Help Me, Help Me, Help Me…next Tuesday

physicians

by Dr. Michael Miller

Health care providers are by nature an altruistic bunch.  I have the honor of interviewing potential entries to my beloved profession as part of the admissions process at the newest Osteopathic Medical School in Indiana, Marian University.  The process is unique in that it does not simply ask the age old questions of “Why you want to be a physician ?”, (“Because I want to do primary care in a rural area”).  No, our probing involves scenarios in which they have to look at a social situation, identify their thoughts, those of the opposing views and then cohesively demonstrate intelligence, confidence, logical thought processes and humanity…all in an 8 minute period repeated 7 times.  Their responses juxtaposed against what I see in my day to day always gives me pause to think about how the practice of medicine has been so perverted by the promotion of self abdication of responsibility.  The “let your government do it for you” mantras and newest politically correct definitions of disabled (encompassing everything from melancholia to dislike of red M and M’s) have resulted in a major paradigm shift in medicine.  Whereas, the hospitals once touted their ability to heal all manner of maladies, they now recognize their cost ineffectiveness, more detrimental than beneficial care (just check the nutritional parameters of anyone pre and post hospitalization) and the downright danger of going to one, unless you are a burgeoning superbug. (more…)

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Flesh-eating bacteria infections are on the rise in the US

Vibrio vulnificus

By Bill Sullivan, Indiana University

Flesh-eating bacteria sounds like the premise of a bad horror movie, but it’s a growing – and potentially fatal – threat to people.

In September 2023, the Centers for Disease Control and Prevention issued a health advisory alerting doctors and public health officials of an increase in flesh-eating bacteria cases that can cause serious wound infections.

I’m a professor at the Indiana University School of Medicine, where my laboratory studies microbiology and infectious disease. Here’s why the CDC is so concerned about this deadly infection – and ways to avoid contracting it.

What does ‘flesh-eating’ mean?

There are several types of bacteria that can infect open wounds and cause a rare condition called necrotizing fasciitis. These bacteria do not merely damage the surface of the skin – they release toxins that destroy the underlying tissue, including muscles, nerves and blood vessels. Once the bacteria reach the bloodstream, they gain ready access to additional tissues and organ systems. If left untreated, necrotizing fasciitis can be fatal, sometimes within 48 hours.

The bacterial species group A Streptococcus, or group A strep, is the most common culprit behind necrotizing fasciitis. But the CDC’s latest warning points to an additional suspect, a type of bacteria called Vibrio vulnificus. There are only 150 to 200 cases of Vibrio vulnificus in the U.S. each year, but the mortality rate is high, with 1 in 5 people succumbing to the infection.

How do you catch flesh-eating bacteria?

Vibrio vulnificus primarily lives in warm seawater but can also be found in brackish water – areas where the ocean mixes with freshwater. Most infections in the U.S. occur in the warmer months, between May and October. People who swim, fish or wade in these bodies of water can contract the bacteria through an open wound or sore.

Vibrio vulnificus can also get into seafood harvested from these waters, especially shellfish like oysters. Eating such foods raw or undercooked can lead to food poisoning, and handling them while having an open wound can provide an entry point for the bacteria to cause necrotizing fasciitis. In the U.S., Vibrio vulnificus is a leading cause of seafood-associated fatality.

Why are flesh-eating bacteria infections rising?

Vibrio vulnificus is found in warm coastal waters around the world. In the U.S., this includes southern Gulf Coast states. But rising ocean temperatures due to global warming are creating new habitats for this type of bacteria, which can now be found along the East Coast as far north as New York and Connecticut. A recent study noted that Vibrio vulnificus wound infections increased eightfold between 1988 and 2018 in the eastern U.S.

Climate change is also fueling stronger hurricanes and storm surges, which have been associated with spikes in flesh-eating bacteria infection cases.

Aside from increasing water temperatures, the number of people who are most vulnerable to severe infection, including those with diabetes and those taking medications that suppress immunity, is on the rise.

What are symptoms of necrotizing fasciitis? How is it treated?

