‘Bath salts’ as new source of flesh-eating infection

 

New Orleans, LA, USA (January 12, 2012) – A study led by Russell R. Russo, MD, a third-year Orthopaedic Surgery resident at LSU Health Sciences Center New Orleans School of Medicine, has identified a new source of life-threatening necrotizing fasciitis – "bath salts." The study, describing the first known case of necrotizing fasciitis from an intramuscular injection of the street drug known as "bath salts," is published in the January 2012 issue of Orthopedics, now available online.

 

Necrotizing fasciitis is an orthopedic emergency. The ability to quickly and accurately diagnose this rapidly spreading disease can save a patient’s life and limb. However, the diagnosis is complex because necrotizing fasciitis usually manifests as a less severe cellulitis or abscess while the majority of the damage rages beneath the surface of the skin. Deep muscular necrosis is often masked by a normal-looking overlying tissue bed. The potential causes and vectors, or carriers, continually change.

 

"As ‘bath salts’ gain popularity, medical centers of all disciplines must be prepared to identify not only the signs of intoxication, but the potential side effects including deadly necrotizing fasciitis," notes Dr. Russo.

 

Dr. Russo and his colleagues treated a 34-year-old woman who presented with forearm pain and redness that began after she attended a party. She did not report other symptoms, but there was also a small red puncture wound on her arm. Treatment for cellulitis with broad-spectrum IV antibiotics dramatically reduced the symptoms, but lingering pain at the injection site led to an ultrasound. She then admitted that she had injected "bath salts" two days before she developed symptoms. When the patient was reexamined, she had rapidly progressing redness, skin sloughing, and drainage. Necrotizing fasciitis was suspected and she immediately underwent emergent surgical debridement and exploration, and more antibiotics were added. The infection moved so fast that pink, healthy tissue was literally dying before the surgeons’ eyes. They had to keep removing tissue until they reached clear margins of healthy tissue to stop the progression of disease. By the time they were finished, the patient’s arm, shoulder, and collarbone had to be amputated, and a radical mastectomy performed. The patient survived and subsequently underwent skin grafting and rehabilitation. Analysis revealed bacterial isolates including alphahemolytic Streptococcus, Streptococcus viridans, Peptostreptococcus micros, Gemella morbillorum, and Actinomyces odontolyticus.

 

The researchers note these infections are usually associated with crush traumas and farm injuries, but now physicians must also be prepared and vigilant when presented with a cellulitic patient who has a history of needle use. Even patients with their own clean needles are not immune, as evident in a report of an asthmatic patient who developed necrotizing fasciitis from an injection of subcutaneous epinephrine.

 

"Despite the drug’s legal status, it must be treated as illicit, and one must be suspicious when examining a patient with this clinical history because the diagnosis of flesh-eating bacteria can masquerade as abscesses and cellulitis," says Dr. Russo.

 

Necrotizing fasciitis has a rapid time-line to tissue destruction and loss of life. A 1995 study found the survival rate of those diagnosed with necrotizing fasciitis to be as low as 50%. However, wide ranges of death exist depending on a multitude of factors.

 

Treatment for this virulent disease remains a swift diagnosis with extensive surgical debridement to obtain complete control of the organism and prevent death. However, the authors maintain, the best treatment is prevention with public, street-based education and early detection.

 

"The recent emerging popularity of this highly obtainable, injectable substance may lead to an increase in cases of necrotizing fasciitis," concludes Dr. Russo, "and surgeons must be ready to diagnose and perform extensive debridements in association with general surgeons in some instances to save limbs, preserve function, and prevent death."

 

 

  • The study team included Dr. Noah Marks, Dr. Katy Morris, and Associate Professor Dr. Ronald Rooney, in the LSUHSC New Orleans Department of Orthopaedic Surgery, as well as Drs. Heather King, and Angelle Gelvin, MD in the LSUHSC New Orleans Department of Surgery.

