Aimee Copeland suffered a gash on her leg in a zip lining accident. Now she is fighting for her life. So far, the cause seems to be a bacterium called Aeromonas hydrophila. This is not the most common cause of necrotizing fasciitis. Here is a recent article on the case, 5/10/12, around 3pm.
http://abcnews.go.com/Health/Wellness/rare-flesh-eating-disease-zip-line-accident-caused/story?id=16319358
We like to learn about scary bacteria and sometimes like the creepiest the best. But this is a real case and suddenly the pictures in the text have another story to tell.
Read the article, look up information on the bacterium (not wikipedia) and post information about the organism or an updated news report (post the time of the report so others can post more recent reports). This is a very sensitive situation, how will you handle devastating cases like this when you are a healthcare worker? What have you learned in Micro that you could apply to the handling of the situation?
Thoughts and prayers to Aimee and her family.
Posts are due by 5/14, midnight.
What is Aeromonas hydrophila? Well, according to some research that I did on the bacteria, the genus Aeromonas is a facultative anaerobe (meaning that it grows in the presence of oxygen, but if deprived from oxygen, can still find other measures of producing energy). Aeromonas does not produce spores and is identified as gram negative bacilli (rods). The reservoir of which this genus is usually found is in aquatic environments such as lakes and rivers, as well as in soil. Aimee fell from the zip line and gashed her calf near a river where this bacterium was growing. It is very common for this genus’s species to cause gastrointestinal disease, however for Aimee this was not the case. The species, which has left her gasping for life is known as a species which causes wound infections; Aeromonas hydrophilia (hydro meaning water and philia meaning love) Aimee’s accident happened just a few days ago in Georgia as weather was probably that of warm temperatures. Warm temperature is where Aeromonas hydrophilia thrives best.
ReplyDeleteAs a future healthcare worker I cannot say how often I feel like I will see situations like Aimee’s. According to many reports the bacterium that has affected her in this devastating way has not been seen too often. After reading the blog article, I believe that ignorance was probably the evil in this devastating situation. Perhaps if doctors were to have run more tests earlier on Aimee’s wound then they would have been able to save her leg and other extremities that are now awaiting amputation. Instead she was sent home with antibiotics which the bacteria was probably resistant to. I feel like I am in no position to be criticizing doctors’ abilities but this is such a devastating situation, it is hard not to try to find the root of the problem.
Aimee’s story relates to everything that we have been learning in micro over the past 13 weeks. Her wound infection is caused by a certain bacterial genus and species, which we all should be aware that countless bacterium exists around and on us at all times. Different bacteria cause different types of diseases, and can grow over different periods of time, temp and pH and vary in terms of virulence factors. The way experts were able to figure out that Aimee was suffering from necrotizing fasciitis due to Aeromonas hydrophilia, was probably via isolation of her wound and investigation on the water and soil surrounding the accident. As in lab, we too have been isolating unknown organisms to figure out what they are. I now realize how important our unknown assignment is. As nurses we will be plating countless organisms to find out what is making healthy people sick.
As of today May 12 Aimee is still in critical condition. On Aimee’s official support website: http://uwgpsychology.org/2012/aimee-copeland/, her father has noted that Aimee will lose her fingers very soon, but doctors are hoping and her family is praying that she will be able to regain sensation and muscle movement in her hand so that she can potentially use prosthetics for fingers.
I found a study online about an Aeromonas hydrophilia outbreak in Australia in 2002, where a total of 26 individuals contracted A. hydrophilia because of their participation in a charity mud football game. You should check it out, very interesting.
http://cid.oxfordjournals.org/content/38/8/1084.full.pdf
the most recent article i could find was in 2004. this article discuses a similar situation to Aimee's in that, 100 people participated in a mud football event. those who had preexisting wounds were infected by Aeromonas hydrophila. apparently they watered the football field during a one month period with a line that was pumping water from a local freshwater river. and we all know that A hydrophila is found in freshwater enviroments. here is the link for the full story: http://www.nature.com/news/2004/040407/full/news040405-4.html
ReplyDeleteas a future health care worker i believe that there will be many devastating situations in a hospital setting but it takes a strong minded person who thinks realistically. i think if you prepare yourself mentally it will definately help adjust to these situations. i think learning about aseptic technique and about how fastidious and pathogenic organisms can be will definately help me in the health care field. learning about how ubiquitous microorganisms are has helped to along with the fact that some multiply and infect very fast.
