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The ‘frightening’ rise of flesh-eating bacteria: Mystery, pain and amputations.

Cindy Martinez contracted a flesh-eating infection in May. Doctors amputated her feet and her right hand last week. (Courtesy of the Martinez family)

A former Marine is fighting her toughest battle yet: Recovering from the devastating effects of flesh-eating bacteria.

Cindy Martinez, a 34-year-old mother of two who lives outside Atlanta, doesn’t know how she contracted necrotizing fasciitis and myositis, but it has already cost her both of her feet and her right hand. They were amputated last week, according to a Facebook page set up to support Martinez and her family.

Necrotizing fasciitis, according to the Centers for Disease Control and Prevention, is a serious bacterial skin infection that spreads quickly and kills the body’s soft tissue.

Martinez was diagnosed with the terrifying disease after she was admitted to the emergency room on May 25 with severe pain in her left shoulder blade, according to the family.

The next day, doctors were fighting to save her life.

Three days after that, doctors were forced to remove dead tissue down the left side of her body.

GoFundMe campaign has raised more than $76,000 to assist the family with medical bills. Martinez’s husband, David, who met his wife in the Marines and currently works as a Gwinnet County police officer, has spent weeks by his wife’s side in the hospital, missing work.

“Sure, she was a little scared,” David Martinez told People following his wife’s triple amputation, “but she was able to fight through that fear and say, ‘Enough is enough.’ ”

Like many victims, Martinez was young and otherwise healthy when she became infected.

Her husband called the source of the disease “a mystery.”

“She didn’t have any injury, and initially at home when she was feeling the pain, I looked at where the pain was at and I didn’t notice anything, and that’s what’s troubling,” he told ABC affiliate WSB earlier this month.

Ruth Berkelman, a professor of epidemiology at the Rollins School of Public Health at Emory University, told the Atlanta Journal-Constitution that it’s not unusual for patients to be unsure about how they contracted the infection. She said the entry point can be as forgettable as a minor cut or insect bite.

“Usually when you talk with patients, if you ask them if they remember having a cut or something, they say ‘yes,’ but not always,” Berkelman told the AJC. “Maybe there was an insect bite or mild abrasion they didn’t pay attention to, but it does happen when people don’t remember anything.”

It’s unclear exactly how many necrotizing fasciitis cases there are each year in the United States.

According to the CDC, there are “about 650 to 850 cases” of necrotizing fasciitis caused by group A streptococcus each year. But, the CDC says, “this is likely an underestimation as some cases are probably not reported.”

And the National Necrotizing Fasciitis Foundation notes that the CDC does not track cases caused by the other bacteria.

But the foundation, a nonprofit founded by two survivors of the disease, say the group A Strep statistics combined “with the as yet unquantifiable numbers of people who contract NF from other forms of bacteria” are “frightening.”

The disease works like this, according to the CDC:

Bacteria spread rapidly once they enter the body. They infect flat layers of a membrane known as the fascia, connective bands of tissue that surround muscles, nerves, fat, and blood vessels. The infection also damages the tissues next to the fascia. Sometimes toxins made by these bacteria destroy the tissue they infect, causing it to die. When this happens, the infection is very serious and can result in loss of limbs or death.

The speed at which necrotizing fasciitis attacks — often originating as simple soreness or swelling — takes many victims by surprise.

Zach Motal’s case was no different.

One day in May, Motal was strolling beside the surf in Fort Myers, Fla.

The next day, he was lying on an operating table having the lower half of his right leg amputated.

In between, his foot swelled up and turned purple, unleashing such excruciating pain on the 46-year-old that he showed up to the hospital in tears thinking it was broken, according to ABC News.

“I figured they were going to put a cast on me and tell me to go home,” Motal told ABC. “I would never in a million years imagine I had a flesh-eating bacteria in me.”

Through a small cut on his toe, Motal had contracted group A streptococcus, according to ABC. The bacterium, doctors explained to Motal, is the most common cause of necrotizing fasciitis.

The flesh-eating infection is caused by multiple kinds of bacterium, including Vibrio vulnificus, which thrives in the Gulf of Mexico and other warm salty waters during the warmer months.

Recent water tests in Fort Myers came back negative for Vibrio vulnificus and doctors have told Motal that he could have contracted group A streptococcus from “anywhere,” according to ABC. Motal, however, is convinced he came into contact with the bacteria during his walk along the beach.

“The water had just splashed over my foot and I didn’t think anything about it,” he told NBC affiliate WBBH.

Aside from being contracted via an open wound, Vibrio vulnificus can also be transmitted by eating raw shellfish, according to the Florida Department of Health.

According to the Centers for Disease Control:

An average of 50 culture-confirmed cases, 45 hospitalizations, and 16 deaths are reported each year from the Gulf Coast region (reporting states are Alabama, Florida, Louisiana, Mississippi, and Texas). Nationwide, there are as many as 95 cases (half of which are culture confirmed), 85 hospitalizations, and 35 deaths.

Two years ago, CNN reported, “the Florida Department of Health reported 11 deaths and 41 infections. Texas reports 15 to 30 annual cases, while Maryland State officials say they see an average of 25 infections per year.”

According to the CDC, Vibrio vulnificus infections prove fatal approximately 50 percent of the time. The infection — which can cause vomiting, diarrhea, abdominal pain and blistering skin lesions — usually kills victims within 24 to 48 hours as it spreads through the bloodstream and begins laying waste to precious tissue.

With so little time to act, doctors are sometimes forced to diagnose patients without a blood test and by relying on experience, according to a 2010 Sun Sentinel story.

“It’s really a surgical emergency,” Brian Brown, a physician assistant, told NBC affiliate WBBH. “They need to get in and do a fasciotomy and clean out the fascial plane and maybe even amputation.”

Doctors had no choice but to amputate Motal’s leg. He told ABC the leg has 2,500 stitches and looks like a prop from a “horror movie.”

A master carpenter and avid motorcycle rider, Motal told ABC he’ll have to find a new profession and hobby.

Even so, he told ABC, it could have been worse.

“The doctor said if I hadn’t have got here when I did, within four hours I would have been dead,” he said.

He added: “I think something does need to be done. The public does need to be aware that there’s a flesh-eating bacteria.”


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