Aimee Copeland, the Georgia graduate student battling a life-threatening, flesh-eating bacterial infection, was still on a respirator Tuesday in a hospital in Augusta, Ga., but she is improving, her father says.
Andy Copeland told the Associated Press that doctors still believe they will have to amputate his daughter's fingers, though they think they can save her palms and right foot. She has lost most of her left leg.
Aimee, 24, still faces months of recovery to treat the infection that developed after she cut her leg when a zip line snapped over a river in Georgia May 1. The gash in her left calf is believed to be the entry point of the infection, necrotizing fasciitis.
It is caused by some of the same Group A strep bacteria that also cause common strep throat and impetigo. Only about 750 cases of flesh-eating bacteria occur each year, usually caused by a type of strep germ, the Centers for Disease Control and Prevention says. About one in five cases prove fatal. But Copeland's infection was caused by another bacteria, Aeromonas hydrophila, the AP reported. Those cases are even rarer.
William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville, discusses how this atypical infection could occur and how it can be treated.
A: It is a very deep soft-tissue infection. Fasciitis refers to the connective tissue covering the muscle. One of the things that characterizes these infections is that because they are deep, they are removed from oxygen. It's not like an infection on the surface. So you need bacteria or a combination of bacteria that can function in a largely oxygen-free environment. And there are a number of different ones, including Aeromonas hydrophila, that can do that.
A: It lives in warm freshwater, usually brackish freshwater such as lakes and streams. That sort of water got into the young lady's deep wound. It can live in an oxygen-abundant environment, but if you put it down in a deep wound and close the wound with stitches, removing it from oxygen, it can switch its metabolism so that it can also function in an oxygen-poor environment, and this is what happened to her.
A: I could dive in that same stream, in the same place, and if I don't injure myself, I'm going to be perfectly fine. It's not going to get on the surface of my skin and burrow in. It tends to be known for causing mild diarrhea.
A: The primary symptons are usually pain, because the fascia is being destroyed and the muscle itself is in the process of being destroyed. Initially, there may not be a great deal of fever, curiously enough. The wound is on the surface and the infection is deep down, and the wound looks fine. It's not inflamed, it's not puffy, there's no discharge, sutures are put in and they stay intact. There's a disconnect between the pain and the wound. So the conclusion, without a lot of fever, is often that it must be a bone bruise or there's bleeding deep in the wound that's causing pain. Appropriate treatment is delayed until it becomes more obvious. But you've lost a lot of ground because the infection is so subtle and sneaky.
A: First, antibiotic care. Often a variety is needed because Aeromonas is resistant to some common antibiotics. More important is aggressive surgery to the local wound, cutting away the diseased tissue and exposing the depth of the wound to oxygen. It's common for surgeons to have to go back a second or even third time to keep up with the spreading infection. … Rigorous supportive care is necessary, because the infection can have systemic effects.
Andy Copeland told the Associated Press that doctors still believe they will have to amputate his daughter's fingers, though they think they can save her palms and right foot. She has lost most of her left leg.
Aimee, 24, still faces months of recovery to treat the infection that developed after she cut her leg when a zip line snapped over a river in Georgia May 1. The gash in her left calf is believed to be the entry point of the infection, necrotizing fasciitis.
It is caused by some of the same Group A strep bacteria that also cause common strep throat and impetigo. Only about 750 cases of flesh-eating bacteria occur each year, usually caused by a type of strep germ, the Centers for Disease Control and Prevention says. About one in five cases prove fatal. But Copeland's infection was caused by another bacteria, Aeromonas hydrophila, the AP reported. Those cases are even rarer.
William Schaffner, an infectious-disease specialist at Vanderbilt University Medical Center in Nashville, discusses how this atypical infection could occur and how it can be treated.
A: It is a very deep soft-tissue infection. Fasciitis refers to the connective tissue covering the muscle. One of the things that characterizes these infections is that because they are deep, they are removed from oxygen. It's not like an infection on the surface. So you need bacteria or a combination of bacteria that can function in a largely oxygen-free environment. And there are a number of different ones, including Aeromonas hydrophila, that can do that.
A: It lives in warm freshwater, usually brackish freshwater such as lakes and streams. That sort of water got into the young lady's deep wound. It can live in an oxygen-abundant environment, but if you put it down in a deep wound and close the wound with stitches, removing it from oxygen, it can switch its metabolism so that it can also function in an oxygen-poor environment, and this is what happened to her.
A: I could dive in that same stream, in the same place, and if I don't injure myself, I'm going to be perfectly fine. It's not going to get on the surface of my skin and burrow in. It tends to be known for causing mild diarrhea.
A: The primary symptons are usually pain, because the fascia is being destroyed and the muscle itself is in the process of being destroyed. Initially, there may not be a great deal of fever, curiously enough. The wound is on the surface and the infection is deep down, and the wound looks fine. It's not inflamed, it's not puffy, there's no discharge, sutures are put in and they stay intact. There's a disconnect between the pain and the wound. So the conclusion, without a lot of fever, is often that it must be a bone bruise or there's bleeding deep in the wound that's causing pain. Appropriate treatment is delayed until it becomes more obvious. But you've lost a lot of ground because the infection is so subtle and sneaky.
A: First, antibiotic care. Often a variety is needed because Aeromonas is resistant to some common antibiotics. More important is aggressive surgery to the local wound, cutting away the diseased tissue and exposing the depth of the wound to oxygen. It's common for surgeons to have to go back a second or even third time to keep up with the spreading infection. … Rigorous supportive care is necessary, because the infection can have systemic effects.
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