ReplyDeleteIt's definitely very scary to read and hear about such devastating cases as this one. And since it's so related to our class and what we've been learning, it makes it all that more interesting. After some further research, i learned that according to the Bad Bug Book, this bacterium, Aeromonas hydrophila, "is a species of bacterium that is present in all freshwater environments and in brackish water...capable of causing illness in fish and amphibians as well as in humans who may acquire infections through open wounds or by ingestion of a sufficient number of the organisms in food or water."Diagnosis of the A. hydrophila can be, "cultured from stools or from blood by plating the organisms on an agar medium containing sheep blood and the antibiotic ampicillin. Ampicillin prevents the growth of most competing microorganisms. The species identification is confirmed by a series of biochemical tests. The ability of the organism to produce the enterotoxins believed to cause the gastrointestinal symptoms can be confirmed by tissue culture assays."
ReplyDeleteGoing into a healthcare career, i know i will be brought into situations such as these. I believe its important to stay strong for the patient and the family and to do everything possible to help them. And treat every little with the utmost care and attention because little things can turn into something devastating as this. Like Gabriela Sharaby said, it's important to remember aseptic technique and everything we are learning now in microbiology. Especially the current unknown project, being able to isolate bacteria and do various tests on them.
As of today, May 13th, they state "Aimee will suffer the loss of her fingers, however physicians have hope of bringing life back to the palms of her hands, which could allow her the muscle control to use helpful prosthetics. They are awaiting a safe time before embarking on surgery for this..." They also state Aimee appears to have normal brain function and was able to mouth words asking what has happened and where she was; her family has started to give her some answers but has not told her that she has lost her leg.
http://abcnews.go.com/Health/aimee-copeland-student-flesh-eating-disease-lose-fingers/story?id=16337666#.T7Ad4o6kAy4
http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm
http://www.cbsnews.com/8301-504763_162-57433571-10391704/family-hopeful-as-aimee-copeland-communicates-through-lip-reading-but-more-amputations-likely/
ReplyDeleteI found the above which was posted this morning, May 14th regarding Aimee Copeland.
"For the infection, bacteria enter the body through cuts and scratches and give off toxins that cut off blood flow, quickly destroying muscle, fat, and skin tissue. That bacteria that infected Copeland, a bug called Aeromonas hydrophila, is found in warm, brackish waters."
It's unnerving to think about how her life was dramatically changed. What could have been a gash that healed and was a good story to tell about the zip-line, is now a life threatening incident.
Interestingly enough, I am a healthcare workers for many cases like Aimee's. I work in a rehabilitation hospital, for people who had life threatening accidents, spinal chord injuries, brain trauma, quadrapelegics, and people who have been run over by cars. Many people have lost their limbs and are learning to walk and talk again. It is our job as healthcare workers to encourage, build up, and do whatever we can to help the patient and their family during this time.
Regarding micro, I see it is our job as nurses to have adequate, complete microbiology culture wound swabs to offer the lab. As doctors, it would be important to understand and be familiar with what kind of organisms are common in different situations so you know what to test for.
Updated Article:
ReplyDeletehttp://thechart.blogs.cnn.com/2012/05/14/say-what-flesh-eating-bacteria-explained/
Other Articles:
http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm
http://cid.oxfordjournals.org/content/38/8/1084.full.pdf
Aeromonas hydrophila
According to the article Bad Bug Book from www.fda.gov, this species of bacteria is found in freshwater environments. It is capable of causing illness among fish and amphibians, as well as humans through open wounds or ingestion of a large quantity of bacteria. In healthy humans it may cause gastroenteritis, inflammation of the gastrointestinal tract which includes the stomach and the small intestines, or septicemia, bacteria in the blood, in people with impaired immune systems. Although many sources have claimed that it is surprisingly rare that this bacteria causes necrotizing results, an updated article regarding Aimee Copeland found on www.CNN.com called Say What?’Flesh- eating bacteria’ explained, states that “Aeromonas hydrophila can also enter the body through an open wound, as happened in the Copeland case. When that occurs the flesh-eating bacteria quickly reproduces, giving off toxins that destroy skin and soft tissue. Such bacteria is adept at hiding from the body's immune system, according to the National Necrotizing Fasciitis Foundation”.
As a healthcare worker, antibiotics would be one of the main options I would turn to. However, according to the article, Outbreak of Aeromonas hydrophila Wound Infections Associated with Mud Football found on www.cid.oxfordjournals.org, “treatment of Aeromonas wound infections is complicated by the fact that members of this genus are universally resistant to penicillin (the result of the presence of chromosomal b-lactamase)”. As we have learned in microbiology, it is a struggle to deal with the different strains of bacteria and the capability of them becoming resistant to effective treatments today. One option that could be effective in minimizing the chances of being infected would be vaccinations. However, due to the fact that this is a rare occurrence, I am not so sure that the cost of new vaccinations will outweigh the threat of the rare bacterial infection.
