Food Poisoning 101

My character ate some fish that's gone more than a little bad. Now what?

As with almost everything in writing, the answer is - that depends. Food poisoning can be caused by any of over 250 substances (bacteria, parasites, fungi, etc), and symptoms range in severity from very mild to life-threatening or fatal. Therefore, as long as you get the basics right, you, the author, can play with the outcome and severity to your hearts content. The most common symptoms of food poisoning include:

• Diarrhea
• Abdominal pain or cramps
• Bloody diarrhea
• Nausea
• Vomiting
• Fever
• Headache
• Weakness
• General malaise (feeling "ill")

Symptoms usually start 2-6 hours after consuming the bad food, though this timeframe can be shorter or much longer (up to several days) depending on the agent of infection (bacteria, toxin, etc). Most food poisoning will clear up on its own without specific medical treatment within a week, depending on the agent, but most people will recover completely within 12-48 hours.

Youngsters and elderly folks tend to get symptoms more easily, and also tend to have more severe complications.

Complications of food poisoning are rare, but can include:

• Significant dehydration and shock
• Kidney failure
• Significant blood loss and shock
• Arthritis or joint pain that doesn't go away with the symptoms
• Nervous system disorders (paralysis, tingling sensations)
• Respiratory failure
• Inflammation of the tissue that surrounds the heart

In all of these cases, seeking medical help is important, but if your character lives in an era or region of the world that doesn't have the technology or knowledge to help, many of these complications can be fatal. A few of the organisms that most often cause fatal food poisoning and the foods they are found on are listed below.

• Salmonella - a bacteria commonly found on birds and reptiles, this little germ (see photo) is transmitted to humans through contact with these or by eating undercooked poultry (bird meat or eggs), consuming unpasturized milk, or eating food that's come into contact with surfaces that have been contaminated by salmonella (ie that old cutting board where he cut up the chicken first and then diced the tomatoes for the salad)
• Chlostridium botulinum - an anaerobic bacteria (non-oxygen environment required for growth) that multiplies in canned foods where the can or jar is damaged, the seal is broken, or the food was not properly sterilized prior to sealing. Even cooking the food thoroughly won't save the fellow who chows down on a can of this, because the bug that makes botulism produces a neurotoxin (nerve poison) that carries on after the germs themselves are dead. Botulism also lives in very low, mild forms in honey, but this is safe for all but the youngest or most immune compromised people. Babies should never be fed honey prior to age 1.
• Shigella - this little bug is passed heavily in the feces (pooh) of people with the infection. So how did it get on your cheeseburger? Somebody didn't wash hands before putting on that bun, more than likely. Ick. Symptoms last up to a week and can include pus in the diarrhea as well as all the usual symptoms. Kids who get severe shigella can develop seizures and brain damage.
• E. coli - unlike media reports would lead you to believe, E. coli is usually a mild infection. Even the most virulent (deadly) form of the infection, a strain called O157:H7 is rarely fatal. Most cases clear up within a few days, but this infection can spread into the rest of the body, causing severe bleeding problems and kidney failure. The most common way to get this little sucker is to eat undercooked ground beef. Why? Because modern food processing machines aren't always the most careful and meat can be contaminated with cow shit. Oops. Cooking ground beef or needle-punch tenderized meat thoroughly can save your characters a lot of problems later.
• Cholera - this type of food poisoning usually isn't passed in food. It's caused by dirty drinking water. Drinking untreated water, particularly in areas of high population, poor sanitation, war, or famine is just asking for it. Cholera outbreaks in pre-modern eras were devastating to populations, and continues to be a major problem in Africa, parts of Asia, India, Mexico and South and Central America. Vaccines are currently in development to prevent this infection but are still in human testing phase

A few other things to consider when poisoning your characters via dinner are the parasites that can be picked up through food. These include but are certainly not limited to:

• Fish tapeworms (giant tapeworms that can reach up to 30ft in length - see photo, yeah, that's not a shoe lace) can be contracted from undercooked or raw fish. In the US, sashimi and sushi-grade fish is flash-frozen at very precise temperatures to kill off these potential pests prior to serving.

