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Bump triggers rare flesh disease

Doctors saved Patricia Barrs' right arm from necrotizing fasciitis, but she can no longer work.

Patricia Barrs bumped her elbow into a sliding glass door on a Saturday night.

No big deal, she thought.

By Wednesday, however, doctors at St. Joseph's Hospital in Tampa were struggling to save what was left of her right arm from necrotizing fasciitis, better known as flesh-eating disease.

They knew it could destroy muscle and bone with frightening speed. They also knew that Barrs, 42, would need both her arms to continue a 12-year career as a surgical nurse. Instead of amputating the arm, they began a series of 11 operations over the next 12 days.

Each time, they took out more of the infected tissue.

"They didn't think for two or three days that I'd live, and if I did, it would be with an amputated arm," she said.

Barrs still has her arm, but it remains bent at the elbow and marked with two 10-inch scars. She can't straighten it, raise it, or carry anything with it.

She says she is broke, jobless and roughly $200,000 in debt for her treatment so far. She still faces physical therapy and more surgery, and must learn to do everything with her left hand.

Barrs bumped her elbow inside her Wesley Chapel home on March 13. As a nurse, she knew that the pain, swelling and fever weren't normal reactions to a bump. She went to the East Pasco Medical Center in Zephyrhills two days later.

An X-ray showed no fracture, and she was sent home with Motrin and a recommendation to contact an orthopedic surgeon.

The next day, Tuesday, a radiologist reviewed the X-ray and noted "findings are suspicious for gas-producing soft tissue germ," or flesh-eating disease. However, Barrs said, nobody told her about the findings.

On Wednesday morning, Barrs' sister, Cathy, also a surgical nurse, came by to check on her. She took a look at the arm and called St. Joseph's emergency room. They were met at the door by an infectious disease specialist and an orthopedic surgeon.

She was taken right to surgery.

Necrotizing fasciitis is as rare as it is ferocious. It's a type of gangrenous infection caused by group A streptococcus bacteria, and it kills up to a third of its victims within days. Survivors generally lose a limb, since it often shows up in an extremity.

Studies of the disease can't pinpoint a single cause. Cases have been associated with surgery, with a minor bump, scrape or muscle pull and with an infected cyst.

If caught early, treatment with antibiotics can work. But the early symptoms of pain, fever and swelling don't usually suggest such a rare diagnosis as flesh-eating disease. By the time the proper diagnosis is made, the disease is usually advanced, requiring the surgical removal of infected tissue and sometimes amputation.

Barrs had seen only two cases during her 12 years as a nurse. Dr. Alan Bisno, an infectious disease specialist at the Miami VA Medical Center, has seen no more than a dozen, but he's collected information on many more cases.

It's a difficult disease to diagnose in its early stages unless the doctor removes a tissue sample and does a biopsy. Such an invasive procedure is hard to justify to patients and insurance companies on the basis of a minor injury.

"The biggest clinical clue would be pain out of proportion to what one can see externally," he said. "If the pain is excruciating, that should alert you that something more serious is going on."

Even then, most doctors would not think to check for necrotizing fasciitis.

"It's a rare disease," said Bisno. "It's not always possible for a primary care physician to diagnose it."

Barrs was working for a nursing temporary agency at South Florida Baptist Hospital in Plant City when she bumped her arm. She planned to start a full-time job at South Florida Baptist in April.

She had no insurance through the temporary agency and has applied for federal disability payments. Every day she discovers something else she can't do like she used to: gardening, driving, cooking, even folding laundry. She had her blond hair cut short because she can't style it one-handed.

She doesn't know how she'll pay for the treatment she still needs, doubts she can ever get insurance again and wonders how she'll manage. She doesn't like relying so heavily on her boyfriend, Mikel Kennedy, 54.

"I was so used to being independent," she said. "I just want to go on with my life."

Text for chart on flesh-eating bacteria disease not provided electronically. Please see microfilm.