Doctor develops simple treatment for flesh-eating disease

Doctor develops simple treatment for flesh-eating disease

It was the crying and pleas for help that drew Dr. John Crew to Lori Madsen’s bedside at Seton Medical Center one day in January 2012.

Madsen, then 51, was several days into a terrifying case of necrotizing fasciitis – also known as flesh-eating disease. Her left arm had swollen to four times its normal size, and she’d had surgery to scrape out dead tissue. The pain was unbearable.

“My arm was dying on the inside. It was extremely horrifying,” said Madsen, now 53. “It wasn’t until it was all over, and I was out of the hospital that Dr. Crew sat down with me and said, ‘Lori, we almost lost you.’ I never knew I was that sick.”

Madsen was Crew’s test subject – the first to undergo a relatively simple-sounding treatment for necrotizing fasciitis that the Daly City doctor says saved her arm and her life.

Typically, necrotizing fasciitis is treated with heavy doses of intravenous antibiotics, along with extensive surgery to remove dead tissue.

Crew’s technique keeps the antibiotics but tries to avoid the repeated surgeries. Doctors irrigate wounds from necrotizing fasciitis with a solution of hypochlorous acid that was developed by NovaBay Pharmaceuticals in Emeryville, then drain the wound with a negative-pressure vacuum apparatus.

Hypochlorous acid – which is made when chlorine is dissolved in water, but also produced naturally by the body’s immune cells – is a common ingredient in cleansing solutions, but it’s usually mixed with other agents. The NovaBay scientists say they’re able to manufacture a pure solution of the acid in saline, which renders it both stronger and safer.

The product, called NeutroPhase, is federally approved for cleaning wounds, but not for treatment of necrotizing fasciitis.

“Historically, people have tried to just cut ahead of the wound. The surgeon comes in and cuts and cuts and cuts the infection,” Crew said. “We’ve been able to come in and take control.”

Crew’s work developing the technique earned him a nomination earlier this year for an international surgical award, called the Lister Legacy Prize. In the two years since he treated Madsen, he’s used it on about 20 other patients in the Bay Area and around the world.

But the treatment has been slow to catch on, for reasons that frustrate Crew but aren’t surprising to others who treat necrotizing fasciitis. It’s an uncommon disease that’s often far advanced by the time it’s diagnosed, and doctors, most of whom rarely see cases, might not be eager to experiment.

More important than any new treatment technique is simply making more doctors familiar with necrotizing fasciitis, so that it can be diagnosed early, said Dr. Stanley Deresinski, a Stanford infectious disease specialist. Crew’s technique, he added, “is not too dissimilar from the way many wounds are handled now.”

“It looks like a pretty effective antiseptic solution that would maybe add some benefit. But I would like to see somebody do clinical trial with it,” Deresinski said. “Of course, this kind of thing, it’s next to impossible to do clinical trials because the cases are so infrequent.”

Necrotizing fasciitis is a bacterial infection that is thought to affect several thousand people in the United States annually, although Crew believes the actual number may be close to 30,000 because many cases are never diagnosed. It’s often deadly – several studies suggest about 1 in 4 people who develop it will die.

Starts with bacteria

The disease can be caused by several types of bacteria, but A Streptococcus, the same bacterium that causes strep throat, is the most common. Necrotizing fasciitis occurs when the bacteria get into an open wound. A combination of toxins released by the bacteria and the body’s own aggressive immune reaction results in destruction of deep tissue.

Early diagnosis can be challenging when much of the damage is happening beneath the skin and is often undetectable even with imaging equipment. And the symptoms can easily be mistaken for other illnesses.

more at http://www.sfgate.com/health/article/Doctor-develops-simple-treatment-for-flesh-eating-5508342.php