Flesh-eating bacteria can infect anyone, through the smallest cut

The killer bug with the scary nickname – flesh-eating bacteria – uses common injuries as a foothold for infection.

A paper cut.

Jennifer Buchanan / The Herald Rich Hicks (left) plays basketball with neighborhood friend Jared Spady during a pickup game at Hicks’ home in Arlington. Hicks lost his lower left leg to a flesh-eating bacteria infection.

A nick while shaving.

A cut lip from a stumble during a basketball game.

Injuries so common that we barely take notice.

Yet, in rare cases and for reasons scientists are still trying to understand, minor cuts such as these can trigger potentially deadly infections.

Nine people in King County have died from the disease, called necrotizing fasciitis, since January.

Two of the people were from Snohomish County, said James Apa, a spokesman for Public Health Seattle and King County. Both were treated at Harborview Medical Center in Seattle.

One was a 35-year-old Everett woman who died Jan. 10. The other was a 41-year-old Edmonds woman who died Feb. 19, he said.

Jacob Finkbonner, a 6-year-old Whatcom County boy, was airlifted to Seattle’s Children’s Hospital and Regional Medical Center in February for treatment of the disease. His infection started with a cut inside his lip he got during a basketball game.

He spent seven weeks in the hospital’s intensive care unit and was recently discharged. Doctors performed plastic surgery to repair damage the disease caused to his face and mouth.

His mother, Elsa Finkbonner, said on Friday that her son’s condition is improving.

There’s no evidence that the bacteria has returned.

Surgery to battle the disease has left scars on his head, neck face and chest.

The family will commute to Seattle about once a week for continuing treatments, she said.

“It’s very spooky,” said Dr. Craig Rubens, who as chief of pediatric infectious disease at Children’s is part of the team of doctors treating Jacob. “It’s seldom you see dramatic things like this in medicine.

“It’s advancing at such a pace you get worried you can’t keep the patient alive, let alone stop the infection.”

The fever caused by necrotizing fasciitis makes it similar to generally less harmful infections. A King County man who died earlier this month was initially thought to have shingles.

One telltale trait separates necrotizing fasciitis from other health problems: The pain is seemingly far out of proportion to the injury.

“There’s nothing to see,” Dr. Marcia Goldoft, a medical epidemiologist with the state Department of Health, said of the ordinary look of the initial cut or scrape.

“The intensive pain is your only clue. … By the time it’s possible to know what’s going on, you’re struggling to save a life.”

Disease hard to control

In a matter of hours, with the precision of falling dominos, the infection can trigger a chain reaction. Bacteria grow rapidly. The body’s means of trying to stop the infection actually helps the bacteria destroy more tissue, said Rubens, the Children’s Hospital physician.

Necrotizing means killing or dying, and fasciitis (pronounced fash-e-i-tis) refers to the fibrous tissue between the skin and muscle where the bacteria attack.

“The infection can just roar through the area,” Goldoft said. “It’s difficult to control.”

As demonstrated by the nine deaths in King County this year, the infection can be ruthless.

The state Department of Health’s Goldoft remembers hearing of one case triggered by a splinter from a fence. “It’s heartbreaking that healthy people can be affected by something that seems so minor,” she said.

There are no steps to prevent it, although basic hygiene such as careful hand washing and cleansing and treating cuts and scrapes is recommended.

Considering how many people cut or scrape themselves every day, the disease is extremely rare, said Dr. Yuan-Po Tu, who specializes in internal medicine at The Everett Clinic. The reason the cases get so much attention is “they’re so devastating and spectacular in a bad way.”

When it does strike, a red spot appears several hours after what appears to be a trivial wound, he said. Later, there’s a black spot with no feeling – a sign the tissue has died.

The blackened tissue is cut away to help the body clean the bacteria out of the area, Rubens said. Antibiotics help fight the infection.

Children’s patients also get hyperbaric oxygen treatments to try to prevent tissue loss, he said.

Jacob Finkbonner’s injury apparently was caused when his face hit a basketball pole and he bit the inside of his lip.

“Why he got this over someone else who would have fallen the same day and in the same way is hard to say,” Rubens said.

