Skin Infection Series


Necrotizing Fasciitis – A common bacterial skin infection

Necrotizing Fasciitis is also known as the flesh eating bacterial skin infection. It is commonly seen due to bacterial infection of staphylococcus and streptococcus. Some other bacteria involved in this infection include E.coli, Clostridium, Klebsiella etc.

This type of bacterial skin infection leads to necrosis and death of the affected tissue and is sudden in onset and severely progressive in nature. It requires immediate attention and can lead to fatal conditions or may produce conditions that lead to amputation of the limbs if left untreated.

Signs And Symptoms Of Necrotizing Fasciitis


  • History of trauma or any bacterial infection in wild or in the closed environment.
  • Intense pain
  • Inflammation of the affected area
  • Fever mostly high grade is recorded
  • Tachycardia or increased heart rate is noted
  • Abnormal respiratory sounds can be heard known as crepitus
  • Skin color progressively changes to violet and blister formation occurs
  • The temperature of the affected area is mostly raised.


Treatment of Necrotizing Fasciitis

  • Debridement of skin – Surgical removal of the damaged skin is done to prevent bacteria from progressively involving the other normal tissue and skin.
  • Use  high potency anti-bacterial, anti-viral and anti-fungal topical lotion such as Microsan® RX Lotion.Microsan Rx Lotion
  • Amputation or removal of the damaged limb may be considered in case of irreversible damage.


Skin grafting is done once the debridement completes


Public Pools Are Swimming With Infections

Public Pool Infections

A little over a week ago, the Centers for Disease Control and Prevention (CDC) issued a press release warning that outbreaks of a parasite called Cryptosporidium, or Crypto, have doubled in the United States since 2014, from 16 to 32 cases. The diarrhea-causing parasite can infect people in pools and water parks, spreading when someone swallows — yup — water contaminated with the feces of a sick person.

In fact, most infections from public pools are due to Crypto, Federico Laham, MD, the medical director for Orlando Health Arnold Palmer Hospital Infectious Diseases, told Fox News. That’s because Crypto is more resistant to chlorine than your average bug: Usually, common concentrations of chlorine in public pools are not enough to kill the parasite, Laham explained.
But Crypto is far from the only disease lurking in public swimming pools. Some infections, like E. coli or Hepatitis A, are also transmitted from fecal matter that others then swallow in the pool. Other infections, like swimmer’s ear, occur when bacteria get inside your ear and start overgrowing, causing painful skin swelling, Laham said.

Another fun one? Lice. Laham explained that you can actually get lice from infected public swimming pools, though your chances are reduced if you have your hair up in a ponytail or bun. Otherwise, Laham said, your hair is essentially mopping up the pool to pick up lice.

But there is some good news: You’re not likely to get a sexually transmitted infection (STI) from a pool, Laham said.

How to protect yourself
There are a few easy ways to protect yourself: First, avoid swallowing water. Try to keep your ears dry and your hair up, and don’t go swimming if you have an open wound or diarrhea, Laham said. Make sure the public pool you’re going to is visibly well maintained and operated — you should be able to smell the chlorine, Laham explained. And, when you’re done swimming, shower and rinse off all excess chlorine and chemicals.


Important Air Travel News

Air Plane Sanitizer

The impact of air travel on the spread of infectious diseases has led to considerable concern but limited study. More than 1 billion people travel by air each year. In a recent fanciful adventure film, Snakes on a Plane, passengers are terrorized by venomous snakes. In reality, more travelers are likely to be afraid of virulent infectious organisms on their flight.Microsan Rx Hand Foaming Hand Sanitizer

There are several important ways in which air travel can influence the global spread of emerging and established infectious disease. Infections may be spread on the aircraft through close contact and large droplets; airborne spread through small-particle aerosols, as in the case of severe acute respiratory syndrome (SARS) or even through contaminated food . Aircraft can transport infected disease vectors, such as rats or malaria-infected mosquitoes, as nonpaying passengers. Perhaps the greatest concern for global health, however, is the ability of a person with a contagious illness to travel to virtually any part of the world within 24 h. The importance of air travel for the spread of seasonal influenza was recently demonstrated by empirical data showing that the spread of influenza was delayed by the decrease in air travel after the attacks of 11 September 2001. With the current heightened awareness of pandemic influenza raised by the avian pandemic of H5N1 influenza, it is timely to reconsider the role played by air travel in the global spread of infectious diseases.