Early symptoms of an infected wound include fever, redness, intense pain or swelling at the site of injury. If you have these symptoms, seek medical attention without delay. Necrotizing fasciitis can progress quickly, producing ulcers, blisters, skin discoloration and pus.

Treating flesh-eating bacteria is a race against time. Clinicians administer antibiotics directly into the bloodstream to kill the bacteria. In many cases, damaged tissue needs to be surgically removed to stop the rapid spread of the infection. This sometimes results in amputation of affected limbs.

Researchers are concerned that an increasing number of cases are becoming impossible to treat because Vibrio vulnificus has evolved resistance to certain antibiotics.

How do I protect myself?

The CDC offers several recommendations to help prevent infection.

People who have a fresh cut, including a new piercing or tattoo, are advised to stay out of water that could be home to Vibrio vulnificus. Otherwise, the wound should be completely covered with a waterproof bandage.

People with an open wound should also avoid handling raw seafood or fish. Wounds that occur while fishing, preparing seafood or swimming should be washed immediately and thoroughly with soap and water.

Anyone can contract necrotizing fasciitis, but people with weakened immune systems are most susceptible to severe disease. This includes people taking immunosuppressive medications or those who have pre-existing conditions such as liver disease, cancer, HIV or diabetes.

It is important to bear in mind that necrotizing fasciitis presently remains very rare. But given its severity, it is beneficial to stay informed.The Conversation


Bill Sullivan, Professor of Pharmacology & Toxicology, Indiana University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Rare ‘Flesh-Eating’ Bacterium Spreads North as Oceans Warm

Map of cases of the flesh eating bacteria Vibrio vulnificus

Debbie King barely gave it a second thought when she scraped her right shin climbing onto her friend’s pontoon for a day of boating in the Gulf of Mexico on Aug. 13.

Even though her friend immediately dressed the slight cut, her shin was red and sore when King awoke the next day. It must be a sunburn, she thought.

But three days later, the red and blistered area had grown. Her doctor took one look and sent King, 72, to the emergency room.

Doctors at HCA Florida Citrus Hospital in Inverness, Florida, rushed King into surgery after recognizing the infection as Vibrio vulnificus, a potentially fatal bacterium that kills healthy tissue around a wound. While King lay on the operating table, the surgeon told her husband she would likely die if they didn’t amputate.

Just four days after the scrape, King lost her leg then spent four days in intensive care.

“The flesh was gone; it was just bone,” she said of her leg.

Cases of V. vulnificus are rare. Between 150 and 200 are reported to the Centers for Disease Control and Prevention every year, with about 20% resulting in death. Most are in states along the Gulf of Mexico, but, in 2019, 7% were on the Pacific Coast. Florida averages about 37 cases and 10 deaths a year.

But a rise in cases nationally and the spread of the disease to states farther north — into coastal communities in states such as Connecticut, New York, and North Carolina — have heightened concerns about the bacterium, which can result in amputations or extensive removal of tissue even in those who survive its infections. And warmer coastal waters caused by climate change, combined with a growing population of older adults, may result in infections doubling by 2060, a study in Scientific Reports warned earlier this year.

“Vibrio distributions are driven in large part by temperature,” said Tracy Mincer, an assistant professor at Florida Atlantic University. “The warmer waters are, the more favorable it is for them.”

 

The eastern United States has seen an eightfold increase in infections over a 30-year period through 2018 as the geographic range of infections shifted north by about 30 miles a year, according to the study, which was cited in a CDC health advisory last month.

The advisory was intended to make doctors more aware of the bacterium when treating infected wounds exposed to coastal waters. Infections can also arise from eating raw or undercooked seafood, particularly oysters, it warned. That can cause symptoms as common as diarrhea and as serious as bloodstream infections and severe blistered skin lesions.

New York and Connecticut this summer issued health warnings about the risk of infection as well. It’s not the first year either state has recorded cases.

“There’s very few cases but when they happen, they’re devastating,” said Paul A. Gulig, a professor in the Department of Molecular Genetics and Microbiology at the University of Florida College of Medicine.

