Pathogens & People:

Flesh-eating bacteria one toughcookie

By EDWARD McSWEEGAN, For The Capital

Published June 01, 2008

There are occasional outbreaks of "flesh-eating" bacteria in the U.S. andelsewhere, and such outbreaks always attract intense media attention. A number of bacteria can cause a flesh-eating syndrome known as necrotizingfasciitis. Two of these bacteria are well known to readers. Staph is one. This bug iscurrently making the rounds in health clubs, schools and hospitals as MRSA. Theother is strep, which is best known as the cause of strep throats.Strep, or Group A Streptococcus pyogenes, is a bacterium that could be described by the old recruiting slogan, "An Army of One." With an array of powerfulenzymes and destructive toxins, GAS can cause a variety of illnesses, includingstrep throat, toxic shock, rheumatic fever, pneumonia, impetigo and NF. JimHenson, the creator of the Muppets, died from a highly pathogenic strain of GAS back in 1990.The Centers for Disease Control and Prevention estimates there are about 10,000annual cases of invasive GAS in the U.S. About six or seven percent of such casesare NF and one quarter of those NF patients will die. Not even early andaggressive treatment can always save a patient suffering from necrotizingfasciitis.Last month, the

Tahoe Daily Tribune

published a story about a 34-year-old woman named Tanya Gludau. She cut her finger with a kitchen knife. The smallcut became infected with GAS and the highly invasive bacteria quickly spreadfrom finger to hand to arm to chest. In order to save her life, surgeons cut away massive amounts of infected skin and tissue. The woman emerged from aninduced six-week coma to find that most of her right upper body was gone. (The

woman, and the newspaper, should be commended for their mutual courage inpublishing a photograph of the damage inflicted by strep and scalpel. It is astartling image that conveys the horror of NF in a way the newspaper's longarticle and my own few words cannot.)How does this microbial ''Army of One'' do some much damage so quickly? As with any good army, this one is equipped with a huge array of clever weaponsdesigned to produce ''shock and awe.'' Literally. Enzymes are released to digestconnective tissue, allowing the bacteria to quickly spread. Other enzymes kill thepatient's white cells, break up red blood cells and degrade DNA.But the worst weapons are toxins called Streptococcal Pyrogenic Exotoxins. Thereare seven known pyrogenic toxins produced by different strains of GAS: A, B, C,F, G, H and J, which was recently discovered by Pat Schlievert at the University of Minnesota. In addition to being toxic and producing a skin rash characteristic of scarlet fever, they are also ''superantigens.''Most microbial components or ''antigens'' provoke limited and highly specificimmune responses. But superantigens are like skeleton keys, unlocking all of thegates that normally regulate immune responses to infection and disease. Once allof those gates are unlocked, there is a rapid proliferation of immune white cells(T-cells) and a sudden release of massive amounts of immune regulators calledcytokines. The resulting "cytokine storm" often leads to shock and organ failure.Patients with NF and streptococcal toxic shock may have fatality rates as high as67 percent. The high death rate likely is due to an unfortunate combination of invasive, toxigenic strains of strep and certain genetic patterns that make somepatients highly susceptible to superantigens. Bad genes meet bad bugs with badtoxins.NF infections demand rapid medical attention. Standard practice has been toaggressively remove any dead or infected tissues, and amputate hopelessly damaged limbs. Penicillin is given to kill the multiplying bacteria, andclindamycin - another antibiotic - is given to shut off toxin production. Still, it's