Aeromonas hydrophila is a faculatative anaerobe that is identified as a gram negative rod. It is usually found in freshwater lakes and rivers, as well as being found in the soil. This bacterium thrives in warm temperatures. It usually causes gastrointestinal distress as well as wound infections.
ReplyDeleteMy heart goes out to this poor girl and her family. What was supposed to be a "day of fun" for her, turned into a nightmare. As of today, May 14, 2012 according to Yahoo News, they had high hopes that they were going to be able to save her palms. As of last week, the Doctors' told her family that there was a good chance she would not survive this ordeal. So hearing this, it is wonderful news for Amy and her family. They amputated one leg and were hoping that her other limbs could be saved. As of today, "She's been asking 'Where am I? How long have I been here?'" Andy Copeland said on NBC's "Today" show. "And when we told her how long she'd been there, her first concern was, 'I've got to be working on my thesis.'" I would say that this statement shows that Amy has an incredible work ethic as well about finishing her education. As of this morning, Amy was still unaware that her leg had been amputated. Her dad has faith in her, saying she was a very strong girl.
As far as becoming a healthcare provider, I think this shows the incredible strength and knowledge that you must provide for the patient and the family. Both the family and especially the patient, need to have someone on their side that is a source of information about these critical situations as well as having a compassionate heart and a source of support during these trying situations.
04/03/2012: http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm
ReplyDeleteAeromonas hydrophila is able to live and thrive in all types of freshwater and are able to cause sickness in humans, amphibians, and fish. It can cause gastroenteritis, which is inflammation of the stomach and small intestines, and it can even infect healthy individuals who do not have an impaired immune system. On the other hand, those with weakened immune systems can be subject to septicemia, or bacteria in the blood. Aeromonas hydrophila can be taken from stools or blood, and are able to grow on agar that contains sheep blood with the antibiotic ampicillin on it. Ampicillin's job in this situation is to inhibit all microbes that would otherwise wish to compete with Aeromonas hydrophila over space to grow. Beyond freshwater sources, Aeromonas hydrophila is also found in fish, shellfish, red meats, and poultry.
5/14/2012: http://mrsatopic.com/2012/05/flesh-eating-bacteria-takes-limbs-of-young-woman-aimee-copeland/
According to the MRSA Topic website, the treatment used for necrotizing fasciitis varies depending on how exactly the patient is wounded. In Miss Copeland's case, she has received antibiotics and surgery. I can only imagine how devastating this new first was, and still very much so is, to both Miss Copeland and her family. Though with all of this research and new information popping up about Aeromonas hydrophila, it must be terrifying for her family. But it should also serve as a sign of hope, because the more that this bacterium is discussed, the more light will be shed upon it, and the more people will look at it, study it, and search for ways to beat it. Already Miss Copeland is improving one day at a time, and with more study on Aeromonas hydrophila I'm sure she'll get the proper and most efficient help she could ever need.
As a future healthcare worker, I would handle situations similar to this just as they doctors are now: with antibiotics and surgery. I would want to make sure that I was working as hard and as fast as I could to ensure that my patient has as easy a recovery as possible. Micro has everything to do with what the Copeland family is dealing with right now. Miss Copeland's wound was caused by a bacterium and each different kind has its own set of preferences: pH, temperature, length of time to grow in, pathogenicity, virulence factors, etc. Another thing we learned in micro that we will be able to apply in the future is tracing the origin of the infecting bacterium. In this case, the doctors probably traced Aeromonas hydrophila back to the site of the accident, or even straight from Miss Copeland's wound itself. Overall, everything that we have learned and continue to learn can be applied in our future health fields, no matter what title we will hold.
