Bacterial Mystery

When a Kirkland man died this week from a fast-moving flesh-eating disease, the media nervously reported it as the third such local death in the past two months. Some media anxiously reported that the second death, of a Tacoma woman killed by the rare strep infection, was last month. In fact, if it's eye-catching headlines they were after, nine local people have been fatally infected in the first three months of 2006 by the somewhat mysterious disease known as necrotizing fasciitis (NF), according to King County Medical Examiner records. Altogether, in the past 27 months, 45 people in the county have died from the disease.

It's an unusual trend but not an epidemic: flesh-eating disease comes from bacteria on a person's skin; some strains are common, others deadly. The disease is not contagious, though it is frequently transmitted by drug users sharing an injection needle, which apparently was the case with two King County Jail inmates who died in 2004. (See "Contagion in the Jail," Dec. 7, 2005.) Still, NF affects everyday folks, and how a person contracts the disease is sometimes never known. It generally requires a deep-skin puncture to enter the body but might result from the most menial daily task. The Tacoma woman, for example, apparently died after a severe strain of bacteria likely entered her system when she nicked a leg shaving.

Unfortunately, "The diagnosis of necrotizing fasciitis can only be definitively made by a pathologist examining affected tissue under a microscope," sometimes after a person dies, notes Dr. Ben Sanders of Public Health–Seattle & King County. "Until then, the diagnosis may only be suspected." Doctors employ antibiotics in the meantime and, if persuaded it's the swift-moving disease, often amputate infected limbs. The wife of the Kirkland man who died April 1 told KIRO-TV that doctors could actually see the disease advance in the form of discoloration moving along his arm. (She didn't know how he contracted it.) Sometimes doctors are less responsive to early, albeit unclear, signs of the disease: The family of the Tacoma woman is weighing a lawsuit against a hospital that originally sent her home with pain killers. However, diagnoses and treatments are improving, and a large majority of patients survive the inflamed and swollen infections—including a 6-year-old Bellingham-area boy, Jake Finkbonner, who is recovering at Children's Hospital in Seattle but faces restorative surgery. His family thinks he contracted NF when he was hit in the mouth by a basketball that cut his lip and infecting him with Type A strep.

Beyond the King County numbers, there are few other reliable indicators of how widespread deaths are. The state Department of Health says it no longer keeps such numbers. Nationally, estimates run from 500 to 1,500 deaths annually from necrotizing fasciitis. A review of local ME reports shows death by the disease might be more frequent than most people think: On average, one infected patient dies every two to three weeks in King County alone. The ME recorded 18 such deaths in both 2004 and 2005. That's 45 deaths in 27 months, counting the nine so far this year. Twenty-eight were males, 35 were white, and ages ranged from 31 to 95; most were in their 40s and 50s. Most were also residents of the Puget Sound region, as were all nine this year, but some in the past two years came from Southwest and Central Washington and several were from out of state. While all deaths are recorded as happening in King County, some victims are here because Harborview Medical Center offers the best treatment.

The sudden spike of nine deaths in the first quarter this year has officials puzzled. They say there's no single known factor behind the increase. County health spokesperson James Apa reiterates that "necrotizing fasciitis is not spread through casual contact and nearly always requires deep insertion of bacteria into body tissues." Comparatively, it is "exceedingly rare in the community," he adds.

randerson@seattleweekly.com