• Trichinella (worms that invade the muscles of animals and humans and cause severe pain) are primarily gotten by eating undercooked pork.
• Giardia are one-celled parasites that spread from infected animals or people. If your character's dog gets bloody diarrhea, plan to fork over some $$ to test for and treat this before it spreads to the people.

As with any medical situation in fiction, consider what your reader needs to know, and what it's reasonable for your character to know. You, the author, might know that the character's symptoms are caused by that nasty waiter not washing his hands after using the toilet, but unless the character has gone to the doctor and been tested, or is prescient, she won't, and if the specific bug isn't important to the story, the reader won't care either.

*****This blog is written for fiction writings, for the purpose of writing fiction. Information herein is not intended for use by real people, pets, trees, or imaginary friends. Arizela is not responsible for information used for purposes other than those expressly intended*****

Animal Attacks

So your character is wandering along, minding his own business when out of nowhere a vicious creature leaps on him intent on lunch. The intrepid hero manages to fight the beast off, or perhaps the plucky heroine rescues him for a change, but he's not without battle wounds. Now what?

What kind of creature was it?

• Small animals like rabbits, rats, and squirrels tend to cause small, painful bites and marks, but unless your character is a hemophiliac, chances are he'll survive.
• Camels, horses, and other large grazing animals can do some major damage with bites, particularly if they occur on the head or face. Another concern with these animals is crushing injuries from hoofed kicks which can be serious or fatal depending on the force of the blows.
• Domestic cats and dogs come in all shapes and sizes, and their damage capacity varies just as much. The ferocious neighborhood chihuahua isn't likely to cause nearly the trauma that crazy old Bill's trio of abused pit bull guard dogs could. Likewise and ancient rolly-polly tabby cat is less likely to eat your face than a muscular tom in his prime.
• Large predator animals, be they tigers, lions or bears (or wolves, coyotes, primates, etc) are the biggest risk. Harder to fight off and with much more advanced weaponry than the average racoon, these big carnivores and omnivores mean business. Their survival depends on their ability to turn the next guy into ground chuck rather than being served up themselves. Big cats in particular come along with an increased risk of infection because they routinely lick their claws, dragging mouth germs all over these 5cm to more than 8cm long weapons.
• Humans (yep, we're animals too, folks) typically only bite during altercations of some sort (and in undead movies). Our teeth can do a lot of damage to hands and faces, but like the grazing animals above, the damage is usually limited to the cosmetic rather than the life-threatening (vampires and zombies aside). The big risk here is that human bites are much more likely to become infected than most animal bites. Yes, your mouth is dirtier than your dog's.

First things first - stop the bleeding

In an emergency situation, the ABC's of triage apply - Airway, Breathing, and Circulation. Most survivable animal attacks are going to endanger the third category, circulation. No blood means no circulation means bye-bye birdie, so the goal of first aid is to keep the blood where it belongs, on the inside. If the blood isn't gushing out, washing the wound in clean running water is recommended to prevent infection, but stopping the bleeding is more important and more immediate a need.

All but the deepest and deadliest injuries in a normal, healthy person are going to respond to pressure. Obviously if the animal has ripped into the abdominal cavity or neck or sliced through an artery, your character had better hope there's a rescue chopper on standby. But for flesh wounds, pressure is your friend. To stop most bleeding, apply direct pressure to minor wounds for 5-10 minutes without peeking. Even for deeper gashes, direct pressure will often stop or slow bleeding until further help can be organized.

Minor scratches can be cleaned with soap and water and covered with a clean bandage. Puncture wounds, deep scratches or wounds on the face should be attended to by a medical professional if at all possible. If your character is enjoying the good life in 1810, however, cleaning the wound with clean water and using stitches to close the wound is about the best you can hope for.

Special cases: Facial and scalp wounds

Face and scalp wounds bleed. A lot. Bleeding from scalp or facial wounds, even small cuts, can be pretty significant. Get pressure on it as soon as possible and seal the wound with stitches or surgical-grade bonding liquid (aka medical grade super glue).

