Source of grisly infection not clear
An Ala Wai plunge surely did not help, disease experts say
Two Hawaii infectious-disease specialists say recent raw sewage spills into the Ala Wai Canal likely contributed to a 34-year-old man's life-threatening bacterial infection, which was contracted after falling into the Ala Wai Boat Harbor on Friday.
But state health officials say it is still unclear whether the waste water played a role in Oliver Johnson's condition. The loan mortgage officer was admitted Sunday to the Queen's Medical Center and remains on life support. The hospital had no comment on his condition.
Meanwhile, police are investigating whether Johnson was thrown into the polluted waters after a fight outside the Harbor Pub. Johnson told friends conflicting stories about what happened, sources said.
At one point he said he fell into the water. At another he told friends he was pushed. A homicide investigation will be opened should Johnson die.
In a news conference yesterday, Dr. Sarah Park, deputy chief of the state Health Department's disease outbreak and control division, said the water at the Ala Wai Boat Harbor "wasn't great" -- even before recent sewage spills sent more than 50 million gallons of untreated waste water into the canal and out to sea.
"There are a lot of different bacteria that live there," she said, adding that Johnson had several open wounds and failed to clean them after falling into the water. "Even by taking a shower and using soap and water, (the bacteria) is going to enter those wounds and there's nothing you can do about it."
She also said that "there's no way to predict" what type of bacteria spurred Johnson's rapid progression into toxic shock syndrome. "He did have multiple bacteria in his culture," she said, adding that "maybe one of them was associated with sewage."
But Dr. Alan Tice, chief infectious-disease specialist at the University of Hawaii's John A. Burns School of Medicine, said Johnson's infection is "almost certainly related to the Ala Wai." He added, "You only get those infections if you're contaminated with water, and the sewage probably made it worse."
Dr. Francis Pien, who recently retired as Straub Clinic & Hospital's chief of infectious diseases, also said that the bacteria found in Oliver Johnson's body -- vibrio vulnificus -- is uncommon in the islands.
According to the Centers for Disease Control, vibrio vulnificus is a bacterium that normally lives in warm sea water.
In rare cases, usually among those with low immune systems, the bacteria infect the bloodstream and cause fever, chills, septic shock and blistering skin lesions. It can also cause infection of the skin when open wounds are exposed to sea water, leading to "skin breakdown and ulceration," the CDC said.
"I've only seen probably three cases in the last 10 years," he said. "Vibrio grows in salt water or brackish water. (It) can grow better in sewage because it has a food source." In all three cases that Pien treated, he said, the infection was diagnosed early, treated "very aggressively" and the patients survived.
But Johnson, Park said, appears to have stalled before seeking proper medical attention and might not have cleaned his wounds properly.
Johnson's friends expressed concern yesterday after state officials decided to take down signs near Fort DeRussy and Ala Moana Beach Park warning people to stay out of the water because of high bacteria counts.
Health officials have defended their actions, saying the bacteria counts have returned to safe levels. They also say that the Ala Wai Boat Harbor is not meant for swimming and always has high bacteria levels.
"We know the bacteria counts at the harbor would be high on any day, even if there was no sewage spill for a hundred days," said Watson Okubo, of the state Department of Health's Clean Water branch.
"People are not swimming in the harbor. The commonsense approach would have us concentrating on the areas where the public swims."
Johnson went into the waters on Friday after drinking at the Harbor Pub across the street from where he lived. Police sources say several different versions of what happened to him that night have emerged. They said he told friends that he fell into the water but also told them he had been pushed in after a fight.
Still another story was that he got into a fight, was disoriented from a blow to the head and fell into the water.
A security guard at Johnson's condominium, the Tradewinds, last saw Johnson at about 5 p.m. on Friday and said he was bloody from what looked like a beating and that his clothes were soaked.
"He stumbled on property, and I said, 'Stay here, I'm calling the ambulance for you,'" guard David Dillener said.
"He had facial abrasions, arm abrasions. His eye had a lot of blood; you couldn't even see it. You could see he'd been roughed up."
Police responded along with paramedics and took down an assault report before Johnson was taken to the Queen's Medical Center. However, a source said Johnson might not have had his wounds cleaned because he was belligerent and refused treatment.
On Sunday, Johnson was readmitted to Queen's, where he was put on life support that night. On Monday, doctors amputated his left leg above the knee.
They are now considering amputating his other leg and left arm to help contain the infection, his friends said.