In an issue of Journal of Infectious Diseases, Luna et al. report on a detailed search, using extensive molecular and conventional methods, for the etiology of respiratory illness among travelers arriving in Germany who fulfilled the case definition for suspected or probable SARS. The 155 adults and children studied were infected with a wide variety of respiratory viruses and atypical bacteria. A pathogen was recovered in 44% of patients; none were infected with SARS coronavirus (CoV). Human parainfluenza virus and influenza virus were most common and were recovered from 15.5% and 14.2% of ill travelers. Other pathogens included adenovirus, non-SARS human CoV, rhinovirus, human metapneumovirus, respiratory syncytial virus, Mycoplasma pneumoniae, and Legionella species.

The authors did not determine whether there was spread of these infections to fellow passengers, but there are several implications of these findings that we should consider. First, case definitions of respiratory illness based on epidemiological characteristics and clinical symptoms are extremely nonspecific. It will be extremely difficult to identify travelers with a specific respiratory infection of concern—such as SARS, tuberculosis, or avian influenza— against the wide backdrop of other respiratory infections with overlapping symptoms. Even in the case of an emerging influenza pandemic, where the new virus is prevalent, the positive predictive value of a case definition will be low. Quarantine measures based on the screening of airline passengers are likely to cause a great deal of economic disruption and limited impact unless they can be linked with accurate and rapid diagnostic tests.

Second, our understanding of the spread of respiratory infections on aircraft is very limited. Key questions include how often transmission can occur by contaminated surfaces, large droplet spread, and airborne spread of small-particle aerosols, as well as the risk for specific organisms. The scientific uncertainty limits the ability to design preventive measures.

Three studies of in-flight influenza transmission have been reported, as reviewed by Mangili and Gendreau. In 2 of these outbreaks, there were relatively high attack rates, but older aircraft [8] and long periods when passengers were on board with an inoperative air handling system limited the generalizability of these outbreaks to modern air travel.

During the SARS outbreak, investigations were conducted among passengers who traveled on 40 flights with patients on board who had symptomatic SARS. Transmission is thought to have occurred on board 5 of 40 flights. On 4 flights, a small number of suspected infections occurred among persons seated within a few rows of the index patient, consistent with spread by large droplets. However, on 1 flight from Hong Kong to Beijing, 22 of 120 passengers and crew were thought to have become infected, which suggests airborne spread over a considerable distance . Many commercial aircraft use vertical airflow and high-efficiency particulate air (HEPA) filters that should limit exposure to small airborne particles. However, there are no regulations requiring HEPA filters or for testing of the function of filters .

In the investigation by Luna et al., the 155 travelers meeting the case definition for SARS arrived in Germany on 146 flights over the course of 69 different days. The number of potentially exposed travelers was not determined but was likely >20,000. Tracking, identifying, and treating these travelers would be extraordinarily difficult.

There are a number of things that can and should be done. We need additional careful epidemiological investigations to understand the frequency and relative importance of different modes of transmission on board aircraft for specific pathogens. We should study the effectiveness of potential interventions, including standardizing air handling, requiring HEPA filtration, and providing better modes of hand hygiene. To screen arriving or departing passengers effectively, accurateand rapid diagnostics would need to be developed to complement case definitions. The ability to track exposed travelers after an important incident could be improved with better databases for contact information. Proposed modifications to the quarantine regulations address this need , but the modifications have been criticized by airlines, public health practitioners, legal experts, privacy advocates, and others. The comment period has passed, and revised modifications are expected soon.

