Medical examiner searching for links between infection victims

Health investigators probing three Curry County cases involving an invasive bacteria have found no direct connection between the victims, according to an epidemiologist with the state health department.

Wednesday, the New Mexico Health Department announced that two Curry County residents — a 23-year-old woman and a 53-year-old man — have died and a 58-year-old man is hospitalized, suffering from an invasive bacteria known as group A streptococcus.

Citing medical privacy, officials have declined to release any identifying information other than age and gender.

However, two Amarillo television stations reported late Thursday that the 23-year-old was a pregnant woman who, along with her infant, died in childbirth because of complications from the bacteria.

Stations KFDA and KAMR said the woman and her baby died on New Year’s Eve at Plains Regional Medical Center. The stations also reported the 53-year-old man was transferred from PRMC to Veterans Affairs Hospital in Amarillo, where he died from the infection.

The 58-year-old man is reportedly recovering in a Lubbock Hospital.

Dr. Chad Smelser, a medical epidemiologist with the state, is working with local, state and federal disease agencies to investigate the incidents.

Investigators are interviewing people who had contact with the three individuals and examining their circumstances in an effort to understand how and why they came down with the infections.

“We haven’t found a link (between the three) but we’re investigating to determine if there was any link other than (the fact) there was a similar time frame and they’re from Curry County,” Smelser said Thursday, explaining if a link is identified that could impact others, the public would be notified.

For now, officials want residents to be aware, and to seek help if they develop symptoms, such as: fever, severe pain and swelling, redness at the site of a wound, a rash over large areas of the body, dizziness or confusion.

Trying to communicate with and educate the public on incidents of group A strep is a difficult chore because experts recognize the symptoms are somewhat nondescript and similar in many ways to other common ailments, NMHD spokeswoman Deborah Busemeyer said Thursday.

“It’s a hard public health message because you have a mild illness that can escalate very quickly and we don’t have great advice for (people),” she said.

“With other kinds of diseases, we can say ‘look for this’, but (it’s harder with group A strep). ... It’s one of those bacteria that’s everywhere.”

But doctors and medical providers know what to look for and when to test, Smelser said.

“Doctors will know what to do. ... It’s a common bacteria. The invasive, deadly disease is less common, but doctors are relatively (familiar with the condition),” he said.

Group A strep is found on the skin, in the throat and can cause strep throat.

While it can often be easily treated with antibiotics, Smelser said, it can also cause an invasive infection in the blood, skin or organs, which progress rapidly and with high mortality rates.

“The biggest issue is these stories are tragic because these people are a little sick and all of a sudden they get sicker very fast,” he said.

Often by the time people seek help, they are already in the throws of rapid progression, he said, explaining, “It can be difficult when you see them because they’re already having multiple medical issues.”

People with diminished immune systems, young children, the elderly, people with skin wounds or lesions and those with a history of alcohol or intravenous drug use, he said, are particularly susceptible, though healthy people too can develop it.

Of the three Curry County cases, Smelser said one was discovered through a throat culture and the other two through blood cultures.

Group A strep is a reportable condition in the state of New Mexico, he said, meaning health officials must be notified when it’s discovered and its occurrence is tracked.

Medical providers throughout the region and even hospitals in neighboring Texas communities have been alerted to the incidents and given protocol for diagnoses, treatment and reporting, Smelser said.

Interviewing those who had contact with the three Curry County patients and continuing to do active surveys to monitor the region are all part of the investigation being conducted by health officials.

As with any contagious disease or bacteria, people can help protect themselves by using basic health precautions — sanitation, hand washing, covering coughs and sneezes, staying home when sick and seeking medical attention if serious symptoms develop, Smelser said.

Facts about severe strep infections:

Some types of group A strep bacteria cause severe infections, such as:

  • Bacteremia or sepsis (bloodstream infections)

  • Toxic shock syndrome (multi-organ infection)

  • Necrotizing fasciitis (flesh-eating disease)

Stats:

 In 2006, 4,587 cases of severe group A streptococcal disease were reported to the Centers for Disease Control and Prevention (CDC).

At greatest risk:

    • Children with chickenpox

    • People with suppressed immune systems

    • Burn victims

    • Elderly people with cellulitis, diabetes, blood vessel disease, or cancer

    • People taking steroid treatments or chemotherapy

    • Intravenous drug users

However, severe group A strep disease may also occur in healthy people who have no known risk factors.

Symptoms:

Depending on the specific infection, symptoms can include

   • Fever

   • Severe pain and swelling

   • Redness at the site of a wound

   • Rash over large areas of the body

   • Dizziness

   • Confusion

Diagnosis:

With identification of symptoms by a doctor, a culture of body fluids, such as blood can accurately identify a Group A Streppocoucus infection.

Treatment:

If identified early, treatment is possible.

Antibiotics used to treat these severe infections include penicillin, erythromycin, and clindamycin.

In cases of tissue damage, surgical removal of the tissue or amputate the limb may be necessary.

Source —National Institute of Health, www3.niaid.nih.gov/topics/strep, and Dr. Chad Smelser, medical epidemiologist with the New Mexico Department of Health

Recent outbreaks:

2002 — 31 out of 163 hospitalized Marine Corps personnel at the Marine Corps Recruit Depot in San Diego, Calif. were diagnosed with pneumonia stemming from group A streptococci. All of the recruits diagnosed with pneumonia  were treated successfully. One fatality in the group was tied to another condition.

1999 — Five female residents in Spokane, Wash., died over the course of two months in a cluster outbreak of invasive group A streptococcus. Each died within five days of the onset of the infection. An investigation revealed the women each had wounds or health issues that contributed to their susceptibility.

On the web:

• Centers for Disease Control, Group A Streptococcal (GAS) Disease — www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm

• The National Institutes of Health, National Institute of Allergy and Infectious Diseases — www3.niaid.nih.gov/topics/strep