"Bacteria threat grows –
Flesh-eating disease hits Boulderites"

Sixteen months after University of Colorado physicist Eric Cornell lost his left arm and shoulder to a rare, invasive form of strep A, at least three more otherwise healthy Boulder residents have been stricken by the same disease in the past four months.

Two who live within one-half mile of each other developed necrotizing fasciitis, otherwise known as flesh-eating bacteria, and had to have multiple surgeries to remove infected tissue. A third developed an infection in the blood and brain and died within 48 hours after first complaining of an ear infection.

"I went into the ER one night thinking I had a bad case of the flu. The next night they were telling my wife and daughters to say goodbye because I wasn`t going to make it," said Robb Kimbrough, 50, who returned home from the hospital Dec. 9, after recovering from organ failure due to septic shock and having both legs amputated below the knee.

Boulder County health officials and infectious disease specialists said they see no connection between the four cases and see no evidence that strep A is on the rise or growing more virulent locally.

The county does not track the incidence of invasive strep A, but chief epidemiologist Heath Harmon said judging by national estimates the county could expect to see as many as nine cases in a 12-month period. Dr. Ken Gershman, chief of the communicable disease program for the state health department, said that in the five-county Denver-metro area, which does track cases, incidence of invasive strep A definitely is on the rise, spiking from 122 cases in 2002 to 188 in 2005.

"It certainly is conceivable that what is happening in the Denver metro area is also happening in Boulder," he said.

Regina Daly, a 39-year-old marathon runner who lives just down the road from Kimbrough up Fourmile Canyon, said she started feeling pain in her shoulder about 10 p.m. Dec. 19, but assumed it was just sore from her morning swim. By the next day, she was vomiting from the pain and had a 103-degree fever. When she fainted on the bathroom floor, her husband rushed her to the emergency room at Boulder Community Hospital.

By that night, she had been diagnosed with necrotizing fasciitis and was undergoing surgery to remove an eight-inch swath of tissue across her torso and under her armpit.

She ultimately was transferred to Presbyterian/St. Luke`s Hospital in Denver, where she underwent more surgeries and spent time in the hospital`s hyberbaric chamber - a common treatment for necrotizing fasciitis. She lost no limbs and believes she will make a near full recovery.

She and her husband believe it was her neighbor`s grave misfortune that helped save her life.

"I think the doctors diagnosed her case so quickly because of Robb`s experience," said Daly`s husband, Peter Robinson. "Regina is incredibly lucky."

Kimbrough`s experience two months earlier was even more terrifying. On Oct. 14, he started feeling feverish and flu-like, with a dull ache in his right upper thigh. He went to work at his construction job anyway, but was home in bed within a few hours. By that night, he could barely walk, so his wife took him to the emergency room at Boulder Community Hospital. They determined he had an infected blood clot, gave him medication and kept him for observation.

The next day, his kidneys and liver appeared to be shutting down, his blood pressure dropped and he was in and out of consciousness. Then he began bleeding uncontrollably, ultimately going through 37 units of blood in one night, the Kimbroughs recall.

"It was like watching a train wreck, it happened so fast," said Robb`s wife, Nancy Kimbrough.

By Sunday, two days after he arrived at the hospital, doctors determined he had both necrotizing fasciitis and streptococcal toxic shock syndrome, both extremely rare infections caused by strep A, the Kimbroughs said. The following Friday, after his hands and feet had grown increasingly black, he was moved to Presbyterian/St. Luke`s for treatment.

"Within an hour of being there, the surgeon came up to me and wanted me to sign a consent form to amputate his feet," Nancy said. John Stevenson, 70, of Boulder, died Jan. 17 of a fast-moving strain of strep A that infected his bloodstream and brain, according to his son Brent Stevenson. Stevenson was extremely healthy, according to family members. At 4 a.m. on a Saturday morning he called his son complaining of an ear infection. He went to the emergency room and returned home with medication that, according to his son, made him feel a lot better.

"I talked to him at 6:45 that night," Brent said. "That was the last conversation we ever had."

Medical experts say strep A bacteria are everywhere, and if they cause symptoms at all they usually are mild illnesses such as strep throat and impetigo, which infect millions of people annually. In some cases, however, strep A turns "invasive," infecting blood and tissues.

Reactions to strep A can vary depending on how the bacteria gets introduced (through an open wound or nasal cavities, for instance), how strong the person`s immune system is, and what strain it is.

According to the Centers for Disease Control, there were an estimated 9,900 cases of invasive strep A nationwide in 2004, with roughly 770 cases resulting in necrotizing fasciitis, and 700 resulting in septic shock.

About 20 percent of the patients who develop necrotizing fasciitis and half of those with septic shock die, according to the CDC.

"This is a common organism and for some unfortunate individuals it can cause very severe disease," said Dr. Nelson Gantz, chief of infectious disease at Boulder Community Hospital. "It is just something that happens."

Gershman said he believes Denver`s apparent spike in cases is probably a result of normal cyclical fluctuations of the disease. However, the state health department has sent isolates to the Centers for Disease Control to see if there is anything particularly virulent about strains circulating in Colorado.

Robb Kimbrough and Regina Daly, who did not know each other before their illnesses, said they have wracked their brains trying to pinpoint a common link where they may have gotten the virus. Kimbrough thinks he may have picked it up at a local gym, walking barefoot in the men`s bathroom when he had a cut on his foot. Daly also worked out the day she fell ill, but at a different recreation center.

"I think it was just a total fluke," she said.

Robb Kimbrough has come to the same conclusion and has no intention of pointing fingers. He said he has a set of prosthetics on the way, and despite his ordeal, hopes to get back to mountain biking and rock climbing as soon as possible.

"I don`t think there is any way you could find out where I got this, and even if I could, what different does it make?" he said. "In the long run, I will be fine. There is no brain damage. I can still see. I`ll still be able to ride my bike. It`s just a matter of getting there from here."