Flesh-eating WAILUKU >> Waikapu resident James M. Kosaka was rushing by a wooden stairwell at his home when he bumped his left knee and received a small cut on March 5, according to his family.
bacteria kill 3
Maui residents
State health officials advise
Symptoms and what to do
residents to get medical help
if a cut causes unusual painBy Gary T. Kubota and Rod Antone
gkubota@starbulletin.com rantone@starbulletin.comFive days later, his leg was amputated to halt the advance of the flesh-eating bacteria as a result of Group A streptococcus infection.
Less than a month later, after a fungal infection and dialysis, Kosaka, 51, a wholesale distributor and former postal worker, was dead from complications.
His ex-wife, Valerie Matsunaga, said she hopes others won't panic as a result of Kosaka's death and the death of two other Maui residents from the same disease in the last three months.
But she hopes people will practice proper hygiene and heed warning signs.
"If the pain is disproportional to the wound, always see your physician," she said.
Physicians and state health officials have issued a similar warning.
Dr. Scott Hoskinson, an infectious-disease specialist at Maui Memorial Medical Center, said he believes the infection and death rates for the bacteria are within statistical boundaries of one to five infections per 100,000 population.
"But we want to be cautious," he said yesterday at a news conference at Maui Memorial Medical Center.
According to the Centers for Disease Control and Prevention, in 1999 there were 564 cases of flesh-eating disease -- necrotizing fasciitis -- from Group A streptococcus nationwide, 141 of which resulted in death. State Health Director Bruce Anderson said while such deaths occur "more frequently than we like to admit," they are not an indication of an epidemic.
Hoskinson said that since November, six Maui residents have contracted Group A streptococcus, including three who have survived and three who have died.
Their ages have ranged from 21 to 70, and their residences have ranged from Lahaina to the Wailuku-Kahului area, he said.
Hoskinson said that while one of the fatalities might have had a predisposition to infection after receiving a spleen operation, most of the people who contracted the disease were healthy.
The two others who died included a 48-year-old woman who was cut by coral while surfing and a 48-year-old man who was bitten by an insect.
Besides Kosaka, two other Maui victims required amputations; one of them lived, the other died.
Hoskinson said many people become infected with less virulent strains of the streptococcus bacteria, including those who suffer from sore throats.
He said the flesh-eating bacteria is a severely toxic strain.
Hoskinson said there is no known drug to treat the bacteria, and the only way to halt its advance is through cutting away sections of the diseased body.
"The only way to stop it is to cut it off," he said. "It moves along by dissolving flesh."
Hoskinson said others have contracted the disease on Maui in the past, but he was not sure about the rate of death from Group A streptococcus annually on Maui.
Anderson said, "Six cases on Maui, three of them fatal, is not an unusual number, given the number of cases we've been tracking over the years, and in fact is not high when you look at what has been experienced nationally."
Anderson does ask the public and physicians to be aware that minor wounds can lead to bigger problems if cuts and scrapes are not properly cleaned and treated. Hoskinson said several of the victims on Maui had gone to see physicians, but the infections were not apparent at the time of the visit, and most of them were later diagnosed after being examined at the hospital emergency room.
State health officials say the problem is, however, that the symptoms of flesh-eating disease are not exclusive and that they can appear to be symptoms of a number of other ailments.
Dr. Paul Effler of the state Communicable Disease Division said that the No. 1 symptom to be aware of is more pain than expected around a cut or bruise and a high fever. Health officials also say that people should look out for a painful infection around the cut that spreads very quickly.
Necrotizing fasciitis develops from a common infection of Group A streptococcus, a bacterium found in the throat and on the skin. While most Group A streptococcus cases end up in relatively mild illnesses as strep throat, they sometimes cause life-threatening diseases such as necrotizing fasciitis.
Necrotizing fasciitis killed one person and infected 41 others on Kauai in 1997. State health statistics also show that from 1992 to the first four months of 2002, there have been an estimated 875 cases of Group A streptococcal on Hawaii, Kauai, Maui and Oahu. However, those numbers do not show how many of those cases of Group A strep may have developed into necrotizing fasciitis.
The disease is similar to one suffered by 5-year-old Alyshia Shimizu after falling down in her Wahiawa home two years ago. Alyshia is fine now after having lost 33 percent of her skin tissue before doctors were able to arrest the flesh-eating disease.
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Redness can spread
an inch an hour
Group A streptococcus is a bacterium often found in the throat and on the skin and may be carried by people who themselves bear no symptoms of illness. The bacterium can enter the body through any type of skin wound including abrasions, punctures, bug bites, stings and burns. While most such infections can result in relatively mild illnesses such as "strep throat," the bacteria can cause other severe and even life-threatening diseases such as necrotizing fasciitis. Early symptoms of necrotizing fasciitis include severe pain, fever, warmth, and swelling or redness around the wound site. As the infection progresses it may destroy muscles, fat and skin.Health officials say there are three important early symptoms of necrotizing fasciitis:
>> An infection around a cut or bruise is much more painful than one would expect. >> The infection spreads fast. In some cases it has been known to spread up arms, legs and other body parts at almost an inch per hour. >> A high fever. Though there is no vaccine to prevent streptococcal infections such as necrotizing fasciitis, health experts say people can cut down their chance of risk by doing the following:
>> Proper and immediate cleaning of all wounds, no matter how small, and keeping them clean and dry throughout the healing process. Wash the wound well in warm, soapy water, and then keep it dry with a bandage. >> Quick diagnosis of the infection by being aware of the symptoms, which include severe pain, redness and swelling. >> State health officials recommend that physicians should also be "proactive" in watching the wound for possible signs of infection and that they should be "prompt" with antibiotic treatment if the signs of infection are there. >> Medicines such as acetaminophen, like Tylenol, are suggested for patients to deal with pain. Other drugs such as ibuprofen are not recommended, as some studies suggest a link between those drugs and the development of necrotizing fasciitis.