TV Bonus: How Flesh-eating Bacteria Work

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Welcome to Stuff You Should Know from howstuffworks.com.

Hey, and welcome to the podcast.  I’m Josh Clark and with me as always is Charles W. “Chuck” Bryant.  He’s giving me the A-okay symbol so we’re all set to go.

And we have a bowl full of dinosaurs in front of us.

Pants are off.

Pants are off; mics are on.

Yes.

That should be our motto.

Should be – yeah.  That would look great on a tee shirt.

That sure would.

The all of our open wounds have been treated according to the step-by-step process included in this article.

Yeah.

Did you read that sidebar?

I did.

It’s gruesome.

Yeah.  And you know what?  This is like – this kind of thing can strike fear into you when it’s in the news, which it has been lately in Georgia and nationwide.  But it’s rare and we can’t say that enough.

True.

So don’t freak out and don’t start slathering yourself with antibacterial gel.

And to the writer’s credit it is pointed out in this article –

Yeah.

– there’s like 500 cases of this a year.

Worldwide, right?

I didn’t get that either way.

Oh, really?

Still, even in the U.S.

Sure.

Now in like maybe Andorra, that would be huge.

Yeah, true.

But, Chuck, after researching this, flesh-eating bacteria scares the tar out of me.

The beep out of you.

Exactly.  Yeah.

We can’t beep any longer.  It’s sad.

You just did, man, you just found a work around.

I just said beep, so that’s not the same thing.  Yeah, it’s pretty scary because it’s silent and it can –

It’s silent, but violent.

– the silent killer, it can creep up on you and in the case of Aimee Copeland, who we’ll get to sadly – like she was going to the hospitals for three days before they diagnosed it.

Yeah.

And by that time it was too late.

Right.

But not too too late because she survived obviously, but –

Yeah, apparently –

– we’ll get to that.

– I was reading an article about her and she’s just like tough as nails.  They said like –

It’s incredible.

– we’re gonna have to amputate your leg and she said like let’s do this –

Yeah.

– is what she said.

I know.

And she couldn’t even talk, she mouthed it.

I know.

So –

Far braver than me I would have been like let’s end this.

Right.  Exactly.

You know –

Unplug me.

– I’m such a wuss.

Right.  Yeah.  I heard now that she’s up and about the first thing she did was take like a half-gallon shot of scotch and punch out a doctor just for fun.

All right.  So we’ll get to her tragic but inspiring story.

Okay.  I was gonna use her as an intro.

Oh, go ahead then.

All right.  So –

We’ll get to it right now.

– Aimee Copeland, she’s 24, she’s a Georgia lady.  And she was on a zip line at a friend’s house and fell off.  I don’t know if the zip line broke or if she let go or whatever, but it was –

I think there was malfunction.

– it was in a – it over like a raviney creek over some brackish water.  And in brackish water, actually in all fresh water there is a bacteria called Aeromonas hydrophila or A. hydrophila.

Yeah.

And it’s everywhere.  Normally if you ingest a little bit of this it’s through swallowed water –

Sure.

– and it gives you the poops –

Just diarrhea though?

That’s it.

Yeah.

The reason why just diarrhea is because you have whole colonies of bacteria and antibodies in your stomach that are designed specifically to take on A. hydrophila –

Right.

– and put the smack down on it.

Yeah.

It’s part of your immune system, right?

Thankfully.

The thing is with Aimee Copeland, she had a gash in her leg from when she fell –

Yeah.

– and the bacteria got in that way.

And that is a whole different host of problems all of a sudden.

Exactly.  Your body is not used to fending off bacteria through wounds –

Yeah.

– and there are certain types of bacteria, which are generally known as flesh-eating bacteria that basically mounts the largest, most vicious virulent campaign of any bacteria around in your human body.

This is what I didn’t quite get though because you did this part as additional research, which I appreciate, but I’m not quite sure.  Is it a dummy attack is going on?

