flesh eating bacteria in lakes and rivers

Flesh-eating Bacteria: How to know to protect yourself this summer!

Imagine playing in the Tallapoosa River one day and then, within days, battling for your life against flesh-eating bacteria.

That's the nightmare transpiring for a University of West Georgia woman, after suffering a zip-cord mishap in the river on May 1, 2012. 24-year old Aimee Copeland was infected with aeromonas hydrophila, an antibiotic-resistant bacteria that thrive in warm and brackish waters of at least 30 US states.

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Many of us have been exposed to Aeromonas but will never get sick -- and if we do, the most likely symptom is diarrhea that results from swallowing the water-borne bacteria.

Aeromonas can be much more destructive, however, when it infects deep recesses of the body that are not commonly exposed to bacteria, such as through a gash, cut or some form of skin opening. Here, the stealthy bacteria can reproduce rapidly, giving off toxins and shunting blood flow to parts of the body. Skin, fat, and muscle tissue may be destroyed and amputations may even be needed to save the individual's life.

A water-safety wake-up call

What makes this story especially concerning is that Aeromonas-infected waters are quite common, though cases of it destroying human flesh are extremely rare.

Streptococcus A is the type of bacteria usually associated with flesh-eating cases, so when symptoms first appear, "most doctors often aren't looking for Aeromonas," said Amy Horneman, an aeromonas expert and microbiologist at the Baltimore VA Medical Center. "This is the Rodney Dangerfield of pathogens. It doesn't get any respect either, (But) when a traumatic infection occurs involving a suitable body of water, that's the first organism you should think of."

Who is at-risk for this flesh-eating bacteria and what you can do to protect yourself?

You are at greater risk if:

  • You have a weakened immune system from illness or cancer treatment, for example.
  • You have a chronic health problem such as liver disease, diabetes, or kidney disease.
  • Have deep cuts in your skin such as from a recent surgery or accident.
  • Have recently had a viral disease that includes a rash such as chickenpox or shingles.
  • You are taking steroids to suppress the immune system for the treatment of another disease.
  • You handle fish regularly such as fish hatchery workers and fishermen, since Aeromonas hydrophila is primarily a fish borne illness.
  • You engage regularly in water sports such as kayakers, boaters, and swimmers.

Symptoms to be aware of

If you do become infected, symptoms often start suddenly after an injury. If you have pain that gets better then gets much worse over 24 to 48 hours, you must get immediate medical attention. The pain may be much worse than expected from the level of injury. Look for:

  • Skin that is red, swollen and hot to the touch
  • Chills and Fever
  • Stomach symptoms such as nausea and vomiting
  • Diarrhea
  Related information  infographic about flesh eating bacteria
Flesh Eating Bacteria infographic

infographic about brain eating ameba
Brain Eating Amoeba infographic

Although there is no such thing as 100% prevention of acquiring a resistant flesh-eating microorganism, here are steps that may decrease your risk.

How to protect yourself

If you cut yourself in the water, be sure to thoroughly wash the wound in clean water (not from the lake or stream). Apply antibiotic ointment and dress the wound to keep it dry and clean. Most importantly, with a puncture or deep wound, stay out of fresh water lakes and streams (and even ocean water) until the wound has healed. And to guard against the more common type of aeromonas that occurs from swallowing the bacteria, following good sanitation practices are key: wash your hands with soap and water before eating or preparing food.

"It's one of the few true infectious-disease emergencies where an hour can make a huge difference," said Otto Yang, an infectious-diseases physician at UCLA's David Geffen School of Medicine.

Want to learn more? Watch MSN.com's interesting video about a related flesh-eating bacteria.

Sources (Accessed May 14, 2012)
http://www.nnff.org/nnff_what.htm
http://www.webmd.com/a-to-z-guides/necrotizing-fasciitis-flesh-eating-bacteria-topic-overview?page=2
http://www.thedailybeast.com/articles/2012/05/11/georgia-woman-fights-for-life-against-flesh-eating-bacteria.html
http://www.webmd.com/a-to-z-guides/necrotizing-fasciitis-flesh-eating-bacteria-topic-overview?page=2
http://news.yahoo.com/georgia-woman-24-battles-flesh-eating-disease-200835702.html
http://www.thedailybeast.com/articles/2012/05/11/georgia-woman-fights-for-life-against-flesh-eating-bacteria.html
http://www.webmd.com/a-to-z-guides/necrotizing-fasciitis-flesh-eating-bacteria-topic-overview?page=2
http://en.wikipedia.org/wiki/Acriflavine
http://en.wikipedia.org/wiki/Aeromonas_hydrophila
http://microbewiki.kenyon.edu/index.php/Aeromonas_Hydrophila
http://aem.asm.org/content/36/5/731.abstract
http://nithacom.sasktelwebhosting.com/attachments/article/31/Aeromonas.pdf

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Showing comment(s)
Alan
July 6, 2017
responding to those in this thread, these bacterias are not isolated to just fresh water. I live in Atlanta and I contracted NF a year ago in the Atlantic Ocean of the coast of Holden Beach N.C. I had no cuts or abrasions on my body. We only surmise that while swimming the waves I must have scraped across the bottom on the sand and shells, which caused the entry point of the bacteria. I was rushed to Emory Hospital where I spent over a month in the hospital, 3 weeks in a coma, and to date I have had 6 required surgeries to save my life. They only gave me a 5% chance of survival. There are several other Georgia cases in the last year. Amiee Copeland is doing well. We have become friends and I will be working with her and her foundation. We will be having our first annual Eudaimonium Festival in Candler Park here in Atlanta on September 9, 2017. I will have a tent to educate the public on Necrotizing Fasciitis. I invite you to stop by and say hello.
Jason at AtlantaHealth.com
July 8, 2017
Thank you for sharing your traumatic experience. I am so happy that things apparently turned out well for you. If you'd send me the details (perhaps with a link, if you have info posted online), I'd love to post a notice of your September event on our AtlantaHealth.com web site to help spread the word.
Sarah
August 22, 2014
Well I swim in the creek every weekend in the summer and I have had no issues at all. Since it is safe for fishing and swimming. I've never gone in with a cut and I've never swallowed the water, and none of my friends have had any trouble. So I guess it just depends on the water and the place.
Jason at AtlantaHealth.com
August 22, 2014
Thanks for your comment Sarah. I agree that summer water activities are a great way to get exercise, have fun and cool off. It sounds like you're using good common sense when it comes to being careful.