Second step - Preventing Bugs

Infection is the most significant risk associated with wounds that are not immediately life-threatening (these include uncontrollable bleeding, penetrating abdominal, head, or chest wounds, neck injuries, head injuries). Keeping wounds clean and covered helps in any setting. In the modern world, small cuts can be covered with a thin layer of antibiotic ointment like Neosporin, Polysporin, or Bacitracin. Large, penetrating wounds may require surgery and/or prophylactic (preventive) antibiotics via either oral or IV methods.

If an infection occurs, symptoms usually start 2-5 days from the initial injury or sometime during the healing process for major wounds (which can take months). Symptoms include redness of the skin around the wounds (see photo, child with infected dog bites to face), increased pain, heat or warmth at the site and on the surrounding skin, foul-smelling drainage or pus (creamy or chunky textured drainage in any of several common colors including yellow, rust-brown, green, pink, blood-tinged, or white), and delayed healing. If the symptoms don't get any worse, minor wounds usually clear up on their own after a few days or a week in healthy individuals. However, folks who are very old, very young, immune-compromised (prone to getting infected), diabetic, or who have circulation issues, or folks who have deep or large wounds, or whose infections are caused by "super bugs" (antibiotic-resistant germs) can get very sick, very quickly and even die from skin infections.

Signs your character needs a doctor, shaman, or undertaker - fever, chills, generalized feelings of weakness, ill ease, fatigue, red-streaks along the skin starting at the wound and tracing lines outward, irregular heartbeat, or difficulty breathing. These symptoms may indicate a life-threatening spread of infection into the blood stream or other body organs. Some few people recover without aid from this sort of infection, but there is a high risk of death.

Third, consider the source

Bites from your fellow humans typically occur during a fight of some sort. In those situations where there is a likelihood of blood from another person entering an open wound, special tests for HIV and hepatitis are recommended.

Small animals, particularly rodents, can be carriers of Yersinia plague (aka The Black Death, see also Rare Diseases: Yersinia Plague). Yes, even in modern times, Yersinia plague can cause deadly disease, but modern antibiotics can cure the plague if given within a very narrow time frame. Seeking medical attention can be life-saving, particularly in regions where animal carriers of the plague are more common, like the US west.

Wild dogs, stray pets, raccoons, and large predator animals are considered to have rabies unless proven otherwise. Rabies is a disease which, if left untreated, leads invariably to madness and death. Treatment consists of giving a series of vaccine injections after exposure but before symptoms develop. Once symptoms show up, best start digging the grave.

Domestic dogs and cats are considered free of rabies if they have been vaccinated or if they could not possibly have come into contact with wild or unvaccinated animals.

Special Case: Bats in the Attic

Though bats are small mammals not birds, these tiny bug-eaters can harbor rabies virus. Bats are responsible for most of the cases of human rabies that occur in the US. According to the Centers for Disease Control, Rabies can be confirmed only in a laboratory. However, any bat that is active by day, is found in a place where bats are not usually seen (for example, in a room in your home or on the lawn), or is unable to fly, is far more likely than others to be rabid. Such bats are often the most easily approached. Therefore, it is best never to handle any bat. Bats have tiny, needle-sharp teeth that can penetrate the skin and infect a human without even leaving a mark, so if a Sunny Susie awakes to a bat flying around the ceiling, she'd best get the bat tested for rabies, or she could end up looking like this:

Just kidding!

Infection: Malaria

I vant to suck your blood!

What better time than Halloween to be thinking about blood suckers. The one you see to the right is Anopheles mosquito, and its bite probably doesn't even hurt, though it might itch later. 41% of the world's population lives in the home territory of these little vampires, but the loss of blood isn't that harmful. What your characters have to be wary of is the VTD - Vampire Transmitted Disease. Anopheles mosquitos are often infected with tiny, microscopic parasites that are the cause of one of the most common parasitic diseases in the world - malaria.

Every year around the world, 350-500 million cases of malaria are diagnosed. This disease is anything but rare.