There is tremendous potential for mathematical biology and network theory to model and understand better the role of air travel and the impact of interventions on the spread of specific diseases such as pandemic influenza . Current models suggest that the impact of travel restrictions will be modest at best. Modeling can be very useful in understanding complex systems and in identifying areas of uncertainty, but these will have to inform, not replace, careful epidemiological and biological investigation.

If you are traveling via air travel protect yourself with Microsan RX Foaming Hand Sanitizer. Recommended by the United States Government for traveling diplomatic personnel.  To order this product go to

Your Worst Nightmare

cold and flu season

A drug-resistant “superbug” that doctors have been dreading has shown up in the U.S. for the first time, researchers reported Thursday.

The bacteria has genetic changes that make it resistant to a last-ditch antibiotic called colistin and while it had been seen in Europe and China, no one in the U.S. had been seen with it before.

A team at the Walter Reed Army Institute for Research identified a strain of E coli from a Pennsylvania woman that carries a much-feared gene called mcr-1 that turns bacteria into “superbugs. Here, a lab worker tests some of the sample.Walter Reed Army Institute of Research

It doesn’t spell doom just yet.

The mutant E. coli germ was found in a Pennsylvania woman with symptoms of a urinary tract infection, but it does not appear to be spreading at epidemic proportions. And it was susceptible to other antibiotics, so the patient was not left without any hope.

What’s worrying is the gene that made the E. coli drug-resistant. It’s called mcr-1, and it is passed from one bacteria to another. It sits on a piece of material called a plasmid, which makes it easy for one species of bacteria to pass it along to another species of bacteria.

Scientist fear an E. coli bacteria with the mcr-1 gene could pass it to another superbug with other mutations– creating a truly super-superbug that resists all known antibiotics.

“It is the end of the road for antibiotics unless we act urgently.”

“It is the end of the road for antibiotics unless we act urgently.”

If such a superbug spread, it would take the world back to a time when there were no antibiotics, says Dr. Tom Frieden, director of the Centers for Disease Control and Prevention.

“It is the end of the road for antibiotics unless we act urgently,” he said.

This discovery suggests the drug-resistance gene has been here in the U.S., flying under the radar.

“This patient hadn’t traveled,” Frieden said.

Patrick McGann and colleagues at the Walter Reed Army Institute of Research just outside Washington D.C. have been looking at samples from patients, keeping an eye out for bacteria with the mutation.

They reported Thursday they found one. The sample is E. coli bacteria with mcr-1.

“I was extremely surprised when it came up positive,” McGann told NBC News. It was the very first sample his lab tested in the new search for the gene.

This little stretch of DNA, which bacteria can swap easily among themselves, gives them the ability to fight off the effects of colistin.

“It was an old antibiotic, but it was the only one left for what I called nightmare bacteria, carbapenem-resistant enterobacteriaceae, or CRE,” Frieden said.

Luckily, this particular bacteria was not also resistant to carbapenems. But it was resistant to several other classes of antibiotics, including fluoroquinolones, and the fact that it had the mcr-1 gene raises alarm bells.

“To the best of our knowledge, this is the first report of mcr-1 in the USA,” the Walter Reed researchers wrote in their report, published in the journal Antimicrobial Agents and Chemotherapy.

They’ve only been looking for this particular mutation for three weeks, so they said they’re not sure just how widespread it is.

“We know now that the more we look, the more we are going to find,” Frieden said in a speech at the National Press Club in Washington. “The more we look at drug resistance, the more concerned we become.”

Later Thursday, the health and Human Services Department said scientists had also found the mcr-1 mutation in a sample from a pig. “Out of 949 animal samples screened so far, one strain of colistin-resistant E. coli was found in a pig intestinal sample,” it said in a statement.

“The DNA sequence of this isolate revealed that the strain contained the mcr-1 gene on a plasmid. The scientists also determined that the mcr-1 carrying colistin-resistantE. coli is resistant to other antibiotics including ampicillin, streptomycin, sulfisoxazole, and tetracycline.”

