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Flesh-eating streptococcus A.

During the 50 years since the introduction of penicillin, we have seen an enormous increase in the availability of antibiotics--those "wonder drugs" that have sounded the death knell to so many infectious agents. Increasingly, however, we are now seeing some of those enemies rising like the proverbial phoenix from their own ashes. New strains of tuberculosis threaten us, the ubiquitous staphylococcus has taken on a new life of its own in many situations, and AIDS has introduced many infections that fail to respond to antibiotics.

Earlier this summer, we began to hear of the latest of these deadly mutants--the flesh-eating streptococcus bacterium that can consume an inch of skin, muscle, or other soft tissue in an hour! The organism was first noted in a news release from England, where several persons died after being virtually eaten alive by it. Now reports have come in from other countries, including our own. One man, exposed to the deadly microbe through a scrape on his leg, died within hours.

Fortunately, there is still no evidence that this newest medical horror is epidemic anywhere, and when treated promptly (preferably within hours) with good old penicillin, the infection can often disappear. This flesh-eating streptococcus is not some previously unheard-of microbial agent, but one of our oldest and best-known infectious agents. Specifically, it is a strain of the so-called group A streptococcus, a member of the family of beta-hemolytic streptococci, so named because of the type of reaction they produce in laboratory cultures.

Nor is this particular clinical manifestation of the streptococcus A something new. Its flesh-eating characteristic is a rare complication of strep skin infections, known as necrotizing fasciitis--in which the organism invades the fascial layer beneath the skin. Because the fascia is not well supplied with blood vessels, which carry infection-fighting immune cells and antibiotics to affected sites, the infection spreads rapidly through the fascial layers, cutting off circulation to the skin and adjoining muscle and other soft tissue, thereby destroying them. At this stage, only surgical excision of the infected tissues can stop the onslaught.

This particularly frightening example of a rare manifestation of infection with a very common organism highlights the problem of ineffectiveness of antibiotics that were formerly highly effective against certain infectious agents. At the time of this writing, there appeared to be no indication that the unfortunate consequences of these strep A infections necessarily resulted from resistance of the bug to penicillin--the drug of choice in strep infections. Nonetheless, we know all too well that strep and many other bacteria can become resistant to the antibiotics that once controlled them.

What, then, leads to the emergence of these resistant strains? In the simplest terms, successive generations of bacteria (which may reproduce themselves in a matter of hours) learn to cope with their enemy (any given antibiotic) by developing over many, many generations genetic characteristics enabling them to survive attack by that antibiotic.

Repeated exposure to a particular antibiotic is essential to this process of change. Thus, resistant strains are more likely to develop when an antibiotic is continually used against a particular bacterium. It is for this reason that physicians are (or should be) reluctant to give antibiotics unless they have reasonable assurance that a particular organism is present. With the annual tonnage of antibiotics used in this country each year, it is little wonder why we have seen the emergence of so many resistant strains.

The responsibility lies not only with our doctors but with us, the patients. Don't try to pressure your doctor into prescribing an antibiotic when he or she hesitates to do so--and don't take antibiotics on your own, using leftovers that Auntie Mame gave you or which are stored in your own medicine cabinet. Also, don't allow for leftovers--take prescribed antibiotics until they're gone, however you may feel after a few days.

Infections only partially treated are conductive to the development of bacterial resistance--and the resistant bacteria thus allowed to reproduce in your own system can become a hazard to all with whom you come in contact.
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Publication:Medical Update
Date:Aug 1, 1994
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