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Flesh-eating disease afflicts 2 Oregon residents

By RANDI BJORNSTAD, The Register-Guard
Published: July 12, 2016, 9:15am

EUGENE, Ore. — The official name is necrotizing fasciitis, known colloquially as flesh-eating disease.

But as two Creswell residents who literally have battled for life and limb recently can attest, anyone who experiences a sudden “perfect storm” of symptoms — high fever; localized pain and hot, red spots or patches anywhere on the body but especially on the limbs; headache; sometimes even vomiting or diarrhea — should head for the hospital quick.

To put it in a “good news, bad news” perspective: Necrotizing fasciitis is statistically rare and not contagious; however, if it’s not identified, and treatment hasn’t begun, within a few days, it can be fatal in up to 25 percent of cases.

The condition is caused by a sudden, massive bacterial infection that attacks membranes called “fascia” that surround muscles, nerves, fats and blood vessels. If unchecked, the toxins given off by the bacteria kill the surrounding tissue and continue spreading to adjacent healthy tissue.

The only remedy for necrotizing fasciitis is intravenous antibiotics and a surgical procedure called debriding to remove dead and dying tissue. The worst cases can involve multiple amputations or death by multiple organ failure.

It can happen when one or more types of bacteria — most commonly group A streptococcus — enter the body through an opening in the skin, such as a bug bite, scrape, scratch, lesion or gash, and for unknown reasons begin to spread unchecked by the body’s natural defenses.

Some other bacteria that have been associated with the condition are Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus and Aeromonas hydrophila, according to the website of the U.S. Centers for Disease Control and Prevention.

However, “(If) you’re healthy, have a strong immune system, and practice good hygiene and proper wound care, your chances of getting necrotizing fasciitis are extremely low,” the CDC said.

About 600 people per year in the United States contract the condition, a prevalence that puts the country third behind China and India among the 120 countries for which statistics are available.

An unlikely candidate

If he’d thought about it at all, Creswell chef Scott Pisani would have put his chances at contracting necrotizing fasciitis next to nil.

The first weekend in June, Pisani and his wife, Chelsea, took their 8- and 10-year-old sons on a family camping trip to Fall Creek, one of their favorite spots to pitch their tent and go fishing.

“It was starting to be evening, and Scott’s left calf started cramping,” Chelsea Pisani recalled. “I’m a massage therapist, so I’m pretty aware of that kind of thing, and there was no redness or hotness, no reason that I could see for a cramp, and he couldn’t remember having done anything to hurt his leg.”

They went to sleep, “and he got up in the middle of the night and literally fell out of the tent,” she said. “I felt him — he was really, really hot — and I gave him some ibuprofen. The next day he was no better, so we just came home, and he crashed.”

On Monday, Pisani went to his physician, still without any symptoms that would pinpoint something as serious as necrotizing fasiitis.

“The doctor thought he might have a blood clot in the leg, so they did a CT scan, and it didn’t show anything,” Chelsea said.

On Tuesday, things started to get worse.

“There was redness on the back of his left calf, and he couldn’t put any weight on that leg,” she said. “He was in excruciating pain — we went to the emergency room, and within three minutes they called a trauma team, and he was taken to the hospital.”

That was surgery the first of seven, Chelsea said, “and they removed a whole chunk of tissue from behind his knee.”

On Friday, more dying tissue was debrided — medically removed — and on Sunday morning, “I got him up to help him to the bathroom, and the entire back of his leg was necrotic,” she said.

That day, Pisani was transferred by his family’s decision to Oregon Health & Science University in Portland, where he underwent surgery No. 3 the next day.

“It was really extensive,” Chelsea said. “They took it all the way down to the Achilles,” threading their way and removing necrotic tissue between the soleus and the gastrocnemius muscles.

Four more surgeries followed, the last laying a film of integra, which consists of an underlayer of pure collagen to help tissue regenerate and an outer layer of silicone to prevent fluid loss and spur healing, a process that takes between two and three weeks.

“It’s been a fun ride,” Scott said, sitting in the shade of a tree in the family’s front yard near downtown Creswell.

The ride’s not over yet. Still to come is weaning off the wound vac, an acronym for vacuum-assisted closure, which pulls out fluids that seep into the wound and further hastens healing.

Three weeks after that, he will be ready for skin grafts, each of which is followed by two more weeks of wound vac usage until the grafts heal sufficiently to be on their own.

“It will be 18 to 24 months before he is fully recovered,” Chelsea said.

Ironically, another family in Creswell recently has gone through the same random illness, and the two cases are eerily similar.

Blake Nelson, a 16-year-old high school student athlete and jazz saxophonist, suddenly contracted the condition around Feb. 29, said his mother, Michelle Nelson, a copy editor at The Register-Guard.

Blake’s case of necrotizing fasciitis also started in the left calf but also occurred in his left thigh, with no warning and no sign of external injuries. He has undergone months of treatment and 10 surgeries at PeaceHealth Sacred Heart Medical Center at RiverBend.

It’s possible in both cases that the men somehow injured internal tissue that left them vulnerable to the presence of the bacteria in their systems, because the condition can occur even without any visible surface signs of injury, according to research articles.

For both Pisani and Nelson, the initial prognosis for survival was ominous, but in both cases antibiotic treatment and frequent debriding helped stop the progression of tissue death, removing the serious threat that both might require amputation of the affected leg.

Unlike Pisani, however, Nelson should not have to undergo skin grafts. He will start his junior year at Creswell High School in September.

When Pisani was stricken, he was scheduled to start a new job as executive chef at Rain Northwest, a new restaurant in west Eugene. One of his previous stints was three years as sous chef at Koho Bistro.

“I’ve been working in kitchens since I was 7,” he said. “I did food at Actors Cabaret, did culinary school at Lane Community College, did a lot of catering and a lot of weddings. But Rain is holding the job for me, and I’m really grateful. I love working — it’s what keeps me going.”

So did the response from the community, which Chelsea calls “overwhelming.”

“There are no words to describe how wonderful people have been in helping us,” including setting up a crowdfunding site to help them meet medical bills, she said. “We don’t even know half the people who have donated.”

Nelson has the same reaction to the small town where both families live.

In Blake’s case, volunteer high school wrestling coach Wayne Roberts immediately started a crowdfunding campaign to raise money to help the Nelsons with medical and incidental expenses. Assistant wrestling coach James Wittenborn and his wife, Brandi, organized meal deliveries and helped with yardwork while Blake was recovering.

Fortunately, the family also had health insurance to help with the costs, Nelson said.

“My husband and I had talked occasionally about leaving Creswell when both of our boys are out of school,” she said. “Now, after the way the community has rallied to support us, we’re saying to ourselves, ‘Why would you ever want to leave a place with such wonderful people?'”

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