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Wednesday, March 15, 2000

Man attacked by saltwater flesh-eating bug -- A sailboat ride nearly cost a Florida man his leg -- and perhaps his life -- after a wound he got from a stingray became infected with flesh-eating bacteria that thrives in salt water. Dr. Gerard Barber, one of the doctors who treated the man at Florida's Lakeland Regional Medical Center, says, "He was very lucky, I think honestly, to have kept his leg and his life." The man was lashed by the stingray when he stepped off his sailboat into ocean water in Tampa Bay about a year ago, Barber says. The stingray left a two-inch, excruciatingly painful gash on his right shin. He went to an emergency room of a local hospital. After waiting about five hours, his wound was cleaned out, stitched up and he was sent home, without antibiotics. "The problem was he was cut, and languished in an emergency room for five hours," says Barber, who is a pharmacologist and public health specialist. "Bacteria that got into that cut had the chance to grow and grow and grow. It established a foothold." Three days after being treated in the hospital, the man developed fever and swelling, and in another day a patch of skin and muscle next to the cut started to turn gray and rot, a condition known as necrotizing fasciitis. By the time he got to the Lakeland center, he had a fever of about 102 degrees F (39 degrees C), and a "wound that went right down to the bone," says Dr. Jeffrey Swygert, who also treated him at Lakeland. Swygert hit the infection with several antibiotics, then brought in surgeons to cut away the dead and infected areas of skin and muscle. The man was hospitalized for seven days, then had to return for several operations to cover the gaping hole in his leg with skin grafts. A year later, he's back at work, and in good shape, although he did lose a lot of muscle tissue, the doctors say. The invader was Photobacterium damsela, a close relative of the bug that causes cholera. Barber says it's named for tendency to glow when it grows in a colony -- Photobacterium -- and for its most common victims -- Damsela fish, which develop big open sores when they get infected. P. damsela is sometimes eaten by people dining on contaminated seafood, and can cause stomach upset and diarrhea, he says. The greatest danger is when a person with an open cut or sore -- or with a weakened immune system -- runs into them. Then the bacteria can kill. In the medical literature, Swygert and Barber found 17 similar cases, including five deaths. Most of the people who died had weak immune systems, caused by diabetes, old age and other diseases. But one, very troubling case was a 34-year-old fisherman, who was in perfect health. He died a few days after getting a P. damsela infection on his arm, Barber says. The doctors, who reported the incident in Thursday's issue of The New England Journal of Medicine, say that this microbe is relatively common in salt water. They hope their report will serve as a warning that people who get wounds in salt water -- while swimming, cleaning fish or stepping off a sailboat -- could become infected with these ocean-dwelling flesh eaters. Barber says, "They're out there. They're all around us. We just need to be a little more mindful of it." Necrotizing fasciitis is most commonly caused by the same kind of bacteria -- Strep A -- that causes strep throat, according to the Website of the National Necrotizing Fasciitis Foundation of Grand Rapids, Mich. Scientists estimate that there are about 1,500 cases a year. In about 20 percent of the cases of necrotizing fasciitis, people die, usually after the germ gets into the blood.

-- Copyright 2000 by United Press International. All rights reserved.

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