Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: WEDNESDAY, June 8, 1994 TAG: 9406080082
SECTION: NATIONAL/INTERNATIONAL PAGE: A-8 EDITION: METRO
SOURCE: Associated Press
DATELINE: NEW YORK LENGTH: Medium
``It's come back, or it's learned a new trick,'' said Vincent Fischetti of Rockefeller University in New York, who directs one of the nation's leading laboratories for research on streptococcus bacteria.
``If you look at infectious diseases, they run in cycles,'' concurred Dr. Edward Kaplan of the University of Minnesota, director of a World Health Organization laboratory devoted to the study of strep. ``The Phoenix returns.''
The overwrought headlines, such as ``Killer Bug Ate My Face,'' first appeared in England, where 15 people have been afflicted with the deadly bacteria since Jan. 1. Eleven have died. Some did indeed lose skin or muscle as a result of the infection, which can spread as rapidly as an inch an hour.
In the United States, the reports touched off a virtual epidemic of news stories warning of the bacteria's dangers. Two people were hospitalized in Connecticut, and both have had ``radical surgery,'' a hospital official said in Norwalk. Another case in Coral Springs, Fla., was reported Monday.
Fortunately, the news coverage is more widespread than the bacteria. Deadly strains of streptococcus remain rare, and the outbreaks are isolated. The U.S. Centers for Disease Control and Prevention said 500 to 1,500 such infections occur each year in the United States. ``I think there was a definite increase beginning in the late 1980s in this country and in Scandinavia,'' said Kaplan. The serious infections may have declined slightly in the last two years, but they are still more common than they were in the 1980s, he said.
Milder strains of strep bacteria are exceedingly common, infecting perhaps 10 percent to 15 percent of Americans, the CDC said. They cause strep throat and a mild form of scarlet fever, Fischetti said.
The deadly strains produce a toxin that poisons skin and muscle tissue or internal organs, causing the body's own disease fighters to careen out of control.
``Once that's begun, you're in trouble. There's no way to reverse it,'' Fischetti said. ``And it's usually fatal.''
Fischetti recoiled at the use of the term ``flesh-eating bacteria.''
``I hate that,'' he said. ``I picture Pac Man organisms.'' The bacteria don't eat tissue, he emphasized. They poison it.
The deadly strains appeared in the United States about five years ago, Fischetti said. ``It's a highly toxic group-A strep,'' he said. ``Strains like this have been around at the turn of the century, when scarlet fever was a deadly disease.''
The severe form of scarlet fever declined in the 1920s. Doctors were not sure why. But now, the strains that caused it appear to have returned, Fischetti said.
Today, scarlet fever, while common, is rarely serious, Fischetti said. It generally causes little more than a rash. But in the 1800s, it was often accompanied by the same kind of tissue poisoning seen in the recent cases, he said.
One of the toxic strains killed Jim Henson, the creator of the Muppets, Fischetti said. In Henson's case, the infection began as strep throat then descended to the chest where it caused pneumonia and poisoned Henson's lungs. The technical term for what happens is necrotizing fasciitis: the death of tissue. According to the CDC, people infected with the strain that causes necrotizing fasciitis have a 28 percent fatality rate. Researchers have warned of bacteria that develop resistance to penicillin and other antibiotics, but such resistance has not appeared in group-A strep, said Alexander Tomasz, another researcher at Rockefeller University.
``Group A is well-handleable with penicillin,'' he said. ``But here the issue is virulence.''
The toxic strains kill so quickly that many patients are caught in an irreversible, out-of-control cascade before they get to a doctor. Doctors treat advanced infections not only with antibiotics but also by cutting out the infected area immediately, including amputating an infected arm or leg if necessary. ``What they do is dissect out the tissue to eliminate the organism and eliminate the toxin,'' Fischetti said. ``Organisms sitting in the necrotic (dead) tissue are pumping out toxin - antibiotics can't get to them.''
``Our physicians have reported seeing cases where this moves as rapidly as an inch an hour, so it is vital that people see a doctor very, very quickly,'' said Bob Howard, a spokesman at the CDC.
``Do not reach into your cabinet and try to treat these at home. Do not reach into your medicine cabinet and pull something out. See a doctor.''
by CNB