“It’s one of those chance things. The bacteria get in the right place at the right time, and the body can’t fight it off.”

Danger in a paper cut

Last year on Mother’s Day, a Lynnwood woman noticed she had a paper cut after flipping through a magazine.

There was a little blood on her index finger. She scrubbed it with soap and water.

That night, she was awakened by throbbing pain. She soaked her finger frequently to try to relieve it. The next evening, the pain returned. It was so intense she told doctors she felt like her finger was going to explode.

Three days after the initial cut, a black dot appeared on her fingertip. Within a few hours, when she sought a doctor’s care, that same black dot had grown to the size of a dime and extended down her finger.

Dr. William Ericson, the Woodinville physician who treated the woman, vividly remembers her fingertip blackened with dead tissue. He rushed her into surgery.

“It was just a paper cut,” Ericson said. “Within hours, it had traveled up her finger. She could have lost her finger, arm, or died.”

The bacteria that caused the infection didn’t necessarily come from the magazine. Doctors said it could have come from anywhere, perhaps even the door of the grocery store she had visited on Mother’s Day. The cut simply provided the bacteria easy entry.

Although necrotizing fasciitis is often associated with the same kind of bacteria that causes strep throat, it can be caused by many types of bacteria, said Dr. Jo Hofmann, communicable disease epidemiologist with the state Department of Health.

No one knows exactly how many people get necrotizing fasciitis in Washington each year. It’s not a disease that local and state health agencies track, because the disease rarely is spread from person to person, Hofmann said. Public health agencies usually monitor diseases where steps can be taken to stop them from spreading.

However, hospitals do report the number of discharged patients with suspected cases. In 2004, 262 people were treated in Washington hospitals for the infection.

People with weak immune systems are the most susceptible to necrotizing fasciitis, Hofmann said. This can be caused by conditions as common as diabetes or alcoholism.

Overall, about 25 percent of people who get the disease die from it, she said. Among those who are medically fragile, death rates can be as high as 76 percent.

A small price to pay

Rich Hicks can still give his 16-year-old son Patrick a run for his money in a game of basketball.

Hicks is also an avid hunter, even though he sometimes has to crawl up the steep grades of the Cascade Range on his hands and knees.

Hicks, 45, works as an estimator for an asphalt construction company in Everett. And unless he is wearing shorts for a round of golf or for chopping wood in the back yard of his Arlington home, most people can’t tell from his quick, sure gait that he has an artificial left leg starting at his knee.

“It has changed some things in my life, but it hasn’t kept me from doing them,” he said.

Doctors amputated Hicks’ leg in 1992 as the best hope for beating back an unusually aggressive case of necrotizing fasciitis.

It was small price to pay, he said.

“What do I want to give up, my life or my leg?”

When he arrived at Swedish Hospital in Seattle, Hicks was struggling to breathe. His leg was swollen and red. He had a fever of 104 degrees.

Even though he didn’t have obvious injuries or wounds, Dr. Martin Mankey, an orthopedic surgeon, quickly suspected the infected area. He consulted with a fellow specialist at Harborview, who told him seven people had died because the disease had not been diagnosed soon enough.

“Get that leg off!” the specialist told Mankey.

As Hicks’ infection worsened, his leg began to turn black and purple. His oxygen levels and other vital signs dropped dangerously low.

“They said he dodged a bullet by about an hour,” said his wife, Kathi Hicks.

No one knows exactly what triggered the disease. It could have started from a case of athlete’s foot he had been battling for several weeks. The infection occurred in a leg that been badly crushed by an on-the-job accident a decade before.

Rich Hicks often talks to school groups about how he adjusted to his new life. He welcomes questions about his artificial leg and jokes with strangers, including airport security employees, about it.

“The crocodile attack, the shark attack,” his wife said with a bemused sigh. “You never know with him. It’s like which story is it going to be?”

Maybe this relish at poking fun at himself is his way of demonstrating how fortunate he feels to have survived.

“It was a snap of the finger – that quick,” he said. “If they hadn’t decided to make those choices, I wouldn’t be here.”

Reporter Sharon Salyer: 425-339-3486 or salyer@ heraldnet.com.