Malaria is caused by several species of parasites - P. falciparum, P. vivax, P. ovale, and P. malariae. These yummy little microscopic bugs have a powerful hunger for red blood cells. The parasites are injected into the body through the bite of infected mosquitoes. Once injected, they race to the liver and begin to multiply. Victims rarely know they are infested during this stage as the 15-100 parasites build an army 30,000 strong before attacking the choice buffet that is the blood stream.

Once inside the blood cells, the parasites multiply and feed, eventually rupturing the blood cell and causing the symptoms of malaria. Symptoms begin anywhere from 7 to 30 days after the mosquito bite, but can be suppressed up to a year by modern anti-malarial drugs. How fast the symptoms start depends on which species of the parasite are infecting the person, and on the person's own body. Classical malaria attacks are rarely observed these days, but attacks occur every 2-3 days and last 6-10 hours each. The reason for this timing is that the parasites incubate inside infected red blood cells for 2-3 days before the blood cells rupture. In classical episodes, the victim goes through three distinct stages of illness.

• The cold stage - shivering, chills


• The hot stage - headaches, fever, possibly seizures (especially in children), vomiting


• The sweating stage - sweats, normal temperature, extreme tiredness

In general, a victim can experience any of the following symptoms, in any order: chills, fever, weakness, vomiting, sweats, headaches, nausea, muscle aches and generally feeling under the weather. In cases of infection with P. falciparum jaundice (yellowing of the skin and whites of the eyes) can occur along with enlargement of the liver and fast breathing.

Right. Sounds like a nasty case of the flu. What's the big deal?

Malaria infection killed nearly a million people in 1995 alone, and accounts for over 10% of all childhood death in developing nations. The strain of parasite, P. falciparum, are much more aggressive than the others and can lead to "severe malaria" in which one or more organ system fails to function. Systems and their symptoms are listed below:

• Brain infection - abnormal behavior, seizures, decreased ability to remain awake, coma or death


• Severe anemia leading to extreme tiredness and breathing trouble


• Respiratory distress (breathing trouble) - flaring of the nose, head bobbing, panting, fast breathing, blue tinge to the fingertips, lips or mouth, the inability to get enough air, passing out, death


• Longer bleeding times before clotting - this can lead to strokes, bruising, actual bleeding, gut-bleeds (bloody or coffee-ground appearance to the poop), bloody urine, etc..


• Cardiovascular collapse (failure of the blood stream to hold enough fluid in to meet the body's needs or failure of the heart to pump blood) - symptoms can include chest pain or difficulty breathing or may mimic shock - low blood pressure, loss of consciousness, rapid heart rate, shaking, cold extremities, sweating, lightheadedness, confusion


• Low blood sugar (starving the brain) - symptoms include dizziness, hunger, headache, shaking, anxiety, and heart palpitations (feels like your heart's doing flip-flops in your chest. On this I speak from experience)

Today, treatment with antimalarial agents reduces the severity and duration of malaria infection. A list of drugs used appears below, taken from the Centers for Disease Control website.

chloroquine
sulfadoxine-pyrimethamine (Fansidar®)
mefloquine (Lariam®)
atovaquone-proguanil (Malarone®)
quinine (Best bet for pre-modern settings)
doxycycline
artemisin derivatives (not licensed for use in the United
States, but often found overseas)

One more nasty little surprise, malaria caused by the P. ovale or P. vivix strains can lay dormant for months to years in the liver, eventually re-emerging to cause symptoms all over again.

A pound of prevention

Currently, the gold standard for prevention of malaria is using mosquito netting around beds and cribs to prevent mosquito bites. A multitude of non-profit organizations exist whose mission it is to send mosquito netting to poor and under-served populations in areas where malaria is endemic. Other methods include draining wet areas and eliminating standing water where mosquitoes breed, using pesticides to reduce mosquito populations, and using anti-malaria drugs prophylactically (to prevent infection) for pregnant women and individuals traveling to areas where the infection is endemic (native).