‘An Accident of Nature’

Vibrio has more than 100 strains, including the bacterium that causes cholera, a disease that causes tens of thousands of deaths worldwide each year.

The V. vulnificus strain likes warm brackish waters close to shorelines where the salinity is not as high as in the open sea. Unlike some other Vibrio strains, it has no mechanism to spread between humans.

It’s found in oysters because the mollusks feed by filtering water, meaning the bacterium can become concentrated in oyster flesh. It can enter humans who swim in salty or brackish waters through the slightest cut in the skin. Infections are treated with antibiotics and, if needed, surgery.

“It’s almost an accident of nature,” Gulig said. “They have all these virulence factors that make them really destructive, but we’re not a part of this bug’s life cycle.”

Once inside the human body, the bacteria thrive.

Scientists don’t believe the bacteria eat flesh, despite how they’re often described. Rather, enzymes and toxins secreted by the bacterium as it multiplies break down the human tissue in the area below the skin, causing necrosis, or death of tissue cells.

The infection spreads like wildfire, Gulig said, making early detection critical.

“If you take a pen and mark where the edge of the redness is and then look at that two or four hours later, the redness would have moved,” Gulig said. “You can almost sit there and watch this spread.”

Researchers have conducted studies on the bacteria, but the small number of cases and deaths make it tough to secure funding, said Gulig. He said he switched his research focus to other areas because of the lack of money.

But growing interest in the bacteria has prompted talk about new research at his university’s Emerging Pathogens Institute.

Examining the bacteria’s genome sequence and comparing it with those of Vibrio strains that don’t attack human flesh could yield insights into potential drugs to interfere with that process, Gulig said.

Shock and Loss

Inside the operating room at HCA Florida Citrus, the only signs of King’s infection were on her shin. The surgeon opened that area and began cutting away a bright red mush of dead flesh.

Hoping to save as much of the leg as possible, the doctor first amputated below her knee.

But the bacteria had spread farther than doctors had hoped. A second amputation, this time 5 inches above the knee, had to be performed.

After surgery, King remained in critical care for four days with sepsis, a reaction to infection that can cause organs to fail.

Her son was there when she awakened. He was the one who told her she had lost her leg, but she was too woozy from medication to take it in.

It wasn’t until she was transferred to a rehab hospital in nearby Brooksville run by Encompass Health that the loss sank in.

A former radiation protection technician, King had always been self-reliant. The idea of needing a wheelchair, of being dependent on others — it felt like she had lost part of her identity.

One morning, she could just not stop crying. “It hit me like a ton of bricks,” she said.

Six different rehab staffers told her she needed to meet with the hospital’s consulting psychologist. She thought she didn’t need help, but she eventually gave in and met with Gerald Todoroff.

In four sessions with King, he said, he worked to redirect her perception of what happened. Amputation is not who you are but what you will learn to deal with, he told her. Your life can be as full as you wish.

“They were magic words that made me feel like a new person,” King said. “They went through me like music.”

Physical therapy moved her forward, too. She learned how to stand longer on her remaining leg, to use her wheelchair, and to maneuver in and out of a car.

Now, back in her Gulf Coast community of Homosassa, those skills have become routine. Her husband, Jim, a former oil company worker and carpenter, built an access ramp out of concrete and pressure-treated wood for their single-story home.

But she is determined to walk with the aid of a prosthetic leg. It’s the motivation for a one-hour regimen of physical therapy she does on her own every day in addition to twice-weekly sessions with a physical therapist.

Recovery still feels like a journey but one marked by progress. She has nicknamed her “stump” Peg. She’s now comfortable sharing before and after pictures of her leg.

And she’s made it her mission to talk about what happened so more people will learn about the danger.

“This is the most horrific thing that can happen to anybody,” she said. “But I’d sit back and think, ‘God put you here for a reason — you’ve got more things to do.’”