CDC has been warning for years about the threat of drug-resistant bacteria. It’s been urging drug companies to develop new antibiotics, and asking people to make better use of the antibiotics now available so that more superbugs do not evolve.

“The medicine cabinet is empty for some patients,” Frieden said.

The CDC said it was working with the state health department in Pennsylvania to talk to the patient and her family to see how she may have been infected.

“We know now that the more we look, the more we are going to find.”

“We know now that the more we look, the more we are going to find.”

They’ll also test others in the area who may have been in contact to see if they are carrying the bacteria – which may not necessarily cause illness or any symptoms at all.

“An urgent public health response is underway to contain and prevent potential spread of mcr-1,” Walter Reed said in a statement.

Dr. David Hyun of the Pew Charitable Trusts, who follows the issue of drug-resistant bacteria, said details will be important. “I am very interested in finding out how did this patient do,” he told NBC News. “What kind of treatment did she receive?”

There have been reports in other countries of patients with bacteria carrying mcr-1, but not many details of how they were cared for or whether other antibiotics cured their infections.

Colistin, used to treat carbapenem-resistant Enterobacteriaceae or CRE, is an older antibiotic with some tough side-effects such as kidney damage. That’s why it’s only used as a last resort.

Hyun said in several of the international cases, people have been infected with CRE that carried the mcr-1 gene. That would leave them with few, if any, option for treatment. “If we are finding it in other countries, chances are that it’s already happened in the United States as well,” he said.

Bacteria develop resistance to drugs quickly. Even before penicillin was introduced in 1943, staphylococcus germs had genes that would have made them resistant to its effects.

Just nine years after tetracycline was introduced in 1950, a resistant strain of Shigella evolved. Methicillin-resistant Staphylococcus aureus (MRSA) evolved just two years after methicillin hit the market in 1960. The last new antibiotic to be introduced was ceftaroline, in 2010. It took just a year for the first staph germ to evolve that resisted its effects.

The CDC says more than two million people are infected by drug-resistant germs each year, and 23,000 die of their infections. The biggest killer by far in the U.S. is diarrhea-causing C. difficile.

Near-untreatable cases of diarrhea, sepsis, pneumonia and gonorrhea are infecting millions more globally, the World Health Organization says.


The Danger of Antibiotic Resistant Bacteria

More than 200 rare antibiotic-resistant genes were found in “nightmare” bacteria tested in 2017, according to a Vital Signs report released Tuesday by the US Centers for Disease Control and Prevention.

“I was surprised by the numbers we found,” said Dr. Anne Schuchat, principal deputy director of the CDC.
The report focused on the new and highly resistant germs that have yet to spread widely. Still, a variety of resistant germs can be found in every state.
“Two million Americans get infections from antibiotic resistance, and 23,000 die from those infections each year,” Schuchat said.
Testing 5,776 isolates of antibiotic-resistant germs from hospitals and nursing homes, the CDC found that about one in four had a gene that helped spread its resistance, while 221 contained an “especially rare resistance gene,” she said.
“This wasn’t just a problem in one or two states,” Schuchat said, adding that the 221 rare genes were found in isolates gathered in 27 states from infection samples that included pneumonia, bloodstream infections and urinary tract infections.
Because this was the first year of testing for rare genes, the CDC does not have trend data, she said, but she hopes this won’t be the “beginning of an inevitable march upwards.”
The new report highlights the work of the CDC’s Antibiotic Resistance Laboratory Network, formed in 2016 to help detect antibiotic resistance in health care, food and the community.
In 1988, health officials in the United States learned that some germs within one family of bacteria, Enterobacteriaceae, could produce an enzyme capable of breaking down common antibiotics. By 2001, the germs had begun to evolve, becoming more resistant to carbapenems and other antibiotic drugs. These carbapenem-resistant Enterobacteriaceae, or CRE — dubbed “nightmare bacteria” by the CDC — spread rapidly in the US and around the globe.
Today, the CDC promotes an aggressive “containment strategy” that includes rapid detection tests and screening for reducing the spread of antibiotic resistance.
“CDC estimates show that even if only 20% effective, the containment strategy can reduce the number of nightmare bacteria cases by 76% over three years in one area,” Schuchat said.
While public health officials concentrate on containment protocols, each of us can help limit antibiotic resistance by keeping our hands clean and disinfecting cuts, the CDC recommends. Also, it is important to talk to health care providers about preventing infections through vaccines and other measures while informing them whether you have been treated in another facility or country.
“Even in remote areas, the threat of (resistant) pathogens is real,” Butler said. Because patients transfer from hospitals and nursing homes, germs can spread across the nation.
Dr. Arjun Srinivasan of the CDC’s Division of Healthcare Quality Promotion emphasized the hopeful message contained in the new report.


