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From: Ilena Rose on 6 Apr 2006 17:17

Thursday, April 6, 2006 - 12:00 AM

http://seattletimes.nwsource.com/cgi-bin/PrintStory.pl?document_id=2002914036&zsection_id=2002111777&slug=bacteria06e&date=20060406

EXCERPT: Those with suppressed immune systems have a higher rate of
mortality, Rubens said. In many cases, no direct cause can be
identified, according to an article published last year in the British
Medical Journal.

PEGGY KOPFMAN
Last Tuesday Ed Kopfman thought he had the flu. He saw a doctor on
Friday; on Sunday he died from necrotizing fasciitis.




Man dies from flesh-destroying disease

By Sonia Krishnan
Seattle Times Eastside bureau

Last Tuesday, Ed Kopfman thought he'd come down with the flu. On
Friday, he went to the doctor. By Sunday, the 47-year-old Kirkland
father of two was taken to Harborview Medical Center and died that
same day.

For those who knew Kopfman, the cause of death was even more shocking:
necrotizing fasciitis, a rare condition also known as "flesh-eating
bacteria."

"It's so unreal," his wife, Peggy Kopfman, said Wednesday. "We're all
still in so much shock."

The bacterial infection took another eight lives in King County from
January to March 15 this year, and 18 more in 2005, according to
Public Health ? Seattle & King County, citing data from the county
Medical Examiner's Office.

Nationwide, statistics vary, but in 1999 the U.S. Centers for Disease
Control and Prevention reported 600 cases of necrotizing fasciitis.

If caught early, chances of survival are high. Last month, for
instance, 6-year-old Jacob Finkbonner of Ferndale contracted it after
cutting his lip playing basketball. He was hospitalized at Children's
Hospital & Regional Medical Center in Seattle, and his condition has
been upgraded from serious to satisfactory.

The infection occurs when invasive forms of streptococcus bacteria
enter the body ? usually through a cut or opening in the skin ? and
quickly flourish between the muscle and deep connective tissues. The
bacteria spread along these planes and give off toxins and enzymes
that kill tissue.

Information



National Necrotizing Fasciitis Foundation: www.nnff.org
"This seems to be an area of the body that's more susceptible to
infection," said Dr. Craig Rubens, chief of Children's
infectious-disease unit. "It destroys very rapidly."

Group A Strep, responsible for strep throat, is the most common strain
of the infection. It's also the strain that killed Kopfman, according
to the Medical Examiner's Office. About 20 percent of people carry the
bacteria in their noses and throats, but few get symptoms, Rubens
said.

Previous injuries, advanced age, chronic kidney failure or diabetes
can make some people more vulnerable.

Intravenous drug users are at high risk, but the infection can strike
anyone. Those with suppressed immune systems have a higher rate of
mortality, Rubens said. In many cases, no direct cause can be
identified, according to an article published last year in the British
Medical Journal.

Doctors familiar with the disease are quick to point out that it is
rare and does not present a public-health hazard because it's not
easily transmitted from one person to another.

Part of the fear and misunderstanding stems from the name
"flesh-eating bacteria," they say, which has spread panic
disproportionate to the number of documented cases.

"The fact is, the bacteria that causes necrotizing fasciitis are very
common in our environment" and rarely evolve into the worst-case
scenario, said Dr. Jeff Duchin, director of communicable-disease
control at Public Health ? Seattle & King County.

But when it does happen, there are often no external clues. Patients
will complain of intense pain with no visible signs on the skin,
Duchin said. Complicating matters is that initial symptoms can mimic
other ailments like the flu, he said.

"The problem is that it's a notoriously difficult diagnosis to make,"
Duchin said. "It can spread before it's recognized and, frequently,
this diagnosis can only be made during surgery. Basically, you have to
see how the deep tissue is inflamed."

Peggy Kopfman is struggling to understand how the disease struck her
robust and healthy husband, a repairman by trade, who never shied away
from heavy lifting or taking on complex carpentry projects.

After being misdiagnosed with shingles on Friday, he was admitted to
Evergreen Hospital Medical Center's emergency room Saturday night when
the pain on his left side wouldn't let up, she said.

The left side of his chest started to swell and bruise, she said. "It
looked like someone beat him up," she said.

Doctors performed exploratory surgery and discovered the dead tissue,
she said. They removed some, stabilized him and transported him to
Harborview. In the time it took to get there, it had traveled down his
arm and killed the tissue, Peggy Kopfman said.

The couple had been married 10 years.



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