After an awful and horrifying ordeal over the past week, we are happy to report that our 27-month-old son, Zaiden, now appears to be well on his way to a complete recovery. He was suffering from a rapidly accelerating Group A Strep Cellulitis that appeared to be fast developing into Necrotizing Fasciitis. Fortunately, quick diagnosis and the help of some top notch doctors helped to prevent the more serious condition from taking root. We present this information and accompanying photos with the hope that they help others to diagnose their situation early, which appears to be the key to saving life and limb in these sorts of infections.
Last Tuesday, October 19, 2004, at 2:30 pm Zaiden got his flu shot. Right after the shot, everything seemed fine.The next day, Wednesday, October 20, early afternoon, Zaiden's daycare called to say that he was acting lethargic and has a slight fever. Wednesday at 4 pm, we took Zaiden to his pediatrician, at which time we noticed that the area just under the injection site was swollen. The doctor said that this is probably just a common reaction to the flu shot, and unless there were any drastic changes, we shouldn't worry. On Wednesday at about 8 pm, we gave Zaiden a bath. On placing him into the bath, the injection site looked pretty much like it did earlier at the pediatrician's office - just a bit swollen. 15 minutes later, on taking him out of the bath, though, swelling increased and lesions spontaneously began forming on his arm.
We rushed him to a packed local emergency room, where the deeply concerned triage nurse bumped Zaiden ahead of everyone else. His arm continued to swell, and the lesions and redness was spreading before our eyes - at a rate of about one inch every half-hour. We were horrified. Several of the ER physicians were consulting with each other outside our presence. They indicated that they were extremely concerned, but didn't want to rush to conclusions. When I asked if they thought we were looking at the "Flesh Eating" bacteria, they indicated that the signs of it were there. My wife and I silently suspected this, but when we heard this aloud, we were in shock. It seemed our worst fears were being realized. They ordered IV antibiotics, and arranged for Zaiden to be transported to A. I. DuPont Hospital for Children in Wilmington, Delaware, about an hour away, where there were pediatric infectious disease specialists. While we waited for the transport to pick us up and take us to DuPont Hospital, the local hospital's pharmacy was ridiculously slow to fill the antibiotic prescription.
The area in the center of the lesions began turning gray, which we were told was a sign that the skin was being deprived of blood-flow and oxygen, and was dying. Once they FINALLY started pumping the antibiotics through his veins (about 3 hours after our arrival), it was soon noticeable that the lesions and swelling stopped spreading. They gave Zaiden 3 separate IV antibiotics in succession: Clindamycin, Oxacillian, and Vancomycin. During the Vancomycin treatment, his entire body turned red and he was itching frantically. We were told that this was a normal reaction to the Vancomycin known as "Red Man Syndrome". Some IV Benadryl soon cleared it up. They eventually took Zaiden off the Vancomycin after they were confident that this was not a staph infection, for which Vancomycin is administered.
It was Thursday morning now, and we were down at DuPont Hospital in Delaware after a sleepless night. The infectious disease specialist saw Zaiden and said that he had what is called a Group A Strep Cellulitis, a potentially very serious skin infection. It appeared, though, that the antibiotics had fortunately taken root and put the situation in check. She said that if we had not reacted as swiftly as we did in getting Zaiden to the hospital, then the likelihood was that the infection would have converted into a full-blown Necrotizing Fasciitis (the so-called Flesh Eating Bacteria condition). Had we waited until the next morning to go to the doctor, or had we not noticed the lesions until the next day, we may not have been so lucky.
We were told that the infection, in all likelihood, was not caused by a bad batch of vaccine (which is apparently exceedingly rare), but rather the Group A Strep germs (which are all around us, and in fact live on our skin), somehow infiltrated the puncture site of the injection (in spite of the fact that it was wiped down with alcohol before the injection).
Over the next couple of days, the swelling of Zaiden's arm (which grew, at its worse, to almost twice it's normal size) gradually reduced. As a precaution, Zaiden was in isolation and was not allowed to leave his hospital room. Although all of this was going on in Zaiden's arm, and although he had an IV tethering him down, and although my wife and my nerves were shattered, Zaiden was in great spirits. He enjoyed all the attention he was getting from us and from all the doctors and nurses, and all the food and desserts (he suffered NO loss of appetite - to the contrary, he was eating very well). For four days and nights, neither my wife nor I left Zaiden's side at the hospital.
After the doctors were confident that Zaiden's condition was stabilized and they were no longer worried that the infection would again spread, we realized how truly fortunate we were. We learned that while we were en route to DuPont Hospital, based on how rapidly the infection appeared to be spreading, they did not think Zaiden was going to make it. Behind the scenes (which we did not know at the time) there was a surgical team at DuPont prepping and awaiting our arrival. Had the antibiotics not taken hold, they would have operated to excise the infected skin and tissue.
On Sunday Zaiden was discharged from the hospital. We are now both with him watching him closely and watching his arm to make sure the infection does not reemerge (we were told that the chances of this were very very remote). After the past 4 days on IV antibiotics, Zaiden will be on oral antibiotics (Amoxicillin) for another week. We were told that Zaiden, by virtue of this incident alone, is no more likely to get another Group A Strep Cellulitis infection than anyone else, which is good news. The fact that he got it does not mean that he is more susceptible to getting it in the future. On the other hand, he is not any less likely either. The fact that he survived it does not mean that he has in any way built up an immunity.
We feel so blessed that our little Zaiden made it through this okay. If we can impart anything to our fellow parents, it is that they should never hesitate to go to the doctor or ER right away. It's often a race against the clock, and for many medical conditions, such as Group A Strep Cellulitis and NF, the sooner treatment begins, the better the odds. Also, when it comes to treating your kids, seek out the best specialists you can. We are fortunate to be within an hour from two of among the best children's hospitals in the country: DuPont Hospital for Children, and Children's Hospital of Philadelphia. Every region has good, mediocre and bad hospitals. Most community hospital ERs are good for stabilizing patients, but they are not usually where the top-notched specialists are. Never hesitate to tell your local ER doc that you want to have your little one transferred to a specialized hospital.
Although, through this experience, I'm on my way to becoming a full-blown germ-a-phobe, our pediatrician has assured me that nothing we did wrong allowed the infection to emerge. He says that all we can do, as parents, is wash our kids' hands (reasonably) often, and when they get scrapes and scratches, treat them with antiseptics, keep them clean, and keep your eye on them. We also learned that there is some new information that alcohol swabs alone may not be the most effective way to kill surface infections in preparation of shots. In Zaiden's case, the alcohol swab clearly did not adequately sterilize the field. Next time your kids (or even you) get an injection, ask the doctor, in addition to an alcohol swab, if they could apply iodine or a similar non-evaporating antiseptic. If they are not convinced, show them the attached photos.