Unlike a typical soft tissue infection, where antibiotics provide the cure, the only option for treating necrotizing fasciitis, a sometimes deadly disease, is “surgery — now,” said a local doctor.
In addition to surgery, antibiotics are also administered to help squelch the fast-spreading, difficult to diagnose disease.
But the infection is so fast moving, said Dr. Patrick Grimsley, medical director of the emergency department at Mid-Columbia Medical Center, that sometimes, after surgeons remove the infected tissue, “by the time they prepare to close up the wound, they can see the stuff spreading again. It’s amazing how rapidly it spreads.”
Mid-Columbia Medical Center has seen three cases of the rare disease this year, which typically affects an estimated 750 people nationwide, killing about 30 percent and costing another 10-15 percent a limb.
One of the three victims, 20-year-old Haley Ruder, remains hospitalized in Portland recovering after contracting the disease in late July (see related story).
Haley Ruder’s plight was publicized first on Facebook, through an appeal for a gofundme account set up in her name called “Helping Hands for Haley.”
No information on the other two patients was available publicly and patient privacy laws prevent the hospital from providing information on them.
“At certain times you run into a few in a row,” Grimsley said.
“Sometimes that’s how medicine works. When that happens, people get alarmed.”
Recent comments on Facebook indicated people feared Ruder got the disease from the hospital.
Ruder’s sister, Laci Rusco, said, “She didn’t get it at the hospital.”
Rusco also said Haley couldn’t have contracted it while giving birth to her daughter at MCMC some six weeks earlier.
“It would’ve shown up a lot earlier. It does not sit dormant in your body.”
Of the three cases at MCMC this year, Dianne Storby, vice president of operations at the hospital, said, “These individuals were either an inpatient or presented to the ED [emergency department] and transferred to higher level of care hospital in Portland.”
Dr. Bill Hamilton, vice president of medical affairs at MCMC and a general surgeon, said, “To my knowledge, in my 29 years here there has never been a case of necrotizing fasciitis that occurred in the hospital without there being some pre-existing infection that caused it.”
Those patients were already in the hospital for surgery for an abdominal infection, such as a ruptured appendix or a perforated colon, and they had a “belly full of pus when they got there,” he said.
Hamilton said, “Our infection rates are incredibly low compared to the national average.”
Necrotizing fasciitis is a “nasty” disease that’s both rare and difficult to diagnose, Grimsley said.
He has seen maybe 10 cases in his 15 years, and just a half dozen in the 13 years he’s worked at MCMC.
It typically appears in extremities or the back of the neck, and often patients present with “pain way out of proportion to what you see, or a very nasty looking wound that looks really infected and painful and they are absolutely indifferent to it,” Grimsley said.
It is believed in those cases the infection has damaged nerve fibers and the person has lost the ability to feel pain.
He said, “Sometimes there can be nothing on the skin. The arm looks fine and you touch it and they jump off the bed.”
They also have “wildly abnormal labs,” he said, as well as low blood pressure and a fast heart rate.
They may or may not have fever, or redness or swelling at the infection site.
It all depends on how early the stages of the disease are and how deep the infection is.
Most people have never heard of necrotizing fasciitis, said Grimsley.
“I just tell them they have a very serious tissue infection that has to be surgically managed and the surgeon’s on his way now.”
Grimsley said when the body is infected, it releases products that fight the infecting organism.
“For some reason, this process gets out of hand” and ends up damaging the body’s own tissues.
Grimsley said the most common bacteria found in necrotizing fasciitis is the same type as what causes strep throat.
“These are common organisms that are everywhere,” he said.
“They’ve gotten an infection in the community and it’s become very pathologic,” Grimsley said of necrotizing fasciitis victims.
Grimsley said the typical patient who gets the disease is “just not horribly healthy,” and has a weakened immune system, such as can be found in diabetics or alcoholics.
Ruder was unusual in that she was healthy when she contracted the disease.
Hamilton has operated on one case of necrotizing fasciitis and it was in Memphis, during his first week of private practice.
She was a typical necrotizing fasciitis patient, obese and diabetic. He operated on her every day for two weeks.
The disease is an infection that causes the death [necrosis] of the fascia, the membrane that lies over the top of muscle and separates muscle from the fatty tissue on top of it.
Normally, the fascia sticks to what is around it, Hamilton said. But with necrotizing fasciitis, “You put your fingers in there and everything lifts up off of it.”
“The idea is you take it back to healthy tissue. That can include excising a lot of tissue,” he said.
“There’s this balancing act of trying to be conservative and making sure you get it all,” Hamilton said.
“You want to preserve as much tissue as you can.”
The principles for healthy tissue are “it looks healthy, it feels healthy and it bleeds. Dead tissue doesn’t bleed,” he said.
He said the reason surgical removal of dead tissue is so critical for treating necrotizing fasciitis is because antibiotics are transmitted in the blood, but dead tissue doesn’t have any blood supply in it.
“Once you make the diagnosis, it’s a true surgical emergency,” Hamilton said.
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