You wanna get into this?  This is how flesh-eating bacteria works.

Yeah, I mean we might as well go ahead and tackle this and then we’ll finish up Aimee’s story and then get into it.

Okay.  So what happens – what happens is the bacteria, which is again A. hydrophila, it’s everywhere –

Yeah.

– and our bodies are used to it.

Right.

Strep – the same Group A strep, streptococcus –

Streptococcus A?

Yeah.  That’s what gives us strep throat.

Sure.

It’s everywhere.  Fifteen to 30% of people are carriers, right?  These things are everywhere and normally when they get into our body through normal channels our body knows how to ward it off.

That’s right.

When they come in through a wound you have potentially big trouble.  And these bacteria are capable of producing toxins.  There’s anterotoxins –

Yeah.

– which are cytotoxins, meaning like they directly go and like kill cells.  They like weaken the membrane or something like that.  So they can go and attack tissues.  And then another thing that they might express genetically is exotoxins.

Right.

These are the ones where if you have a bacteria that expresses exotoxins –

That’s good, right?

No.

I thought that prompts the immune response.

It does.  The problem is is these bacteria are setting off almost – it seems like purposefully –

Right.

– an immune response from your T-cells.

Oh, okay.

But it’s too big and this huge response comes about and it’s like this big lumbering clumsy response from your T-cells.  So your T-cells are going haywire because this basically dummy attack has been launched by this bacteria to distract the T-cells.

So this is what I don’t get.  Are the T-cells attacking the wrong thing?

The T-cells aren’t attacking anything.  The T-cell’s going on high alert, signal the production of cytokines –

Okay.

– which are like signals, they’re like triggers, like histamines are.  They’re an immune response trigger, cytokines are.  The cytokines in turn over produce – or over excite macrophages and those things go and like eat cell detritus or detritus.

Actually I listened to the pronunciation.  It’s actually detritus.

Okay.  So it eats cell detritus.

Yeah.

So they’re going haywire and then last but not least they promote the release of free radicals, which normally go and target bacteria, but in this huge undirected immune response –

Over-response.

– that this bacteria has purposefully triggered, the free radicals are attacking all this tissue.

Okay.

So you have cytotoxic anterotoxins that the bacteria’s producing directly.

Yeah.

And then it’s also indirectly affecting this healthy tissue by promoting the release of free radicals.

It does seem purposeful.

It – very much does.

Like it sits around and reads The Art of War and decides this is how I’m gonna take you down.

Exactly.

Wow.

And it works like a charm.  So you have your tissue that’s being destroyed, right?

Yeah.

Which is where you get the term necrotizing fasciitis, which is the correct term for flesh-eating bacteria.

That’s right.

And it also promotes something called toxic shock syndrome.

Is that when your organs start shutting down?

That’s part of it.

Wow.

Yeah.

All right.  Well that makes sense.  And that’s scary.  And the scariest part of all this is that it starts out by something really tiny, like it can be a pinprick –

Right.

– of an open wound.  It doesn’t have to be some big gash on your leg and it starts out as something small and turns into something big –

Right.

– which is really scary.  And you know if you have a cut on your hand or on your leg and you – actually even if you haven’t been in any kind of brackish water, if you just – if it starts to hurt a lot worse than you think it should, then it’s probably not one of the 500 cases, but you should probably start looking into it.

Well, what was surprising to me was it doesn’t even have to be a cut, man.  It can be an abrasion, a bruise –

Yeah, how could a bruise?  I don’t get that.

I don’t know if your skin is thinned out at that site?

Really?  Like so thin it can just get through the outer dermas?

Maybe.

Wow.

But yeah – and it doesn’t just have to be like you said brackish water, like if you have a cut – an open wound on your finger –

Yeah.

– and you’re around somebody with strep throat –

Yeah.

– you could conceivably – all the stuff is in place for you to contract necrotizing fasciitis.

