Doctor answers 6 questions about flesh-eating bacteria

It started as a small pain in her shoulder, but ended with the amputation of two feet and a hand.

When Cindy Martinez's husband took her to Gwinnett Medical Center last year, she learned her mysterious illness was a flesh-eating bacteria called necrotizing fasciitis.

Doctors surgically removed the Dacula woman's infected feet and her right hand last June. About a month later, Martinez's legs were amputated just below the knees, her right arm was ambutated to above the elbow, and several fingers on her left hand were removed.

The mother of two learned how to use prosthetic legs before leaving Atlanta's Shepherd Center.

Doctors say they are uncertain how Martinez contracted a flesh-eating bacteria that forever changed her family’s life.

The bacteria usually enters the body through an open wound, doctors say.

Four years ago, Aimee Copeland, then a 24-year-old graduate student from Snellville, battled a similar flesh-decaying disease after a zip-lining accident, according to previous reports by The Atlanta Journal-Constitution.

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>> Woman gets flesh-eating bacteria while fishing in Gulf of Mexico

Dr. A. Scott Lea, a professor of internal medicine and infectious diseases at the University of Texas Medical Branch in Galveston, spoke with Katie Hall of the Austin American-Statesman about Vibrio vulnificus to answer some questions about the bacteria.

Q: What advice do you have for families headed to the beach this summer?

A: The waters of the Gulf of Mexico are generally safe, and individual accounts of shark bites, sea lice, flesh-eating bacteria, Portuguese man-of-war stings and sting ray wounds, while horrifying and dramatic, are unusual. I would not be afraid to go to the beach and enjoy the water and sun for a day.

Individuals should watch for the signs of problems and take general precautions when necessary while on the beach. For instance, use a high number sunscreen and watch for blooms (large numbers) of jellyfish and man-of-war that have washed ashore. Watch for large fish kills and pollution on the beach.

(Those with) large, fresh wounds should not go into the water until healed. Having said that, there is no way one can identify every scrape and abrasion on a child or an adult.

Q: How likely is it that someone swimming in coastal waters will become infected with Vibrio?

A: Vibrio vulnificus is a small, curved bacteria that prefers salty environments with salinity similar to that of human beings. It survives best in the estuarine waters (brackish waters of bays, marshes and mouths of rivers). Vibrios exist in the sediment (bottom mud and sand) and are, therefore, found frequently associated with shellfish (shrimp, oysters and crabs).

Vibrio infection is much more likely to be associated with recreational injuries while fishing, boating or netting. People working around boats and docks have problems with Vibrio. Most folks generally do not swim in bays, marshes or around boat docks. Things like fishhook injuries; fish, shellfish spine punctures; barnacle cuts; and wade fishing cuts (and) abrasions are much more likely to cause problems than a swimming exposure in the Gulf of Mexico.

The University of Texas Medical Branch identifies and cares for five to 10 documented cases each year on average.

There are other bacteria that cause marine-associated infections: Erysipelothrix, Shewanella and Edwardsiella are genera of bacteria that are examples, but they are very unusual. Hepatitis viruses are the best known viral infections associated with marine environments. Again, almost all of these are associated with handling of shellfish and skin trauma.

Q: Are there steps people can take after being in the water that would lessen the likelihood of infection?

A: The most important step after leaving the water is to shower. Some of the beaches ... have showers for bathers as they leave the beach. Once back home or in one's motel/hotel room, soap and water is a good idea. Antibacterial soaps contain antibacterial chemicals and may be of help.

Individuals should be very attentive to any area of the skin that may be a developing infection and bring this to medical attention immediately. The fact that a person has been in the marine environment makes the possibility of infection due to Vibrio and other problem microorganisms more likely. This is particularly important if the individual doesn’t live on the coast where physicians are not always ‘on the lookout’ for these infections. Unnecessary delays in the proper diagnosis can lead to the prescription of inadequate antibiotics for this particular type of infection. So, the concern about infection acquired on the beach or while fishing along the coast is a pivotal piece of information that should be brought to a physician’s attention.

Q: What are the risks associated with consuming fish that have the bacteria?

A: Oysters are the only protein source that individuals eat that are both raw and alive. Crabs and shrimp are frequently steamed or quickly boiled before eating to maintain their flavor and moistness. These cooking methods may not be adequate for destruction of micro-organisms.

Septic shock can be associated with ingestion of poorly cooked shellfish. ‘Vibrio-induced sepsis’ occurs with increased frequency in people who have underlying liver disease (Hepatitis C and alcohol-associated disease), various forms of arthritis and patients with malignancies, such as leukemia and lymphoma.

Thoroughly cooking seafood is a protective measure and a good idea for patients with the diseases listed above.

Q: What are the risks associated with fishing? Should anglers wear gloves, boots?

A: Fishing involves the use of sharp hooks, knives and shellfish as bait. Puncture wounds and cuts incurred in the water while fishing are events that can result in inoculation of Vibrio into human tissues. Water shoes and waders provide some protection, but the most important activity is washing the wound with soap and water and being attentive to the occurrence of irritation at the wound site. Fishermen are the group of people at highest risk in our experience at UTMB. They should bring these wounds to medical attention immediately, emphasizing the exposure to salt water.

Q: Is this a seasonal problem? Do the bacterial counts in the water vary with an infusion of fresh water from rain runoff?

A: Vibrio infections begin to occur with increasing frequency as the water warms up along the coast during the late spring and summer. Bacteria need warmth, salinity and other environmental requirements that support their existence. The influx of waters from rivers and streams during the spring serves to add nutrients to the environment.

The increased flow agitates the sediments, which serves to flush out the bays and marshes and remix bacterial and invertebrate populations. This reestablishes the fertile ground for growth and reproduction — not only of Vibrio, but also for the shellfish that filter and harbor the organisms.