Family counts blessings after superbug scare
A young father-of-three is learning to walk again after a terrifying battle with the deadly flesh-eating disease necrotising fasciitis.
Rick Teal, 33, of Wellington, was at work last month when he noticed a nagging pain in his right leg.
Within half an hour he was limping, and two days later he was in Wellington Hospital giving doctors permission to amputate his leg.
Doctors managed to save it, but had to remove large areas of infected flesh between his knee and ankle.
It will take Teal months to recover the strength in his leg and for the skin grafts from his thigh to heal. Necrotising fasciitis is rare, but is on the rise in New Zealand.
However, scientists are puzzled about why the deadly disease strikes some and not others, saying it can come down to "unlucky coincidence".
It is caused by bacteria penetrating a skin wound, sometimes just a tiny scratch or insect bite, and destroying the soft tissue. Teal's doctors couldn't find a scratch on him, and he has no idea how the bug came to attack him.
It is only now that Teal's wife, Kellee, will let herself think about how close she came to losing her husband of eight years, and father of their three children, Ruben, 5, Jaslyn, 3, and Joshua, 18 months.
"It's not until I look back now that I realise he could have died, or how close he came to losing his leg.
"When we were together in the hospital room and two surgeons were hovering over his bed and saying there's a chance we might take his leg . . . I feel that was a moment that really bonded us together.
"It was definitely a moment where we looked into each other's eyes. I could see the fear in his eyes and he could see the fear in my eyes, and we hung on to each other for dear life."
Necrotising fasciitis came to worldwide attention this month when American guitarist Jeff Hanneman, founder of the heavy metal band Slayer, died of liver failure while recovering from the disease. He had been bitten by a spider.
The disease has risen in New Zealand from fewer than 10 cases in 1990 to more than 70 in 2006. Otago University research of 812 cases in that time showed 148 people died.
The latest Ministry of Health figures show there are around 50 hospitalisations a year from the disease, and 13 people died in the last two years figures are available (2008-09).
One of the most common bacterial triggers is group A streptococcus which lives in the nose, throat and on skin of healthy people but can develop into a strep-throat infection, rheumatic fever or necrotising fasciitis.
"Sometimes it's from splits in the skin from athlete's foot or whatever, or something minor, a splinter or something too small to see or even remember," Wellington microbiologist Tim Blackmore said.
There is no common injury which dictates whether the infection will develop. "It's unlucky coincidence."
The biggest threat to life is blood clots developing from dead tissue. Although limbs are the most likely to get infected, things become complicated when the abdomen, armpits or genitals are involved.
"That gets pretty nasty. You've got to cut away fat and tissue and cover it up later," Blackmore said.
Otago University department of public health associate professor Michael Baker has investigated the disease, but says more research is needed.
"I would say there's enough cases and enough concern that we should probably look at doing a case control study on this disease.
"But the chance of getting funding for it is very limited. There's virtually no research money in New Zealand."
Meanwhile, Teal is learning to walk on his weakened leg.
"If I lie still I'm relatively free of pain but when I get up and move around, the blood rushes to my leg and it's really painful."
It will take two months to regain his strength and two years of keeping his leg out of the sun as the skin grafts heal.
Kellee Teal says the family's faith pulled them through.
"I don't know how people do it otherwise. And your family and friends are your cheer squad. But yeah, it was definitely pretty freaky."
Bacteria commonly found in healthy people – group A Streptococcus, Staphylococcus Aureus and gut organisms – are the largest contributors to the disease.
Infection occurs when the bacteria penetrates deep into a skin wound, which can be as small as an insect bite or scratch, eating away at fat and tissue.
Infection is not usually evident by looking at the skin, but is painful.
Severe localised pain coupled with a temperature are warning signs of infection, and treatment should be sought immediately.
It can be treated with penicillin if caught quickly.
Anti-inflammatory drugs should be avoided as they can mask symptoms.
No two immune systems are the same, so the chance of developing the disease is different for everyone.
Diabetics are most at risk of complications from the disease due to poor blood circulation.
Sources: Dr Tim Blackmore, Wellington Hospital microbiologist and Otago University department of public health associate professor Michael Baker.
The Dominion Post