An evolutionary twist

One of the most fascinating phenomenon I studied in nursing school was Sickle Cell Anemia. This disorder is a genetic change to the shape of red blood cells that can cause severe problems and even death in those who are symptomatic. However, the trait for Sickle Cell disease actually conveys a protective factor against malaria infection! Considering that this trait developed in the part of the world where malaria have been endemic for the whole of human history, it's interesting that a twist of genetic selection could breed a trait to keep people from getting sick.

Despite this protective factor, those who develop full-blown sickling, where many red blood cells actually change shape to resemble a curved sickle (see picture), can have life-long severe pain and complications.

Addendum - you can find a map of the parts of the world where malaria is currently endemic (native) at the World Health Organization's website, this URL http://www.who.int/malaria/malariaendemiccountries.html.

Rare Diseases: Yersinia Plague

Yersinia plague is most famously known as The Black Death, a name given to it in the 14th century pandemic that swept away 25 million souls over the course of five horrific years. When plague is mentioned in modern times, folks often scoff - that stuff only happened in the middle ages, right? Nope. Each year, 10-15 cases of Yersinia plague are reported in the United States, and as many as 300,000 deaths world-wide are attributed to the bacteria which causes three distinct forms of plague - bubonic, septicemic, and pneumonic. Asia and Madagascar are currently experiencing "mostly controlled" epidemics, and three major pandemics, the most recent of which began in the 1980's, have brought this deadly menace to nearly every corner of the globe, with the possible exception of Australia.

Yersinia plague is caused by the bacteria Yersinia pestis (see photo). Y. pestis is a rod-shaped bacteria that has developed a solid reservoir among wild rodent populations, including prairie dogs, squirrels, and chipmunks but most famously associated with rats. In fact, it is speculated that the plague originated in Egypt and was introduced to the rest of the world by the black rat stow-aways on trade ships. It is very rare indeed for a human to be infected directly by a rodent, however. Much more commonly, the fleas that pester the infected rats spread the disease among humans. Y. pestis closes off the throat of the fleas, making them unable to swallow food. The poor starving parasites go on a feeding frenzy and with each bite and unsuccessful suck, spread the bacteria into their intended snacks - other rodents, wild animals, and humans.

Bubonic Plague

The most famous form of Yersinia plague, the bubonic plague, is also the least fatal of the three forms. Initial symptoms include the development of large, painful "bubos" (see photo below). The bubos are actually very swollen lymph nodes which served as points of initial infection and most often show up in the groin, under-arm, or neck. They tend to be red with a bruise around them and the tissue may die, turning the characteristic black color. Other symptoms make the common flu look like a kiddy ride - high fever, nausea, vomitting (possibly bloody), severe muscle/joint pain, sore throat, headache, debilitating weakness, chills, and a general sense of feeling so miserable you'd gladly lay down in front of a steam roller for a little relief. With modern antibiotics, if given quickly, the relief is more likely - only 15% of patients treated with antibiotic therapy and supportive therapy die, as opposed to 40-60% of people who go untreated. Bubonic plague can lead to septicemic or pneumonic plague.

Septicemic Plague

Septicemia is a severe, generalized infection - the bacteria circulate through the blood stream and can impact any organ in the body. Septicemic plague can occur after the formation of bubos or without bubos (rare) and the symptoms listed under the bubonic form of the disease. In addition, septicemic plague can cause symptoms throughout the body depending on which areas are affected - diarrhea (often bloody), constipation, severe belly pain, cough (often bloody), muscle pain, stiff neck, bleeding from just about anywhere, gangrene of the fingers, toes, penis, or nose, seizures, confusion, delirium, or coma. Untreated, septicemic plague is 100% fatal and can lead to pneumonic plague.

Pneumonic Plague

Pneumonic plague can be contracted two different ways - from the advancement of bubonic or septicemic plague or from coming into contact with another person or animal who has pneumonic plague. This form of the disease may include bubos and bloody cough, along with general symptoms of the plague and signs of pneumonia. The difference here is unlike bubonic plague and septicemic plague, pneumonic plague is extremely contagious person-to-person. While the other forms of Yersinia plague can pass person-to-person with close contact and exchange of bodily fluid, stepping within a few feet of a person suffering pneumonic plague and taking a few unprotected breaths can be quite literally a death sentence. Survival if treated with modern antibiotics within the first 24 hours of infection with pneumonic plague is often effective at preventing death, but left untreated, this form of the plague is 100% fatal.