Since warm, freshwater appears to be most problematic when it comes to water-related illnesses, I was curious to learn what health experts mean when they say "warm." Shockingly, the CDC says that the brain-eating amoeba, Naegleria fowleri mentioned in a couple of the comments below, thrives at around 115°F and drops off as temperatures decline from there. However, it can survive in lake and river sediment at temperatures well below what it needs to thrive in water.

The optimum temperature for aeromonas hydrophila bacteria, which is the antibiotic-resistant bacteria that's the subject of the above article about Aimee Copeland, is 95-99°F but it can survive in water as cold as 39°F and as hot as 113°F.

(To give you an idea of how hot those upper temperatures would be, hot tubs (spas) sold in the US are not permitted to go above 104°F.)
Sid
October 10, 2013
I think I'm done with any sort of water sports. I can't believe that the best advice the Louisiana health official in this USA Today article has to offer for preventing some of these waterborne diseases is to "avoid getting water in your nose when swimming or bathing." That's nuts! http://www.usatoday.com/story/news/nation/2013/10/09/water-system-brain-eating-amoeba/2951933/
Jason at AtlantaHealth.com
October 11, 2013
I agree, Sid. That is awfully scary advice. But to be clear, that USA Today article about the drinking water in Louisiana relates to the brain eating amoeba issue. Almost every documented case of Naegleria fowleri infection comes from people getting the contaminated water up their nose. The aeromonas hydrophila bacteria, which is the subject of the article above about Aimee Copeland, is of greatest concern for people with cuts or other skin openings.
Ben
July 15, 2014
To add to what Sid said above; I'm afraid to even go swimming any more. Here's another article about a girl in Kansas who died from that same brain-eating amoeba mentioned in the Louisiana case, and the medical advice seems awfully contradictory. The CDC says "The amoeba is fairly common but the infection it can cause is rare." Why would it be so rare when the county health dept. says, "The amoeba goes up through the nose and into the brain and once it's there, there's really nothing anybody can do.'' Nothing in this article makes it sound like the 9-year-old girl was in any way immune-compromised. http://www.usatoday.com/story/news/nation/2014/07/13/girl-dead-brain-eating-amoeba/12600863/
Jason at AtlantaHealth.com
July 27, 2014
Hi Ben, According to the CDC, there were only 34 Naegleria fowleri infections in the US in the 10 years from 2004 to 2013 (132 infections in the 50 years between 1962 to 2013) despite the fact that hundreds of millions of people swim recreationally every year.

In general, tips for avoiding recreational water illnesses include:
1) Avoid any waters that you think may be contaminated by sewer, livestock, algae, dead fish, chemical pollution, urban or agricultural run-off, etc.
2) Keep your head above water and plug your nose or wear a nose clip when swimming in warm, fresh water.
3) Avoid getting water in your mouth or swallowing it.
4) Avoid stirring up the mud or sediment in shallow, warm, freshwaters.
5) Stay out of the water if you have open cuts or sores.
6) Shower-up with soap and water after water activities.
7) Immediately see a doctor if you become ill or show signs of infection.

Here are more recommendations from
- the Florida Dept. of Health: http://newsroom.doh.state.fl.us/wp-content/uploads/newsroom/2014/06/06.04.14Naegleria-Fowleri.pdf and
- the NC Dept. of Health: http://epi.publichealth.nc.gov/cd/water/prevent.html
Chuck
October 1, 2013
I've heard of several cases similar to this in Florida recently. Do you know if those are related in any way to this one in Georgia? I wonder if flesh eating bacteria cases are on the rise?
Jason at AtlantaHealth.com
October 2, 2013
Thank you for your message, Chuck. Since I am not a medical expert, I've requested a call back from the Brevard County Environmental Health supervisor in Florida for the most accurate information. But, apparently, the different types of flesh-eating bacteria are involved. The most recent fatality, which involved a man wading in Florida's Halifax River involved Vibrio vulnificus bacteria which requires lower to moderate water salinity -- such as where rivers and oceans meet. The bacteria that infected Aimee Copeland, Aeromonas hydrophila, can survive in either fresh or brackish water. To make things even more scary, two cases of a rare brain eating amoeba (primary amoebic meningoencephalitis) were reported this summer -- one in Florida and one in Arkansas. But amoeba are different from bacteria. According to an expert from the University of NC at Charlotte, it appears that the rising of ocean temperatures is making at least some water-borne infections much more common.
Adria
June 8, 2013
Do you know how things worked out for the young woman at the beginning of your article?
Jason at AtlantaHealth.com
June 9, 2013
Fortunately, Ms. Copeland survived. And though she had to undergo the amputation of both hands and one leg, she doing wonderfully: http://abcnews.go.com/Health/aimee-copeland-achieved-accident/story?id=19559033
Jason at AtlantaHealth.com
December 20, 2013
Here is yet another article about this topic, pertaining to a girl swimming in, of all places, Minnesota! http://www.usatoday.com/story/news/nation/2013/12/04/brain-eating-amoeba-annie-bahneman-pam-parasite/3633531/
 
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