Can anyone tell me the name of a staff infection that eats away at the tissues? I was on a call today that this same infection has affected the pt for 6 years. The pt started out by losing a toe, then another toe, until today the leg about the knee down is gone. Pt has had about 50 surgeries to date. The pt is no longer able to get vein access other than a port placed in.
I was wondering the name, the longevity of this, but most of all how contagious this can be. I was the driver on this run and did not have much pt contact, but would like to know the effects this could have. Thanks!!
Hey -
It's unlikely that your patient had the staph type necrotizing fasciitis. It is usually much more rapidly progressive (within hours), but thanks to the 'wonderful' pictures the media distributed in the '90s, it's the one most people think about. The mortality rate in staph NF was around 10% in the 90's. It's more likely that your patients had repeated re-infections while being immuno-compromised.
Other causes of Necrotizing fasciitis:
Grp A Strep - Also known as Strep pyogenes, this is the most common cause of NF, with a mortality rate approaching 20% (1). Incidentally, this is also the bug that causes strep throat, impetigo, and strep toxic shock syndrome (toxic shock like syndrome). This bacteria is pretty much everywhere.
Early Signs: Fever, severe pain, swelling, and redness around the wound site. (kinda general huh?)
Vibrio vulnificus - this little bacteria is picked up (normally) by those with (or getting) an open wound while either swimming in warm/tropical coastal waters or handling salt-water fish. It's harbored by copepods. Iron overload states (like hemochromatosis) appears to be a risk factor for this infection. (2)
Clostridium perfringens - This one is ubiquitous as well (all over the place), including residing in the human gut as normal flora. This is also the common cause of gas gangrene (myonecrosis) and can additionally produce a seriously nasty necrotizing intestinal disease. (3) This one can often be cultured from NF in IVDA. (4)
Other bacteria in the normal flora can also cause NF. Particularly, this is more common with diabetic patients, especially in areas of poor circulation and/or sites of injection.
To make you feel better:
The things that cause NF are all around us, all the time. In all that I read, immuno-compromised conditions (cancers, DM, transplant patients, etc) and skin/mucosal penetrations are almost always required (or deep wounds with the C. perfringens) to develop these conditions. (Some patients had apparently been infected through undetectable skin lacs).
Disinfection of your truck should be easily accomplished by the same procedures you follow after each patient. (You do wipe the cot down, right?)
(Be aware there is a hoax on the internet - something about bananas and NF - it is patently false.)
1)
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm
2) Sherris Medical Microbiology 4th ed. p 378
3) Sherris Medical Microbiology 4th ed. p 316-317
4) National Institutes of health:
http://gateway.nlm.nih.gov/MeetingAbstracts/102270104.html
Other sources:
- there is an NNFF dot org site - don't know anything about them, so didn't want to provide a 'real' link. They
appear to be a good source of information and support.
- A google scholar search produces some solid results -
be warned they often contain very disturbing images, don't let your kids in the room if you are looking!
Sorry if this was more information than you wanted, but I felt having it at your fingertips might make you feel a bit better.
tc
-B
