right away.

The symptoms often start suddenly (over a few hours or a day), and the infection may spread rapidly and can quickly become life threatening. Serious illness and shock can develop in addition to tissue damage. Necrotizing fasciitis can lead to organ failure and, sometimes, death.

The infection is diagnosed based on symptoms and how fast the infection progresses. It can also be cultured to identify the offending bacteria.

Typically, by the time a person is seen by their doctor they are very sick. This is a medical emergency that requires hospital admittance, high dose antibiotics and supportive care for organ failure and shock.

This link to the National Necrotizing Fasciitis Foundation has “preventive” measure recommendations.

To help out Cari and her family, please visit the page “Future Funds For Cari, Chaz, Andrew”

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