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What to know about flesh-eating bacteria infections

Flesh-eating bacteria infections may look similar to other diseases in the early stages, which can make diagnosis difficult. Here's how to spot it before it's too late.

Carolyn Fleming of Ellenton, Florida, may have been the latest person to die of a flesh-eating bacteria infection, which she contracted infection swimming off the coast of Anna Maria Island in Florida, her family says.

Cases of the deadly infection, called necrotizing fasciitis, may be on the rise because of climate change.

In fact, a study published last month in the Annals of Internal Medicine said that rising water temperatures in the Delaware Bay may be to blame for an increase in the number of cases of infections in the previously rarely affected waters. The authors of the study described five cases of Vibrio vulnificus necrotizing fasciitis that occurred during the summer of 2017 and 2018. In the eight years before 2017, the doctors saw only one case of the infection.

Fleming, on the other hand, acquired the infection in Florida waters, her family says, where the bacteria are naturally found.

Here’s what you need to know about necrotizing fasciitis:

What is necrotizing fasciitis?

Necrotizing fasciitis is a skin infection caused by rare bacteria that enters the body through a break in the skin. From this opening, the bacteria aggressively attacks muscles and other organs resulting in rapid destruction of the tissues. Vibrio bacteria are one group that can cause this infection; one type, called Vibrio vulnificus, is particularly dangerous. It is usually contracted when an open wound comes into contact with coastal saltwater. Necrotizing fasciitis can quickly develop soon after. If not treated promptly with antibiotics, the infection can become fatal. But more often, the bacteria are ingested in raw or undercooked seafood, causing diarrhea. The resulting illness is rarely life-threatening and symptoms occur within 24 hours and last about three days.

Group A strep is another type of bacteria that can cause necrotizing fasciitis and severe diarrhea, as well as a system-wide blood infection that leads to severely low blood pressure and multiple organ failure, called streptococcal toxic shock syndrome.

Who is most likely to get it?

Those with health conditions that weaken the body’s immune system such as:

  • Diabetes
  • Kidney disease
  • Liver disease, and
  • Cancer

“V. vulnificus, which seems to be on the rise, causes human health concerns in the form of blood infection and wound infection. The elderly, those who are immune-compromised, and the very young are at greatest risk,” said Kimberly Reece, chair of Aquatic Health Sciences at the Virginia Institute of Marine Science.

Contact with Group A strep or V. vulnificus rarely leads to infection in healthy teenagers and adults, but anyone with open wounds should avoid swimming pools, hot tubs and natural bodies of water like lakes, rivers, estuaries and oceans.

How common is the disease?

The infection is pretty rare, but Dr. Glenn Morris, director of the Emerging Pathogens Institute at the University of Florida, says people should be made aware of it.

“Vibrio vulnificus is a small problem but nevertheless significant. It can cause a nasty cellulitis in a small group of patients,” Morris said. “If you fall into one of these high-risk categories, people should be aware that there are bacteria in the water that can cause serious infections.”

According to the CDC, every year, 700 to 1,200 cases are diagnosed in the U.S., although the CDC notes that this is likely an underestimate. About 25 percent to 30 percent of those cases result in death.

Necrotizing fasciitis is rarely contagious.

How to spot necrotizing fasciitis

Early symptoms include:

  • Changes in skin color
  • A rapidly spreading inflamed or swollen area of the skin
  • Severe pain, including pain beyond the area of the skin that is red or swollen, and
  • Fever

Later on ulcers or blisters can form, as well as dizziness, fatigue, nausea, and diarrhea. The infection often spreads quickly so it is imperative to seek medical attention if someone is experiencing one or more of these symptoms.

How is necrotizing fasciitis treated?

Necrotizing fasciitis is a serious illness that requires immediate hospital attention. Antibiotics and surgery are typically the first lines of defense, but even with prompt treatment the CDC says up to one in three people can die from the infection.