 

LSU Health Sciences Center New Orleans educates Louisiana’s health care professionals. The state’s academic health leader, LSUHSC consists of a School of Medicine, the state’s only School of Dentistry, Louisiana’s only public School of Public Health, the only School of Nursing within an academic health center in Louisiana, and Schools of Allied Health Professions, and Graduate Studies. LSUHSC faculty take care of patients in public and private hospitals and clinics throughout the region. In the vanguard of biosciences research in a number of areas in a worldwide arena, the LSUHSC research enterprise generates jobs and enormous economic impact. LSUHSC faculty have made lifesaving discoveries and continue to work to prevent, advance treatment, or cure disease. To learn more, visit http://www.lsuhsc.edu and http://www.twitter.com/LSUHSCHealth.  

 

 


Louisiana State University Health Sciences Center, New Orleans, LA, USA, 12.01.2012 (tB).

MEDICAL NEWS

Fitness watches generate useful information, but increase patient anxiety
A new device provides added protection against COVID-19 during endoscopic…
81 million Americans lacking space or bathrooms to follow COVID…
Front-line physicians stressed and anxious at work and home
EULAR: High-Dose Glucocorticoids and IL-6 Receptor inhibition can reduce COVID-19…

SCHMERZ PAINCARE

Morbus Fabry mittels Datenanalysen aus dem PraxisRegister Schmerz aufspüren
Neandertaler besaßen niedrigere Schmerzschwelle
Deutscher Schmerz- und Palliativtag 2020 – ONLINE
Deutsche Gesellschaft für Schmerzmedizin fordert Anerkennung von Nicht-Psychologen in der…
DBfK: Besondere Rolle für Pflegeexpert/innen Schmerz – nicht nur in…

DIABETES

“Körperstolz”: Michael Krauser managt seinen Diabetes digital
Der richtige Sensor – von Anfang an
Diabetes mellitus: Ein Risikofaktor für frühe Darmkrebserkrankungen
Fastenmonat Ramadan: Alte und neue Herausforderung für chronisch Erkrankte während…
Sanofi setzt sich für die Bedürfnisse von Menschen mit Diabetes…

ERNÄHRUNG

Corona-Erkrankung: Fehl- und Mangelernährung sind unterschätze Risikofaktoren
Gesundheitliche Auswirkungen des Salzkonsums bleiben unklar: Weder der Nutzen noch…
Fast Food, Bio-Lebensmittel, Energydrinks: neue Daten zum Ernährungsverhalten in Deutschland
Neue Daten zur Ernährungssituation in deutschen Krankenhäusern und Pflegeheimen: Mangelernährung…
Baxter: Parenterale Ernährung von Patienten mit hohem Aminosäurenbedarf

ONKOLOGIE

Darolutamid bei Prostatakarzinom: Hinweis auf beträchtlichen Zusatznutzen
Multiples Myelom: Wissenschaftler überprüfen den Stellenwert der Blutstammzelltransplantation
Neues zur onkologischen Supportiv- und Misteltherapie und aktuelle Kongress-Highlights zum…
Finanzierung der ambulanten Krebsberatung weiterhin nicht gesichert
Lungenkrebsscreening mittels Low-Dose-CT

MULTIPLE SKLEROSE

Geschützt: Multiple Sklerose: Novartis’ Siponimod verzögert Krankheitsprogression und Hirnatrophie bei…
Neurofilamente als Diagnose- und Prognosemarker für Multiple Sklerose
Bedeutung der Langzeittherapie bei Multipler Sklerose – mehr Sicherheit und…
Bristol Myers Squibb erhält Zulassung der Europäischen Kommission für Ozanimod…
Einige MS-Medikamente könnten vor SARS-CoV-2/COVID-19 schützen

PARKINSON

Neue Studie zur tiefen Hirnstimulation bei Parkinson-Erkrankung als Meilenstein der…
Putzfimmel im Gehirn
Parkinson-Patienten in der Coronakrise: Versorgungssituation und ein neuer Ratgeber
Neuer Test: Frühzeitige Differenzialdiagose der Parkinson-Erkrankung
Gegen das Zittern: Parkinson- und essentiellen Tremor mit Ultraschall behandeln…