Thursday, June 12, 2003

By Steve Levin, Post-Gazette Staff Writer

It's the same bacteria that causes such common illnesses as strep throat and impetigo.

But the illness that recently sent three South Hills residents to St. Clair Memorial Hospital -- necrotizing fasciitis -- is the type of streptococcus that really gets under the skin.

It's popularly known as "flesh-eating bacteria," named for the way it eats away body tissue. Since blood can't reach the dead tissue, the immune system can't fight the fast-spreading bacteria. About one-quarter of people with the infection die.

According to the Allegheny County Health Department, a 30-year-old male was admitted in mid-May to the hospital. He has since been released.

On May 23, a 55-year-old man was admitted and about two weeks later, on June 5, a 65-year-old woman was admitted. A Health Department spokesman said the two were still being treated.

Three cases are about average for Allegheny County each year, said spokes-man Guillermo Cole.

"We don't think there is any public health significance," Cole said. "It's just a coincidence that these three ended up at the same hospital."

Dr. G. Alan Yeasted, the hospital's vice president for medical affairs, agreed.

"This wasn't a big deal to us," he said.

He stressed that the infection, also known as group A streptococcus, was "community acquired," meaning that the unrelated residents were infected prior to being admitted to the hospital.

Necrotizing fasciitis (pronounced neck-row-tize-ing fash-e-itis) most often begins with bacteria entering the body through something as innocuous as a paper cut, staple puncture or pin prick, or even a bruise or a blister.

It can also be transmitted in person-to-person contact through infectious secretions.

According to the National Necrotizing Fasciitis Foundation, flu-like symptoms occur within 24 hours, such as vomiting, diarrhea, malaise and fever. Muscle pain becomes disproportionate to the injury. Within three or four days, the limb experiencing the pain swells and may exhibit large dark marks. The wound may turn bluish, white or dark, with a mottled flaky appearance.

Within four or five days, victims' blood pressure can drop precipitously, and the body begins to go into toxic shock from the bacteria's toxins.

Surgery is usually required to cut out or amputate the diseased area. Yeasted said one of the three people admitted to the hospital underwent surgery, but he declined to elaborate.

Other methods of treatment of necrotizing fasciitis, according to the foundation's Web site (www.nnff.org ) include intravenous antibiotic therapy and medications to raise blood pressure.

According to the Centers for Disease Control and Prevention, about 11,000 cases of group A streptococcus occurred nationally in 2001, about 770 of them necrotizing fasciitis.

Those at greatest risk include children with chicken pox, people with suppressed immune systems, burn victims, elderly suffering from cellulitis, diabetes, blood vessel disease or cancer, intravenous drug users and people taking steroids or chemotherapy.

Steve Levin can be reached at slevin@post-gazette.com or 412-263-1919.