A substance found in parasitic worms’ spit might help prevent thousands of amputations a year, scientists in north Queensland have said. James Cook University researchers in Cairns are harnessing the molecule produced by a Thai liver parasite that can “supercharge” the healing of wounds.
Australian Institute of Tropical Health and Medicine parasitologist Michael Smout said non-healing wounds were of particular concern for diabetics and smokers. Dr Smout said the parasite used the molecule to keep its host healthy and prolong its own life. “It’ll live for a decade or two, and it’s munching around your liver, and zipping up the wounds as it goes,” he said. (more…)
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.
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.
Safety and Efficacy Study of VM202 in the Treatment of Chronic Non-Healing Foot Ulcers. This study will assess the safety and efficacy of using gene therapy via intramuscular injections of the calf for patients with chronic non-healing foot ulcers.
The first patient has been dosed in a Phase III trial assessing ViroMed’s VM202, the first pivotal study of a gene therapy indicated for patients with nonhealing diabetic foot ulcers (NHU) and concomitant peripheral artery disease (PAD).
The Phase III trial (NCT02563522) is a double-blind, placebo-controlled, multicenter study designed to evaluate VM202 for safety and efficacy in 300 adults with a diabetic foot ulcer and concomitant PAD. Two hundred patients will be randomized to VM202 and the other 100 to placebo, ViroMed’s U.S. division VM BioPharma said yesterday. (more…)
Washington, D.C. — In a presentation to the American Chemical Society meeting, Ankit Agarwal, a postdoctoral researcher at the University of Wisconsin-Madison, described an experimental approach to wound healing that could take advantage of silver’s anti-bacterial properties, while sidestepping the damage silver can cause to cells needed for healing.
Silver is widely used to prevent bacterial contamination in wound dressings, says Agarwal, “but these dressings deliver a very large load of silver, and that can kill a lot of cells in the wound.” (more…)
Laughlin Center for Wound Care and Hyperbarics has been honored as the Wound Care Center of the Year as well as recognized with a national award for continued excellence in wound healing by Healogics Inc., a wound care management company.
Leaders, physicians and clinicians from Laughlin Center for Wound Care and Hyperbarics recently gathered to celebrate the center’s receipt of the Robert A. Warriner III Center of Excellence award, according to a news release.
LUBBOCK, TX (NEWS RELEASE) – The Covenant Center for Wound Care & Hyperbaric Medicine has been honored as a Wound Care Center® of the Year by Healogics, Inc., the nation’s leading and largest wound care management company. The center also was awarded Center of Distinction and the President’s Circle Award.
The center has achieved patient satisfaction rates higher than 92 percent, a healing rate of at least 91 percent in less than 31 median days and healed almost 90 percent of its patients in less than 14 weeks. Out of the 630 Centers eligible in 2016, only seven centers across the country received this prestigious award. Covenant’s center was awarded as Center of the Year for the southwest region, which includes Texas, Oklahoma, Louisiana and New Mexico. (more…)
Nash UNC Health Care is continuing its effort to bring cutting-edge technology to the hospital.
Through a recent partnership with a Maryland-based medical imaging and data analytics company called Tissue Analytics, which is dedicated to revolutionizing wound care, Nash UNC Health Care has adopted new state-of-the-art wound imaging technology to its outpatient Wound Care Center. (more…)
I recently saw an ad for a pending lecture at a national conference that piqued my interest much like “deflate-gate”. The title of this lecture horrifically touted that Amputation need not be considered failure. As a full time wound care doc, I work to identify those conditions that place patients at risk of all consequences both limited and catastrophic. We use the catchy title of “Limb Preservation”. We start the process by engaging in the unusual behavior of making definitive diagnoses, then systematically address them in as comprehensive manner as possible. I am proud to tell you that while there are occasions in which a terminally damaged digit is lost, that we have rarely sacrificed the greater part of a foot and more, have had only 3 lower extremity amputations in the last 5 years on patients who’s care remained exclusively with us. Of course, when a patient for whom we have created and implemented a “Limb Pres” care plan is taken out of our system (usually via a hospitalization for a reason other then the lower extremity problem), the facility forces that be unfortunately but infrequently demonstrate their inadequacy and paranoia by gang-harangueing the patient and family. They are lambasted with lurid tales of the condition marching up the leg engulfing the foot, knee, torso, and brains much like a flesh-eating PacMan. The patient’s confidence now neutered has little chance against this persistent onslaught of inadequacy and so, much like the Queen song, “Another One Bites The Dust”. (more…)
When Dr. Breanne Everett began training to become a plastic surgeon she was shocked by the number of foot problems, including amputations, she was seeing among diabetic patients. She decided to look for a solution.
That led the 32-year-old physician to put her medical training on hold and make the transition into business and technology.
She invented a device to alert diabetic patients before a sore spot on their foot turned into a wound that could cause severe complications.
The Calgary company she founded — Orpyx — developed pressure-sensitive insole technology to feed information to patients and prevent the kinds of wounds that can lead to amputations in diabetics with peripheral neuropathy, which can cause numbness in the feet.
The company’s smart-sole foot protection system is attracting attention around the world with ongoing clinical trials in both the U.S. and U.K. The product is available through the company, which calls it the only device of its type on the market.
Using maggots to treat wounds dates back to 1931 in this country. Until the advent of antibiotics in the 1940s, maggots were used routinely. In the 1980s, interest in them revived due to the increasing emergence of antibiotic-resistant bacteria.
At Select Specialty Hospital Houston in Texas, we recently decided to try maggot therapy for a patient with a particularly difficult wound. In this case study, we share our experience. (more…)
A study in Ostomy Wound Management states the risk classification of patients using Braden Scale scores should comprise three (rather than five) levels: high risk, with a total score ≤11; moderate risk, with a total score of 12 to 16; and mild risk, with a total score ≥17.
The retrospective analysis of consecutively admitted patients at risk for pressure ulcer to an acute-care facility included 2,625 patients, with an age range from 1 month to 98 years; 3.1% developed a pressure ulcer. (more…)
Silence, roving eyes, fidgeting, excuses, a quick subject change—these are typical responses from healthcare clinicians when asked, “What’s the patient’s ankle-brachial index?” You’d think someone had just uttered a dirty word.
The ankle-brachial index (ABI) is a key component of the lower-extremity vascular exam, recommended and in some cases mandated by numerous clinical practice guidelines, including the most recent international guidelines on preventing and treating pressure ulcers. (more…)