And it can go person-to-person for sure, but without an open wound it’s pretty unlikely.

Right.

Like that’s how they get in.

Yeah.

And they eat the fat, they eat the tissue and then they start to consume your organs.

Right.  And the reason the flesh-eating bacteria – clinically, the clinical term is necrotizing fasciitis, which means the killing of the fascia.

Right.

The fascia’s like this membrane that acts as connecting tissue between your skin and fatty layer and your muscles and joints and tendons and ligaments and bones and organs.

Yeah.

And it’s this uninterrupted membrane that covers your entire body beneath your skin.  It’s like one of those – what are they called?  The one guy sent it to us.  We have a green screen one.

Oh, the –

Root suit.

Yeah, the body suit?

It’s like a root suit.

Yeah.

But it’s between your skin and your muscles.

Right.

This is where this infection takes place.  And since it’s uninterrupted it can go everywhere.  It just basically chugs along and separates your skin from your muscles by killing all the tissue around it.

Well and the other scary part is it’s really, really, really fast.

Yeah.

Like this football player from the University of Tulsa died in a week.

Yep.

Big healthy tight end, you know.  Like you don’t have to be weak and you don’t have to be old or a child, like it can attack anyone that gets it and take you out pretty quickly.

Yeah.  In just a matter of days.  Like you said it can go from a pinprick to, you know you just lost your leg.

Yeah.  Well, which is what happened with Aimee Copeland.  I mean it’s a miracle that she’s alive right now.

Yeah.

But she ended up having her left leg completely amputated.  Her right foot, both of her hands and part of her torso –

God.

– and she got out of the hospital and then like – I mean it took a while, but then I think two or three days later she was – already had taught herself how to eat.  This company has thrown in to build like a 30 – $40,000 addition to her home –

Nice.

– for like rehabilitation and stuff.  And – yeah, pretty amazing.  Like her spirit – her dad has been posting like crazy on like Facebook and on her website they started and –

She’s a bad mama-jama.

Way badder than me.

She’s tough.

Yeah.  Very inspiring.

So when – say – what’s also crazy, Chuck.  It’s not just her.  There was another dude from Cartersville, Georgia –

I heard about that.

– who had another necrotizing fasciitis case.

Yeah.

And they were actually in the rooms next to one another at one point.

Wow.

They were at I think a burn center in Augusta –

Was it?

– because this place is one of the few places in Georgia that like knows what they’re doing with necrotizing fasciitis.

Right.

And so, you know how do you treat this thing?

Well the first thing you do once it’s diagnosed is like huge, huge heavy doses of antibiotics –

Yeah.

– to – obviously to try and kill it.  But like we’re not talking like pop a pill every six hours.

No.  Like constant drip, just basically –

Yeah.

– flooding your body with it.  And immunoglobulin – globulin – immunoglobulin.

Jerry thought that was funny.

Yeah, I heard.

So they want to remove like any of the dying flesh and try and isolate it and remove the bad parts, which is what they were doing with her.  And it just spread so quickly, you know they were like fighting a really uphill battle in her case.

I read in a case study – have you seen any pictures of this stuff?

No.

So I read a case study of this woman who came in and she had it in her arm.  And you could just – first of all her arm was swollen.  It was like Cabbage Patch Kid’s arm.

Yeah.

But then there’s like splotches of like purple and then splotches of black –

Yeah.

– and then what’s called desquamation, where like the top layer of skin is just peeling off.  And all of this had happened to her like over the course of hours.

Yeah.

And as they were treating it one of the things that they’ll do before amputation is called debridement where basically they take the limb that’s infected – or the area that’s infected and they just scrape the tissue off.

Yeah.  I read about that.

I saw a picture of it, it’s horrific.

Yeah.  I didn’t look at the pictures.

And then after that they have to treat it with skin grafts after it’s been – after they got all of it hopefully.  If they can’t get it –

Well, that’s what she did on her torso.