As mentioned, Aeromonas hydrophilia is found in all freshwater. The most common way to enter a human is when an open wound comes in contact with contaminated water. In the article, it explained that it is unusual to see Aeromonas hydrophilia have the effect it did on Aimee. Usually it causes symptons such as diarrhea and fever. However, I learned that A. hydrophilia can cause myonecrosis. Myonecrosis is the localised death of muscle cell fibers. This occurs because A. hydrophilia produces a toxin that cuts off blood flow to the infected area. This is called a necrotizing faciitis, as mentioned. Some symptons include small, red, painful lump or bump on the skin, changes to a very painful bruise-like area and grows rapidly, sometimes in less than an hour, the center may become black and die and the skin may break open and ooze fluid. Aeromonas hydrophilia can also cause Ecthyma gangrenosum which is a infectious disease resulting in lesions and pustules on the skin. For A. hydrophilia to cause this disease is very uncommon because Ecthyma gangrnosum is an opportunistic pathogen usually caused by Pseudomonas aeruginosa. For this reasons the healthcare workers probaly sent Aimee away with nothing but staples and pain pills. I hate to here when events like this occur. A patient keeps expressing that they are in unusual pain and they think something serious is wrong but the healthcare workers turn a blind eye. However it is ALWAYS better to be safe than sorry and test for anything and everything that could be wrong. Why? Because human lives are at stake!
ReplyDeleteKayla Clarke
The bacterium Aeromonas hydrophilia is found in freshwater environments as well as brackish water. Aeromonas hydrophilia may have different effects in healthy people versus people who have impaired immune systems. If a healthy person contracts Aeromonas hydrophilia, it may induce gastroenteritis. If a person who has an impaired immune system contracts Aeromonas hydrophilia, it may induce septicemia. The bacteria enters a human through a open wound or ingestion of contaminated water. It thrives in warm climates.
ReplyDeleteThe latest update on ABC News states that they are waiting for a safe time before they amputate her fingers. She has gone through so much since they first treated her for the gash on her leg. Even though she has been showing signs of recovery, she's still relying on a ventilator for oxygen. Another good sign is that she's able to communicate with her family by lip reading.
As a healthcare provider, you have to be quick to take action when it is needed most. A healthcare provider needs to be able to get the information of what is going on to the patient and their family. Having a compassionate heart will make the experience for both parties a little bit easier. I would follow the same plan of action as what the doctors and nurses are doing now. I would also be doing research to see if there was any new study or information on the disease. Sometimes researching the disease numerous times will lead you in a different direction for a cure that would be more beneficial to the patient.
http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm
http://abcnews.go.com/Health/Wellness/girl-flesh-eating-disease-remember-events/story?id=16342276#.T7HL5o6ZMng
Aeromonas hydrophila is an opportunistic pathogen that lives in warm condition and fresh water.Just like any other bacteria this bacterium also enters the human system through wound and abarassions.When the wound is stapled or stitched without proper treatment the bacteria starts multiplying and spreads.According to reports 750 cases of infection are reported every year because of Aeromonas hydrophila.People who have weak immune system are easily susceptible.One of the symptom after the infection is the person will not be able to remember what happened or what is happening around them.As a health care provider I would try to get more information and find out ways to stop the infection from spreading and also I would talk to the patients family to be optimistic and confident.If the family is strong the patient would feel little strong and that would give them some strength to fight the disease.It is the fear that kills a patient mostly than the disease itself.Being a micro student has exposed me to understand the micro organisms which are ubiquitous better than ever.It has made me think of microorganisms in a whole different way, of how we can use them for our own benefits.
ReplyDeletePersonally, I would hate to be in the doctors positon; you would have to decide and for the most part basically estimate the spread of this bacterium. If you take to little then the bacterium will spread even further and the patient will lose much more; however, if you take to much you can potentially be damaging this patient and possibly hadicapping them more then you should of. The only think I can hope for as a doctor is that i recognize these sympthoms right away and can make the right decisions so that my patient can go home with minimum amount of damage possible.
ReplyDeleteFrom what ive read from: http://www.extension.purdue.edu/extmedia/AS/AS-461.pdf
This bacterium is commonly found in different organs of fish and is an ubiquitous gram-negative rod. This bacterium is commonly found in freshwater ponds. this article is mainly about the infection of fish but it also explains how this bacterium is a zoonotic disease and can be transfered to and from fish to humans.This article talks about the different entry ways for the bacterium to enter such as cuts and scrapes. This article also talks about two antibiotics to give your fish if it has sympthoms of the disease. Im not sure if they've found any antibiotics to use for humans yet though.
According to:
http://onlinelibrary.wiley.com/doi/10.1046/j.1472-765X.1997.00156.x/abstract
I was only allowed to read the abstract but it said that there was some antibiotics that worked well against this bacterium but there were also some strands that were resistant to ampicillian. However this test was done on fish so i dont know that if the same results would translate to humans, but if it were tested it may help treating the disease. i know that once the damage is done it probably wont be able to be fixed, but maybe it can prevent the spread so that patients wouldnt have to lose a whole limb.
