[Click on the name of the moon above for astronomical information.]

Amalthea (Greek): Nymph who fed Zeus with goat's milk. One of the horns of the goat broke off and was placed amongst the stars as Cornu Amaltheae, from which nectar and ambrosia were said to flow. (Moon of Jupiter.)

Flesh-Eating Bacteria: Facts Behind the Bug

[Much of the following information was obtained through The National Necrotizing Fasciitis Foundation and Center for Disease Control.]

Necrotizing fasciitis is a bacterial infection. These bacteria attack the soft tissue, usually in an extremity following minor trauma. There are also many cases of this occurring after surgery, and most often abdominal surgery.

NNFF can tell you about people who contracted it after a c-section, after abdominal surgery, after scratching a rash, after giving birth vaginally, from a scratch, after bumping a leg with a golf bag, after a friendly punch in the arm from a buddy, after a little cut on the finger, after a cut on the foot, after a rug burn, after having a routine blood draw in a physical exam, after a broken arm, and after a broken leg, and from no known trauma at all.

The bacteria are introduced from a person carrying Strep Type A or from an area where Strep Type A is present. These bacteria are the same as those that cause "Strep throat." However, there are various strains of the bacteria, some of which are more powerful than others (with stronger m-protein serotypes).

The name "flesh-eating-bacteria" is a little sensational, but essentially, the bacteria do "eat flesh." They attack the subcutaneous (soft) tissue, which then becomes gangrenous. Infection moves swiftly, usually under the skin, where it is unobservable. Once tissue becomes necrotic (dead), it has to be removed.

Few people who come in contact with a virulent strain of GAS will develop invasive GAS disease; many will have a routine throat or skin infection, and most will have no symptoms whatsoever. Although healthy people can get invasive GAS disease, those with chronic illnesses like cancer, diabetes, and kidney disease requiring dialysis and those who use medications such as steroids are at higher risk. In addition, breaks in the skin, like cuts, wounds, or chickenpox may provide an opportunity for the bacteria to enter the body.

If diagnosed very early, tissue loss can be "relatively" small, and surgery would be less severe, with removal of flesh, subcutaneous tissue, and fat only. The bacteria usually will not attack muscle or bone. In more advanced cases, major limb amputation is necessary. Death from this condition is not uncommon; however, many people are successfully treated.

In addition to the tissue decay, the bacteria causes the rest of the system to go into systemic shock. This may result in respiratory failure, heart failure, low blood pressure and renal failure. Basically, every system of the body can fail as a result of the severe infection and toxicity of the system.

Prompt treatment is essential due to the speed with which the infection spreads.

Unfortunately, symptoms of Necrotizing fasciitis resemble influenza ("the flu"), and most people delay treatment. No major trauma is necessary. In fact, the condition often occurs following minor trauma, or even a bruise or abrasion. As mentioned above, it can occur after surgery. In any case, the symptoms are the same.

Often after treatment is sought, misdiagnosis or delayed diagnosis occurs. Even in the hospital following surgery many cases have gone unrecognized until it was too late to save the patient. In the early stages, Necrotizing fasciitis may be indistinguishable from typical acute cellulitis, yet prompt diagnosis is essential because it correlates strongly with a more favorable outcome.

Here are some of the symptoms to look for in the general order in which they occur as the condition advances:

  1. Trauma of some type (however slight)
  2. Discomfort in the general region of the trauma
  3. Increased pain/tenderness; the pain is out of proportion in relation to the injury
  4. Flu-like symptoms: vomiting, diarrhea, dehydration, general malaise, weakness, muscle pain, and fever
  5. Swollen tissue and/or redness; affected area feels hot and very painful
  6. Condition worsens without any improvement of the above conditions
  7. Less frequent urination
  8. Potential appearance of a sunburn-type rash
  9. Large, dark boil-like blister(s) may or may not form
  10. Possibility of shock

When seeking medical help, be sure to call these symptoms to the attention of medical personnel. This minimizes the risk of a delayed diagnosis if indeed the symptoms are those of Necrotizing fasciitis.

The single, most important preventative measure is keeping the skin intact!

Next is cleanliness. Always wash even the smallest opening in the skin and apply an antibiotic ointment. Buy tubes of antibiotic ointment and keep one in your car, your desk, your exercise bag, and at home.

The spread of all types of GAS infections may be reduced by good handwashing, especially after coughing and sneezing, before preparing foods and before eating. Persons with sore throats should be seen by a doctor who can perform tests to find out whether it is "strep throat"; if so, the person should stay home from work, school, or day care until 24 hours or more after taking an antibiotic. All wounds should be kept clean and watched for possible signs of infection: increasing redness, swelling, drainage, and pain at the wound site. A person with signs of an infected wound, especially if fever develops, should seek medical care.

Be respectful to protect others from infection if you suspect that you may have a Strep infection, such as Strep throat, or have been exposed to someone with a known Strep infection. Carriers of the disease will not necessarily exhibit symptoms.

According to New Scientist: "A rare form of the horrific "flesh-eating" disease... may be on the upsurge in Canada, infectious disease specialists warn. Five cases caused by group B Streptococcus have appeared in Montreal since April 1996. Only four had been documented worldwide in the past 40 years."

In late 1996, Donald E. Low, MD and colleagues reported in the New England Journal of Medicine that children with chickenpox have among the highest risks for invasive group A streptococcal (GAS) disease. For children younger than 10, the investigators estimated that those who have chickenpox are at 39 times higher risk for invasive GAS infections than those who do not have chickenpox, according to researchers. Among children younger than 10 who have chickenpox, the attack rate for invasive GAS infections was 4.4 per 100,000 cases of chickenpox.

Strep A Kills 26 in Texas

AUSTIN, Texas, March 6 (UPI) _ The Texas Department of Health says an outbreak of group A streptococcal disease that began Dec. 1 has now claimed the lives of 26 people.

According to updated statistics released today, 117 Texans have been stricken by the potentially deadly bacterial disease, with the cases clustered mostly in the Houston, San Antonio and Austin areas.

The latest victim was a 71-year-old man, who died Wednesday at an Austin nursing home.

Dr. Steven Harris of the Austin/Travis County Health and Human Services Department said the elderly man had a moderate strain of the bacterial infection that usually isn't fatal, and that age was likely a factor in his death.

The Health Department report said the 26 dead include 17 adults and nine children. Ten of the deaths were in Harris County, six were in Travis and two were in Bexar.

Since last Saturday, the department has logged more than 1,200 calls from people with questions about the recent outbreak of group A strep. The agency says the hot line will remain open as long as there's a demand.

Health experts say they don't know what caused the outbreak that began Dec. 1 or why it affects different patients in different ways. But since the prevalence of the disease is seasonal, they say the number of cases will decline with the approach of spring.

In some patients, strep A causes no more than a sore throat, while in others, it progresses to more serious and fatal stages. In its most virulent form, the bacteria can cause the infamous ``flesh-eating'' disease.

Copyright 1998 by United Press International.

Further Resources

Miracle Victory Over the Flesh-Eating Bacteria
by David L. Cowles

Overcoming Necrotitis Fasciitis
(A book written by survivors of the disease)

Emerging and Reemerging Viruses

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