Yeah.  Okay.  And if they can’t get it then they amputate.

Wow.

Yeah.  It’s a pretty serious condition.

Yeah.  Okay, so what to look out for.  We said if you have like a smallish wound that’s like disproportionately painful you should go on high alert.  If it becomes like swollen and red and hot that’s a really bad sign.  If you get typical things you might associate with bacteria and a bacterial infection like diarrhea and fever and chills, nausea and vomiting, that’s a really bad sign too.  Especially if you have just a small cut in your arm.

So that nausea, vomiting, all that stuff could be the result of the infection.  It could also be the infection leading to toxic shock syndrome.

Right.

Which in and of itself is pretty interesting.  Apparently we’ve only known about that since 1978.

Really?

Yeah.  Do you remember like associating it with tampons?

No.

Well, when it first came out like almost all the case studies of this toxic shock syndrome, which is like basically your organ – multi-organ failure which is three or more, lowered blood pressure, all this other stuff – all of the cases were of people who were using like high-absorbency tampons.  They were women.  Then they started to look more and more and they realized that that didn’t hold true.  When you looked at more of the case studies there were a lot of men and everything.  And now they realize that it’s the result of an infection.  So like the lower blood pressure –

Right.

– is like your body mounting this huge immune defense.  And so histamines are released so your blood vessels dilate so your blood pressure decreases to a really dangerous level.

Wow.

It’s basically your body having this enormous allergic reaction to an infection.

And it had nothing to do with tampons?

No, it did.  It still did –

Oh.

– but they thought it was just tampons –

Oh, okay.

– that triggered toxic shock.

Wow.

Yeah, even still there’s like warnings on boxes I think –

Oh, really?

– that say like toxic shock syndrome warning.

Gees – that’s pretty scary.

I had older sisters.

I did too, but I didn’t get in their business.  So in the first 24 hours, you know you’re gonna feel these pains.  The second – I’m sorry, three to four days in there’s gonna be some swelling and that’s when you might get this purply rash or like blisters that are filled with a dark fluid.  That’s not a good sign at all.  And your skin even at that point, even three to four days in might start to flake off and turn white or dark.  And that is definitely a bad sign.

That’s the desquamation.

Then four to five days in that’s when the toxic shock happens and you’re pretty lucky if you haven’t been treated at this point to make it out alive.

Right.  Toxic shock alone, 50% of cases are fatal.  With flesh-eating bacteria overall 30 to 40 – I saw 25 is the lowest – 25 to 40% of cases are fatal.

Wow.  So should we talk about wound care?

Sure.  I’ve never cleaned a wound like this.

Well, then you haven’t been cleaning your wounds correctly.

This is one of the ways to prevent flesh-eating bacteria.

That’s right.  You want to flush your wound with cold water initially – no soap.  And in fact you don’t even want to get soap into the wound apparently.  You want to clean around it with soap and a cloth and then get some alcohol and put it on your tweezers.  Use the tweezers to clean out any gunk that’s in there.

In the wound site.

Yeah.  You don’t wanna stick your finger in there.

I’ve never stuck tweezers in one of my cuts – ever.

Well, that means you didn’t have anything in there.  Or you did and you didn’t know it.

I did and I was like I’m not putting tweezers in there.

Then you want to apply a bandage if it’s a place that can be exposed to dirt.  And they say to ask a doctor whether or not to bandage because sometimes wounds are better unbandaged and heal quicker.  Sometimes they’re better bandaged.  And then the old antibiotic ointment will always do you right.

Yeah.  And don’t forget the – well, yeah.  I almost always put a band-aid on.

Do you really?

I never had a wound where I’m like oh, I probably shouldn’t put a band-aid on that.

A symbolic band-aid.

Right.

What else you got?

Oh, I’ve got some other stuff like risk factors.  You can be totally healthy.  Just from the badness of Aimee Copeland, I assume she’s probably a healthy person.