What to Know About ‘Flesh-Eating’ Bacterium Vibrio vulnificus

Infection Symptoms:

  • Diarrhea, often accompanied by stomach cramping, nausea, vomiting, and fever.
  • Wound infections cause redness, pain, swelling, warmth, discoloration, and discharge. They may spread to the rest of the body and cause fever.
  • Bloodstream infections cause fever, chills, dangerously low blood pressure, and blistering skin lesions.

To Protect Against Vibrio Infections:

  • Stay out of saltwater or brackish water if you have a wound or a recent surgery, piercing, or tattoo.
  • Cover wounds with a waterproof bandage if they could come into contact with seawater or raw or undercooked seafood and its juices.
  • Wash wounds and cuts thoroughly with soap and water after contact with saltwater, brackish water, raw seafood, or its juices.

Who Is Most at Risk:

  • Anyone can get a wound infection. People with liver disease, cancer, or diabetes, and those over 40 or with weakened immune systems, are more likely to get an infection and have severe complications.

Sources:

This article was produced in partnership with the Tampa Bay Times.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

 

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Salivary peptide promotes wound healing, research reveals

salivary peptide wound healing wca

A study published online in The FASEB Journal delves into the mystifying fact that wounds in your mouth heal faster and more efficiently than wounds elsewhere. Until now, it was understood that saliva played a part in the wound healing process, though the extent of its role was unknown. The study examined the effects of salivary peptide histatin-1 on angiogenesis (blood vessel formation), which is critical to the efficiency of wound healing. Researchers found that histatin-1 promotes angiogenesis, as well as cell adhesion and migration. (more…)

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Crawford bags FDA clearance for wound dressing that will ‘save limbs’

fda wound dressing save limb

Crawford Healthcare, one of the biggest makers of advanced wound-care products in the UK, has won clearance from US regulators for a medical dressing that it says will “save limbs”.

The product, called KerraCel AG, soaks up fluid and bacteria from nasty, oozing wounds and locks it away as a gel. It is also the only dressing of its kind to contain silver at a special concentration to kill all bacteria – even those resistant to antibiotics – that prevent chronic wounds, such as diabetic ulcers and pressure sores, from healing.  (more…)

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Dragon blood may help wounds heal faster

synthetic peptide heal komodo dragon

A new study has identified a peptide, derived from the Komodo dragon, called VK25, which can be synthesized and used as an antimicrobial peptide to promote wound healing.

The new research has identified (see below) a peptide found from the Komodo dragon (Varanus komodoensis), called VK25, which appears to be useful as a cationic antimicrobial peptide (CAMP). There is currently considerable interest in antimicrobial peptides in a world where antibiotic effectiveness is in decline. These peptides are potent, broad spectrum antibiotics which demonstrate potential as novel therapeutic agents. (more…)

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2018 American Nurse Today Education Guide

Moving ahead with your nursing education

Deciding to continue your education is exciting as well as daunting. You’ll need support from your friends and family, as well as your colleagues and fellow students. But you also can get support from the nursing profession. In this article, you’ll find information about a variety of resources to aid you along this next step in your career.

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Ready, set, go… to school!

With 79.6% of employers now requiring or having a strong preference for nurses with a baccalaureate degree and a growing demand for nurses, there’s no better time to return to school.

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Frontiers of nursing education

edu frontier nursing education table contents laptop cap scrollIn the first quarter of the 21st century, nursing education is an amalgam of traditional classrooms, innovativeeducational tracks, and technology-enhanced training. This new frontier is geared toward the learning and lifestyle needs of students and the changing healthcare environment in which new RNs will care for patients.

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Is an accelerated nursing program right for you?

Are you up for the challenge of an accelerated nursing program? You can earn your degree quickly and be off the races in your career, but these programs require dedication, self-discipline, and an ability to immerse yourself in the learning experience.

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Returning to nursing school? Keys to success

edu retuning nursing school keys success table contents color pencilCongratulations! You have decided to pursue additional nursing education and been accepted at the program of your choice. You’re happy—right? But you also may be feeling a bit anxious, especially if you haven’t been in school for a while. This article offers tips about how to get organized and stay engaged with fellow students and faculty, as well as steps you can take to enhance your computer and writing skills.

