Jeannie Jackson, 59, thought it was a “hair bump” on her right thigh that grew quickly redder and swelled to the size of a grapefruit. It was actually necrotizing fasciitis, the devastating infection that has afflicted Aimee Copeland and claimed her left leg, her hands and her foot.
As Copeland likely will face, Jackson spent months at the Joseph M. Still Burn Center and underwent surgery after surgery, but doctors were ultimately able to save most of her leg, though she still has a large crater on her right thigh.
Jackson, who lives in Augusta, has a message for Aimee: “It’s OK to lose your parts. I’d rather have life.”
Copeland apparently contracted the bacterial infection earlier this month and has been at the center at Doctors battling for her life since. Doctors is a national and regional referral center for those types of infections, and last year it treated 42 necrotizing fasciitis cases, 33 from Georgia alone, spokeswoman Barclay Bishop said.
Although it is fairly rare overall, infectious disease expert Dr. Jack Austin said he sees probably one or two cases a month at University Hospital. Because it is a referral center, it is not uncommon for Medical College of Georgia Hospital to see massive soft-tissue infections on a weekly basis, said Dr. Steven Holsten, associate professor of trauma and critical care at Georgia Health Sciences University.
While Copeland’s doctors have not commented publicly, Austin and Holsten, who have not consulted on her case, said fighting such a massive and devastating infection can be tricky. Despite the public fascination with so-called “flesh-eating bacteria,” it is not so much the bacteria as it is the nature of the infection and the body’s reaction to it that can lead to the destruction of the surrounding tissue, organ failure and potentially death, they said.
“Patients that have this kind of overwhelming infection, it doesn’t just affect their immune system; it affects their cardiovascular system, their respiratory system” and can lead to multisystem organ failure, Holsten said. Fighting the massive infection means battling along several fronts, he said.
These infections most often occur in people whose immune system was already compromised, Austin said.
“They have underlying diabetes or they have other situations that make them at risk for these kinds of things,” he said. But even with healthy individuals, a series of unfortunate turns – an infection getting into the wrong place quickly or an especially virulent strain of common bacteria – can lead to necrotizing fasciitis, Austin said.
“A lot of things have to be right to set up conditions for this,” he said. “That’s why these things are so uncommon.”
While in some cases it is unclear how the infection started, Austin said it often begins with a wound.
As the infection grows, it can use the fascia, the membranes between muscle groups and organs, as a reservoir to replicate and spread quickly. Toxins and enzymes produced by the bacteria can attack surrounding tissue, but the damage can also come from restricting blood supply, he said. These types of widespread infections and the resulting inflammation can cause what is known as disseminated intravascular coagulation, Austin said, where the clotting factors in the blood become overactive and form small clots that can clog off blood vessels.
“Those small arteries of the hands and feet are the ones that really take the brunt of it, although the arteries of the kidneys can also have problems,” he said.
Widespread infection or sepsis can also cause a dangerous drop in blood pressure, and then the medications used to combat that, called “pressors,” can add to the problem, Holsten said. While they might be keeping blood pressure up for certain vital organs, such as the heart and the brain and lungs, they can “sacrifice” blood pressure to others, he said. The body’s own inflammatory response can add to the damage, Holsten said.
“When there is tissue injury, your body releases a lot of chemicals that normally would be good for you but in excess can lead to trouble with your heart, your lungs, your kidneys” and other organs, he said. When multiple organs are failing, it can be difficult to reverse the damage and bring the patient back, Holsten said. Often, surgery is necessary to contain the initial infection, Austin said.
“Surgery is critical in these types of patients,” he said. “That’s why early recognition is so important so that the appropriate aggressive surgery can be done, along with antibiotics and things like that.”
In Jackson’s case in 2010, it was a visiting nurse from the Healthy Grandparents Program at GHSU who looked at the swollen infection and told her to go to the hospital. At University Hospital, doctors recognized it as necrotizing fasciitis, and surgeries on her leg as well as whirlpool treatments followed. But within about a week, Jackson was told she would have to be transferred to the wound care center at Doctors.
“There’s nothing else I can do for you,” the doctor told her.
She was transported by ambulance, and Dr. Fred Mullins performed surgery the next day to try to control the infection, the first of at least four she would endure. Her body became swollen, and the pain was terrible. Her brother, Keith Sims, feared she might not leave the hospital alive.
“The doctors had said anyone with that type of infection, they normally don’t make it,” he said. “I’d always tell her, ‘Hang in there, Sis. Keep praying.’ She is a praying woman.”
“It was so bad that my brother even went to the church and fell on the altar and asked them to pray,” Jackson said. “It was just that bad.”
Her kidneys nearly failed, and she had to receive blood transfusions and insulin. But after 3 1/2 months she left the hospital, only to bounce right back for another couple of months because she was still so sick and weak. Skin grafts from the outside of her leg were used to cover damage on the inside of her thigh, and there is still a large crater the size of a serving bowl at the top of her thigh that wraps around to the back. But they were able to save the leg. Still, when Jackson thought about that possibility, she could take courage from those she sees in her job at Walton Options for Independent Living who often have no use of their limbs but are determined to live independent lives.
“They are really more productive in doing things than I am because they are determined that they are going to be a survivor,” Jackson said. The family credits the staff and Mullins for how well it turned out.
“Dr. Mullins was good to me,” Jackson said.
Even though it was nearly a yearlong ordeal that left her with some pain and weakness to this day, Jackson has a hopeful message for the Copeland family.
“If they keep the faith and keep speaking positive things to her, even in that state, that she shall live and she shall not die, she will come out of it,” she said. “There’s life after this, a life on this side. There’s life after. And I am speaking from experience.”
Staff photographer Emily Rose Bennett contributed to this report.