From what i learned in Micro, the best way to combat a bacterium is to fully understand the way it works so that you can use its natural mechanisms against it. But due to the lack of information on this particular bacterium it is still now completly understood.
According to:
http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/BadBugBook/ucm070523.htm?utm_campaign=Google2&utm_source=fdaSearch&utm_medium=website&utm_term=aeromonas hydrophila&utm_content=1
This bacterium is found in numerous places and can cause other illnesses, however it doesnt say that it can cause necrotizing fasciitis, this article says a couple of times that it is lacking some data on this bacterium due to its ubiquity.
this is article about Aimee Copela is very tragic but my hopes and prayers go out to her family and her recovery.
This comment has been removed by the author.
ReplyDeleteAeromonas hydrophila is found in any freshwater environment. It it able to cause sickness in amphibians and fish as well as humans. The most common sickness Aeromonas hydrophila is able to cause in humans is gastroenteritis. It has 2 types: the first being similar to Cholera with watery diarrhea and the second is the dysentary illness with stools containing mucus and blood. Also, it is reported that Aeromonas hydrophila is also found in red meats such as beef, pork, and lamb, as well as poultry. Aeromonas hydrophila can also enter the body via open wounds, however, other infectious diseases cause by the bacterium are not as common. Therefore, any cures or any way to help treat it are little to none.
ReplyDeleteMy prayers go out to the Copelands for Aimee's recovery. Her family is positive and that is all that really matters at the moment. Aimee needs to see that her family is by her side so she can power through this obstacle. She's already showing signs of improvement and we should all hope for the best. Not much is known about as to why this bacterium caused this terrible outcome, but showing signs of recovery is an achievement.
As a future healthcare provider, I would definitely encourage the family to be as supportive as much as possible, like the Copelands. There is nothing worse than a group of people looking at the negative side rather than the improvements made. Also, I would also continue to research the bacterium and why and how it caused it.
As a micro student, the most important way on handling this situation in the hospital is the use of aseptic technique. We don't want any more bacteria to add to the infection so clean tools are extremely important as well as basic hygiene. ALWAYS WASH YOUR HANDS!!! You don't know what is in your hands. So if you're not sure if you washed your hands 10 minutes ago, wash it again. Better safe than sorry.
Aeromonas hydrophila, a Gram negative rod, has been identified as the bacterium which infected Aimee Copeland. It is a facultative anaerobe, meaning it uses oxygen when it is present, but can also survive without it, and it creates an oxidase positive result, thus creating cytochrome oxidase. Its optimal growth temperature is 28 degrees Celsius, but it can also survive from 4-37 degrees Celsius, which can also be why they were found where Aimee was kayaking. When humans get in contact to it, there are usually three types of wounds: cellulitis, myonecrosis, and ecthyma gangrenosum. The first can be handled easily; however, the other two wounds cause severe damages including amputations (like in Aimee’s case), and possibly fatal.
ReplyDeleteAs a healthcare provider, I will treat each and every single case with the most amount of security and privacy. I currently volunteer at Henry Mayo Hospital, and have already been trained on issues regarding patient privacy, especially HIPAA. I understand the importance of making sure a patient feels protected and secure, including all types of cases.
We have learned about many topics in Micro that relate to this topic. The reason why this bacterium is so dangerous is partly because of its bag of tricks, in which it is resistant to common antibiotics (like penicillin and ampicilin), making treatment much worse. Multiple articles discuss the contamination of water by this bacteria, and how open wounds can be extremely dangerous. I more clearly understand the significance of aseptic technique.
I hope and pray that Aimee can remain strong and fight these bacteria
Aeromonas hydrophila is mainly found in fresh water, but can also be found in brackish water(salty water but not as salty as sea water). In an article from American Society for Microbiology (http://aem.asm.org/content/36/5/731.abstract) They "measured [it] in 147 natural aquatic habitats[,] in 30 states and Puerto Rico." It most healthy people it will cause gastroenteritis, but according to the Bad Bug Book (BBB) it was actually in controversy that is does in fact cause that. It is also found in some fish and shellfish and "It has also been found in market samples of red meats (beef, pork, lamb) and poultry."(BBB)
ReplyDeleteIt is best grown on sheep blood agar.
I don't think I will ever go in a lake or river again, not that I ever really did anyway. I feel so sorry for Aimee and that it wasn't figured out right away or even thought that something like that could happen. I want to be a neonatal and labor and delivery nurse, so in the healthcare community I believe doctors and nurses should remember more about these diseases and when something like that happens there should be more tests done to make sure they either know there is or isn't something like that happening in someone's body. I really hope Aimee can pull through and make it.