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Ready to change specialties?

The opportunities within nursing are practically limitless. You can choose patient care, education, pharmaceutical sales, research…the list goes on and on. That’s part of the challenge. With so many choices, you need to know yourself and what you want as well as understand what will be required to get you to this next stage in your career.

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Lifelong Learning: Is a postmaster’s certificate the right option for you

edu lifelong learning postmasters certificate option table contents scrollPursuing a postmaster’s certificate is a great way to advance your career. As you explore program options, pay particular attention to admission requirements, program length, delivery method, and costs. You’ll want all of these factors to align with your professional goals and personal circumstances.

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Interprofessional education

Imagine the depth of knowledge you would gain by learning along side students in other healthcare disciplines. In education settings that embrace interprofessional education, students learn with, from, and about each other to enable effective communication and improve patient outcomes.

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Can nursing meet the 80/2020 goal?

In 2010, a goal was set to have 80% of nurses with BSNs by 2020. Read this article to find out what kind of progress we’ve made so far.

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Your doctorate and the path to persistence

High attrition rates for doctoral nursing students (reported to be as much as 50%) in the face of an increasing demand for PhD-prepared nursing faculty is a growing concern. So, what’s at the crux of this problem and how do we solve it? When I was a doctoral student, I researched how other doctoral students balanced work, family, and school. The goal was to learn more about the strategies used by these students.

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2017-2018 Education Guide

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3 reasons why cornea is the new Glaucoma

Glaucoma

development of glaucomaOphthalmology is a great specialty partly because procedures, devices and drugs constantly evolve, keeping us learning and giving our patients better care. Ask your colleagues in other specialties, and you’ll find that the pace of change in most other medical fields is not nearly as rapid as in ours.

Over the past few years, this pace of change has been very evident in glaucoma, where minimally invasive procedures have greatly diminished the frequency of trabeculectomy and tube shunt procedures. In this issue of OSN, our cover story focuses on a specialty that’s now moving as quickly as glaucoma. And here are three reasons I believe cornea will continue to be the “next big thing” in eye care: (more…)

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Flexible Materials Innovations Advances Wound Care

Flexible Materials Innovations Advances Wound Care

The cutting-edge of wound care is a progressively flexible one, where textiles, foams, and films are applied to wound management technology with the goal of synergistic physiological function. These innately intuitive materials underpin the emerging medical solutions that practitioners and their patients are finding more effective than traditional wound care and closure methods. With an aging population more frequently seeking medical care and a surge in diabetes diagnoses, market analysts predict a continuing rise in demand for advanced wound care management products, fueling an annual industry growth rate of 6.4% over the next five years. (more…)

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Fish Skin for Human Wounds: Iceland’s Pioneering Treatment

Fish Skin for Human Wounds

The FDA-approved skin substitute reduces inflammation and transforms chronic wounds into acute injuries.

Six hours north of Reykjavik, along a narrow road tracing windswept fjords, is the Icelandic town of Isafjordur, home of 3,000 people and the midnight sun. On a blustery May afternoon, snow still fills the couloirs that loom over the docks, where the Pall Palsson, a 583-ton trawler, has just returned from a three-day trip. Below the rust-spotted deck, neat boxes are packed with freshly caught fish and ice. “If you take all the skins from that trawler,” says Fertram Sigurjonsson, the chairman and chief executive officer of Kerecis Ltd., gesturing over the catch, “we would be able to treat one in five wounds in the world.” (more…)

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Smart bandage uses nanosensors to track how a wound is healing

smart bandage

Bandages are intended to keep a dressing secure and clean in order to reduce healing time and infection rate. However, they may be about to get a new use-case, courtesy of a project from the United Kingdom’s Swansea University Institute of Life Science.

What researchers there have been working on is a new smart bandage capable of tracking how a wound is healing and sending that data back to doctors, via 5G technology. To do this it would employ tiny “nanosensors” able to fit comfortably within the fabric of regular bandages. (more…)

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