STI: Disease: Fatal flesh-eating bug

May 10, 2004

Disease: Fatal flesh-eating bug

Clue: Tiny black spot on finger
by Salma Khalik

IT STARTED with mild fever and a sore throat.

No one knew that three-year-old Pearline Tan was infected with a rare flesh-eating bacterium that would destroy part of her anus and vagina before doctors realised what was making her ill.

If not for an alert nursing officer at Mount Alvernia Hospital, the girl might have lost her womb or even died.

Nurse Lim Sem Choo noticed a tiny black spot of dead flesh on the girl's right index finger and immediately alerted the doctors, who caught the infection, necrotising fasciitis, before it destroyed Pearline's womb.

Necrotising fasciitis happens when bacteria found naturally on the skin surface go under the skin, often through a cut or bruise, and start destroying soft tissue and the fascia, the thin sheath covering the muscle.

The only way to stop it is to cut away the affected area. If not, the infection spreads quickly and is almost always fatal, said Associate Professor Paul Tambyah, an infectious disease expert at the National University Hospital.

In Canada last week, one woman died and a man was in serious condition when they contracted necrotising fasciitis after day surgery in the same hospital.

The man is now recovering, but people who came into close contact with the two were given antibiotics in case they too were infected.

Doctors can't explain why some people are unable to fight the infection.

And how Pearline caught it remains a mystery. Her two brothers, aged two and eight, are fine.

Otherwise healthy and active, the girl had fever and a sore throat on April 7. Her mother, Mrs Angie Tan, took her to see a general practitioner (GP) who gave her paracetamol.

Two days later, she was worse. Mrs Tan took her to Mount Alvernia Hospital, where she was given antibiotics.

The next day, when the child said her bottom hurt, her mother took her back to the GP, who gave her a cream and something to bathe with.

But nothing seemed to help. She even fell asleep in front of the TV while watching a favourite show. Said Mrs Tan: 'She was like a robot. Totally unlike her usual hyperactive self.'

The next day, she had to be taken back to the hospital when she said she couldn't urinate. Doctors tried to drain the urine with a catheter, but found the area around her vagina and anus to be swollen.

She had to be operated on the next day to release the urine. But it was only four days later, on April 16, that the observant nurse noticed the telltale black spot.

Often, necrotising fasciitis patients die because the infection is diagnosed too late. Of 89 patients admitted to Changi General Hospital (CGH) between 1997 and 2002, 19 died. Another 20 needed a limb amputated.

According to a team of CGH doctors whose article on the illness was published in the Journal Of Bone And Joint Surgery, advanced age, other illnesses and delayed surgery make death more likely.

Most of the 89 patients were elderly and 70 per cent also had diabetes. Their ages ranged from 27 to 84. For 62 patients, the infection began in their legs.

The 70 who survived needed an average of 2.7 operations to clear their body of the bacteria.

According to the team, one of the signs of necrotising fasciitis, which can be caused by several different bacteria, is pain that is out of proportion to the apparent wound.

Dr Helen Oh, a senior infectious disease consultant at CGH, said children under five and people in their 50s or older are more susceptible.

The risk is higher if they are diabetic, obese, malnourished, drug abusers or alcoholics with scarred livers, and if they have high blood pressure or clogged blood vessels.

Pearline still needs to go for checkups, but she is now home and her mother said she's back to her usual self.