Yeah.  I think so.

I think a lot of people typically are healthy so you can still come down with flesh-eating bacteria – necrotizing fasciitis as a healthy person.  But there are some risk factors that would put you in the higher likelihood camp.  If you’ve had an infection recently, especially one with a rash like chicken pox –

Yeah.

– that’s one.  Cuts, abrasions, those are big ones.  Steroid use – you don’t want to be using steroids anyway, but even if they were prescribed –

Yeah, there’s a lot of steroid medications that are good.

– and you have a cut – I think steroid – steroids prevent cuts from healing as fast.

Is that what it is?

So I think those two combined make you at a higher risk.  If your immune system is lower.

Sure.  Like if you’ve just been sick maybe?

Yeah.  Diabetes is a big one.

Oh, yeah?

Yeah.  And then if you are a black tar heroin user there’ve been outbreaks of necrotizing fasciitis among heroin users before.  There was one in the late ‘90s in San Francisco.

Really?

And black tar in particular sets you up for it because it’s like this lower purity heroin that’s gummy.  It’s gummier than regular heroin so it collapses your veins like almost immediately.  So people who shoot black tar heroin do what’s called skin-popping where they shoot it just under the skin or into their muscles.

Gross.

And then because it’s not the least bit refined – that’s why it’s gummy – there’s often impurities and sometimes some of those impurities are clostridia, which is a kind of bacteria that can be a flesh-eating bacteria.  So basically if you’re shooting black tar heroin you’re running the risk of directly injecting flesh-eating bacteria.  And there’s people who’ve lost arms, shoulders, ribs to flesh-eating bacteria by shooting black tar heroin.

I think the stuff you should now advise is to not do heroin.  Let’s just go ahead and just throw that out there.

Sure.  I could get by on that.

You’re avoiding a whole host of problems if you don’t do heroin –

Yeah.

– the H.

So what else can you do to prevent it?

Well keep the wounds clean, wash your hands a lot and that means warm water and soap and like 15 to 20 seconds of good scrubbing like you’re going into surgery.  Get between the fingers, dry it off really well and then after you dry it off don’t go and put your hand back on the faucet –

Right.

– to turn it off in a public bathroom or even your own bathroom.  Although I don’t know if I would do that in my own home.

No, I think your own home’s okay.

Yeah.

I feel like there should be some sort of – I mean it could lead to a rise in superbugs, but we already face those so what do we have to lose.  But I feel like there should be more cleaning products handy in like public bathrooms.

Well there are increasingly, you see those little hand sanitizer machines everywhere now.

No, I mean like here’s a bottle of like bleach water and just go ahead and spray that toilet seat or –

Well, I’m not like a Howard Hughes type but I definitely after I wash my hands in the bathroom in public, like I don’t put my hand on the door handle –

Right.

– or anything like that.  I always try and muscle my way out or put a paper towel between me and the thing.

I’m extremely conscious of that too, especially at the gym.

Yeah, I’ve been more conscious about it.

Which pops up with your character in an episode in our TV show that’s coming out.

That’s right.  Is that a little teaser?

Yeah.

Very nice.

Big teaser right there.

That’s true.

You got anything else?

No.  I mean Aimee Copeland’s story has been prominent lately obviously and they are accepting donations –

Oh, that’s good.

– and I think we’d be remiss if we didn’t announce that.  She spells her name A-i-m-e-e.  So it’s A-i-m-e-e C-o-p-e-l-a-n-d dot com, slash donations.  And just go to the website anyway and just – her story’s on there and her progress is on there –

Yeah.

– and it’s both frightening and inspiring in her case, so it’s definitely I think that triggered our desire to do this, right?  Or did it?

Well, yeah.  I mean not only that, but it seemed that nobody really had a good idea of what flesh-eating bacteria does.

A bunch of lousy local news reports.