While a single provider may be at the center of each case of antibiotic resistance, “no provider has to go it alone,” he said. Working with hospital and state infection control teams, the spread of a rare infection can be stopped.
It’s not a “one and done” deal, Srinivasan said. Health officials “keep at it,” he said, until the spread of a potentially deadly infection is controlled.

Your Hands Are The Key

Did you know that 85% of all infections are carried by your hands.  Your hands touch just about everything and you do touch you mouth, eyes, ears and nose 1 to 3 times every 5 minutes.  These are portals of entry into body for bacteria, viruses, yeast and mold.   Just look others around you and you will see that this scientific fact is true.  The other 15% of the time you are infected by someone who is sick and sneezing or perhaps you ate something that was contaminated with pathogenic bacteria or a nasty virus.  This is why it is important to keep your hands clean and as germ free as possible.

Germs in the Gym

MRSA Superbug in Gym Clubs: 7 Ways to Stay Safe

High Incidence Among School Athletes Puts Spotlight On Health Clubs

With the number of MRSA Superbug cases rising among high school and college athletes, could the same risk factors put members of commercial gyms and health clubs at risk? Common sense says yes.

An inventory of the leading medical establishments’ MRSA-related websites shows that there is cause for extra caution these days while working on your abs and taking yoga class at your local health club.

The Mayo Clinic reports the following risk factors:

Participating in contact sports. CA-MRSA has crept into both amateur and professional sports teams. The bacteria is spread easily through cuts and abrasions and skin-to-skin contact.

-Sharing towels or athletic equipment. Although few outbreaks have been reported in public gyms, CA-MRSA has spread among athletes sharing razors, towels, uniforms or equipment.

From the Centers For Disease Control (CDC) on preventing MRSA:

practicing good hygiene (e.g., keeping your hands clean by washing with soap and water or using a quality hand sanitizer with a proven efficacy and showering immediately after participating in exercise);

-avoiding sharing personal items (e.g., towels, razors) that come into contact with your bare skin; and using a barrier (e.g., clothing or a towel) between your skin and shared equipment such as weight-training benches.

While the CDC advice was directed more to the school setting, the same opportunities for the spread of MSRA exist in membership gyms and health clubs as well.

Some easy precautions for avoiding MRSA while working on your abs at the local health club:

  1. Many gyms provide cleaning sprays like Microcide SQ and paper towels for use by patrons. Spray the handles of cardio equipment both before and after use. If your health club does not provide cleaning products, tell them they should.
  2. Use a towel between you and the bench when lifting weights.
  3. Use a towel between you and hand weights when weight training,
  4. Carry an proven hand sanitizer that meets CDC guidelines, like Microsan RX Foaming Hand Sanitizer and use it between machines when circuit training.
  5. Bring your own yoga mat.
  6. Ask if your gym washes and dries towels in hot water and hot dryers. If you suspect it doesn’t, or they don’t know, bring your own towels from home.
  7. Wash your own gym clothes at home in hot water and a hot dryer after every work-out.

Medical experts believe that the MRSA Superbug evolved from a common Staph bacterium because of  the over prescribing of prescription antibiotics.