“Flesh-eating bacteria consumes woman” Sounds like a National Enquirer headline, not some real-world nightmare.
Flesh-eating bacteria is a euphemism for Streptococcus Pyogenes. Yes, that’s Streptococcus, as in “strep throat.” These are not unusual bacteria, they are pretty much part of the human condition. It would be easy enough for someone to swab their arm and find some strep among the jillions of bacteria that are normally on our skin.
So this isn’t the worst bug you can imagine. You have already been in contact with this bug lots of times. There’s no getting away from it. There are just places this bug should be, and others where it definitely should not be.
In this age of antibiotics, we physicians have forgotten a lot of what we knew about wound care. We have come to believe that wound care isn’t very important because we can always throw antibiotics at it. That usually works out OK for all involved.
Unfortunately, when it fails, it fails spectacularly.
If you want to know wound care, talk to a surgical intern. Wound care is a lot more that simply sewing. In fact, an old surgical adage is: “the more you know, the less you sew.”
The first rule of wound care is get it clean. This means get any dirt, foreign material or dead tissue out of the wound. You need to pay attention to the mechanism of the injury. Was it a cut, rip, saw or burst wound. Some of these mechanisms cause a lot of dead tissue to be present in the wound.
Any saw wound grinds up tissue as well as cutting it. Saws make sawdust. This ground-up or killed tissue needs to be removed from the wound if you are going to close it. Otherwise you have created a perfect area for bacteria to grow deep in the body. Dead tissue is pretty hard to clear infection from since it has no circulation.
Sometimes wounds should be cleaned and left open. Modern society doesn’t like open wounds, they look terrible, are hard to take care of, and sometimes scar badly. But they almost never get badly infected because they can freely drain.
To understand this problem, you need to know the body is built in layers. All the muscles are surrounded by a fibrous capsule that allows them to slide over each other.
Since the muscles slide over each other, there aren’t many blood vessels supplying this area. So we have a passageway that isn’t well defended and makes travel easy for infection.
This particular bug can get so aggressive that is dissolves the fibrous capsule around the muscle, allowing it to spread even easier. Once this gets going, it is very hard to stop. The anatomy is simply working against you. As the infection spreads, the toxin can overwhelm the body and problems develop with blood pressure and circulation.
The condition of the patient to start with has a lot to do with the body keeping itself out of trouble. Anything that depresses your immune system adds to the risk. That can be something well known like HIV or diabetes. It can also be physical exhaustion, something that many young people flirt with frequently.
So don’t stay up late worrying about flesh-eating bacteria. It takes a whole bunch of bad luck, an especially nasty wound, questionable surgical procedures, and a poorly functioning immune system to put you in this situation.
Take care.
Dr. B.