The pandemics that swept through the pre-modern world drastically altered the face of the world, not just in terms of the depopulation, but in political, scientific, and religious terms as well. Volumes have been written which point to the Black Death of 14th century Europe as the single most important disease event in shaping the face of the modern world, creating the infancy of modern medicine and ending the dark ages.

Modern sanitation, pest control, and antibiotics have reduced this one-time mega killer to a smaller stature on the scale of world threats, but modern man might yet feel the real bite of this beast. In the age of terrorism, Yersinia plague in aerosol (airborn) form is considered one of the most feared as a potential biological weapon. And unlike small pox and polio, this deadly disease has host colonies the world over and will very likely continue to be a threat looming over us forever.

Rare Disease Column: Tetanus

Ever gone to the ER for a few stitches in a minor wound and had the nurse ask you when your last tetanus booster was? Oh great. A shot.

Well, don't be too hard on her. Tetanus might seem like no big deal now in the age of the vaccine, but it is still a deadly menace. The number of cases reported in the US has fallen considerably since the invention of tetanus toxoid, which primes the body to immunity against the bacteria that causes this highly infectious (but not contagious) disease - Clostridium tetani (see photo).

Tetanus, known as Lockjaw prior to the 1920's, was described as early as Biblical times, and no wonder. The C. tetani bacteria can live for years in soil or animal carriers and is widespread. While it seems to prefer geographical areas that are warm, moist, and which have high levels of organic matter, it can live just about anywhere and in the inactive spore form can survive most chemical antiseptics as well as autoclaving (heating to sterilize) to 112C or 249.8F for 10-15 minutes. CDC

The real danger of C. tetani is in the toxin it produces - an exotoxin which is one of the most powerful neurotoxins known to man. Less than 200 nanograms of C. tetani's deadly neurotoxin is enough to kill most humans. The generalized form of this disease is among the most dramatic and cruel non-contagious diseases out there. The toxin produces progressive spasming of the muscles, starting with the jaw, which locks tight and prevents opening the mouth or swallowing. Sometimes the illness ends here, with the person having difficulty breathing and a quick death, but most often, the stiffening, uncontrollable muscle spasms progress down the body - the neck stiffens and hyperextends over the back, the arms and shoulders begin to posture and so forth. The spasms themselves can be so powerful as to snap bones, and for those who survive, paralysis from broken spinal cords may be a reality. ~30% of cases will not survive, however, and many will end up looking like this poor soldier (see portrait) who died shortly after this posture was seen.


So how does one get tetanus? A common misconception about the disease is that you have to step on a rusty nail, but in truth, any deep puncture, cut, or chronic wound can become infected, regardless of what caused it. Nails and tools that are left out in soil have an obvious advantage in this regard, as the soil is one of the main places C. tetani is located. However, consider the fiction implications of cultures who thrust their great swords into the dirt prior to battle (please don't try this with your katana or rapier, as your character is more likely to suffer death by virtue of having a broken weapon in battle than to inflict it upon the enemy via tetanus).

In modern times, treatment consists of managing the original wound - keeping it clean and bandaged, plus updating tetanus boosters if appropriate. In individuals who've never had a 3-dose series (which is a standard for children in the US), passive immunity can be confered by giving an injection of antibodies from another human host who is immune. Once symptoms start, the anti-toxin is of limited use, but is often still given to keep symptoms from worsening. Supportive therapy for airway, draining the bladder, providing nutrition, etc are the mainstays of treatment. Each year in the present-day US, approximately 20-100 people still develop tetanus infections, with about 10% dying, most often related to not updating boosters every 10 years or IV drug use (particularly heroin, which is sometimes contaminated with C. tetani).