Yeah.  And I mean not even local, like the national stuff too is like, you know really misinformed, like they’re like it eats through your tissue.  It doesn’t eat through your tissue.  Nobody dug into how it really works –

Yeah.

– it was very frustrating.

You know why?  Because it’s way easier just to scare people with things – with non-facts.

Right, but this is one of the ones where it was like the more I looked into it the more scared I became even.

Yeah, well, people are lazy.

Yeah.  Oh, I’ve got a little more.

All right.

I got one more.  So like it wasn’t until 1952 that somebody used the term necrotizing fasciitis and we really started to understand that it was bacteria or whatever.  But the – we knew about it since the Civil War.

Wow, that’s crazy.  What did they call it though in the Civil War?

Well, they used to name it according to the doctor who reported it.  So like – and it was also based on the area of the body that was infected.  So like if you had Fournier’s or Fournier’s gangrene, it meant that you had flesh-eating bacteria around your genitals.  If you had Ludwig’s angina it meant you had flesh-eating bacteria around your face or mouth or jaw.

Really?

Yeah.  And then they figured like oh, wait, we should classify it by the kind of bacteria and that these are not separate things.  Like this is all the same thing.  These people just had like a cut around there that this got into.

Boy, you were in big trouble back then too.

Oh, yeah.

If you’re in big trouble now, imagine back then.  Pretty scary.

Yeah.  Well that first guy that discovered it was a Confederate Civil War surgeon named Joseph Jones –

Really?

– and I’m sure he was like I can’t do anything for you, man.

Right.  He retired –

Yeah.

– to the country.

Yeah.

So that’s it; flesh-eating bacteria.

If you want to learn more about it you can type that in – flesh, hyphen – eating bacteria into the search bar at howstuffworks.com and that will bring up Listener Mail.

I am gonna call this We Love the Irish as always.  Josh and Chuck and Jerry, just a short note from an old geezer living in Limerick in Ireland who is one of your most devoted fans.  For the last number of years when walking my dogs every Sunday in the mountains of Oriland and Alpine areas occasionally, I’m listening to Stuff You Should Know on the iPod.

My biggest problem is that I’ve not been able to source a set of earphones that will suit my border collies, who is cool, intelligent peace would easily tune into you laidback Southern dudes.  So he wants his dogs to listen.  That’s nice.

I thoroughly enjoy the show and particularly your easy symbiotic style and have recommended it widely.  In particular I enjoyed the shrunken head show because I used to have one.

Nice.

How, you might ask.  My sister worked in Columbia in the ‘70s and ‘80s and brought me home a present of a shrunken head.  It looked very real so the first question I asked was is it real?  No, it’s not she said, but added if you really want a genuine head I’ll bring one next time.  Needless to say I declined.  Which was a big mistake I think.

Seriously.

The original head is still hanging behind the bar of a pub on the West Coast of Co.Clare.  Is that –?

County Clare.

County Clare?  All right.

That’s what they do in Ireland – C-o.

C-o.  And that is from Mike Keyes and then Judy and Glen are the dogs.  He named his dogs Judy and Glen.

That’s very nice.

That’s very sweet.

They sound like a nice couple from the ‘50s.

I know and he’s just marching around Ireland listening to us –

Awesome.

– with his shrunken head around his neck I guess.

Well keep marching Glen and Judy and –

Mike is the human.

– Mike, the human.  Thank you very much for writing in on behalf of all three of you.  It’s pretty cool.

[inaudible].

So this one was a [inaudible] request.  If you have a request we want to hear it.  We’re always looking for good topic suggestions.  You can Tweet to us at SYSK Podcast.  Topic request is less than 140 characters almost every time.

Yep.

You can join us on facebook.com/stuffyoushouldknow.  Unlimited characters there.  Or you can send us an email to stuffpodcast@discovery.com.

For more on this and thousands of other topics, visit howstuffworks.com.

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27 Minutes