Another nasty little note about tetanus - surviving it once doesn't protect someone from getting it again. Also, infants can develop tetanus from infection of umbilical cords, particularly if they are cut with non-sterile instruments, but only in mothers who are not vaccinated. The incidence of this worldwide is still relatively high, but in the US, only 2 cases have been reported in the last couple of decades.

For more information on tetanus:

Centers for Disease Control
MedLine Plus, National Institute for Infectious Disease

Rare Diseases: Necrotizing Fasciitis

Necrotizing Fasciitis, or flesh-eating disease as the media likes to call it, is a rapidly spreading infection along the fascia or the layer of tissue that binds skin to muscle. This deadly disease is caused by a virulent strain of the same bacteria also responsible for strep throat, rheumatoid fever, scarlet fever, impetigo, childbed fever, and toxic shock syndrome - Group A Streptococcus pyogenes.

This particular form of strep infection usually starts at an area of trivial skin injury - a bruise, scrape, or small cut. The area becomes reddened and hot to the touch as the infection begins, but over 2-3 days the infected tissue begins to die (necrotize). The skin will gradually darken to purplish or black, and large, blood-filled blisters called bullae will begin to form. The below photo from UCSD med school illustrates both the appearance of skin infected with necrotizing fasciitis and the blood-filled bullae.



Left untreated, this infection can quickly march over enormous areas of the body and lead to death in a matter of a couple of days. Treatment involves surgically removing all dead and infected tissue in a process called debridement (de-breed-ment), which usually leaves the muscle layer intact and simply removes all the superficial tissue and skin in the affected region and for a clear margin around the lesion. If the infection continues to spread over limbs after attempts to debride, amputation may be life saving.

Both the infection itself and the treatment are horrendously painful. The lady in the photo above would likely have all the skin stripped off her leg from below the knee to the crotch if she wants to live, after which she'll look like she's been partially dissected until after skin grafts are applied. Meanwhile, not having skin is a huge risk for other types of infections. Recovery is likely to be a long process, involving physical therapy and plastic surgery and lots and lots of medications.

While very rare, the Centers for Disease Control reports that there are fewer than 1000 cases a year in the US. Even with quick treatment, death occurs in many cases. Some names you may recognize of individuals who have been infected or died from Group A Strep necrotizing fasciitis include Jim Henson of muppet fame, and Melvin Franklin of The Tempations.

For more information, see these articles from:
-- The Centers for Disease Control though this article discusses all invasive forms of Group A Strep together, not just Necrotizing Fasciitis.
-- WebMD

Infected Cuts

Q: What do infected cuts look like?

A: First off, there is likely to be an angry red color around the margins that extends anywhere from a few millimeters to several inches (reasonable size for a smallish cut 1-5cm). The area will be swollen, tender to the touch, and warmer than the surrounding skin.

The wound may drain blood, clear fluid, or pus or a combination of these. Pus colors range based on what the infectious organism is, and can include yellow, yellow-green, green, white, or tan/beige, but can also be tinted pink by blood getting into it. Blood from a wound that is infected will often be very dark or have clumps of pus floating in it.

The wound may form a moist-looking yellow scab or a dark, hard scab as it attempts to heal - these are both composed of dead tissue and the wound will heal faster and cleaner if they are removed and the wound bed is kept moist but not sopping wet. That said, constantly picking at a wound is a bad idea, too.

The best treatment for a small cut is to wash with soap and water, and cover with a clean dry bandage (and an ointment like Polysporin if modern era). Try to keep it clean and don't do what my son does and leave the bandage on for two weeks or until it disintegrates in the shower.

Large or deep cuts may require sutures or some sort of adhesive glue meant for surgical application (no, please don't use SuperGlue. It works like a charm, but non-toxic really isn't meant to read: safe to pour into open wounds). Again, washing the wound, keeping it clean, and keeping the wound-bed moist or the sutured cut dry will aid healing.

Infected minor cuts rarely turn into systemic problems, but if the red margin of the wound starts to look streaky or the red starts to follow veins in streaks, this is a sign of serious, potentially fatal infection of the bloodstream and needs emergent treatment. Likewise, a sudden, serious increase in pain, or severe swelling of the area can indicate serious infections.