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Thursday, April 6, 2006 - Page updated at 05:31 PM

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Clarification: Of the nine deaths in King County this year from necrotizing fasciitis, six were King County residents; of the 18 deaths in 2005, eight were county residents. A previous version of this story did not make clear that some of the fatalities were residents from outside who were transported to King County for treatment.

Man dies from flesh-destroying disease

Seattle Times Eastside bureau

Last Tuesday, Ed Kopfman thought he'd come down with the flu. On Friday, he went to the doctor. By Sunday, the 47-year-old Kirkland father of two was taken to Harborview Medical Center and died that same day.

For those who knew Kopfman, the cause of death was even more shocking: necrotizing fasciitis, a rare condition also known as "flesh-eating bacteria."

"It's so unreal," his wife, Peggy Kopfman, said Wednesday. "We're all still in so much shock."

The bacterial infection took the lives of five King County residents from January to March 15 this year, and eight more in 2005, according to Public Health — Seattle & King County, citing data from the county Medical Examiner's Office.

Nationwide, statistics vary, but in 1999 the U.S. Centers for Disease Control and Prevention reported 600 cases of necrotizing fasciitis.

If caught early, chances of survival are high. Last month, for instance, 6-year-old Jacob Finkbonner of Ferndale contracted it after cutting his lip playing basketball. He was hospitalized at Children's Hospital & Regional Medical Center in Seattle, and his condition has been upgraded from serious to satisfactory.

The infection occurs when invasive forms of streptococcus bacteria enter the body — usually through a cut or opening in the skin — and quickly flourish between the muscle and deep connective tissues. The bacteria spread along these planes and give off toxins and enzymes that kill tissue.

Information


National Necrotizing Fasciitis Foundation: www.nnff.org

"This seems to be an area of the body that's more susceptible to infection," said Dr. Craig Rubens, chief of Children's infectious-disease unit. "It destroys very rapidly."

Group A Strep, responsible for strep throat, is the most common strain of the infection. It's also the strain that killed Kopfman, according to the Medical Examiner's Office. About 20 percent of people carry the bacteria in their noses and throats, but few get symptoms, Rubens said.

Previous injuries, advanced age, chronic kidney failure or diabetes can make some people more vulnerable.

Intravenous drug users are at high risk, but the infection can strike anyone. Those with suppressed immune systems have a higher rate of mortality, Rubens said. In many cases, no direct cause can be identified, according to an article published last year in the British Medical Journal.

Doctors familiar with the disease are quick to point out that it is rare and does not present a public-health hazard because it's not easily transmitted from one person to another.

Part of the fear and misunderstanding stems from the name "flesh-eating bacteria," they say, which has spread panic disproportionate to the number of documented cases.

"The fact is, the bacteria that causes necrotizing fasciitis are very common in our environment" and rarely evolve into the worst-case scenario, said Dr. Jeff Duchin, director of communicable-disease control at Public Health — Seattle & King County.

But when it does happen, there are often no external clues. Patients will complain of intense pain with no visible signs on the skin, Duchin said. Complicating matters is that initial symptoms can mimic other ailments like the flu, he said.

"The problem is that it's a notoriously difficult diagnosis to make," Duchin said. "It can spread before it's recognized and, frequently, this diagnosis can only be made during surgery. Basically, you have to see how the deep tissue is inflamed."

Peggy Kopfman is struggling to understand how the disease struck her robust and healthy husband, a repairman by trade, who never shied away from heavy lifting or taking on complex carpentry projects.

After being misdiagnosed with shingles on Friday, he was admitted to Evergreen Hospital Medical Center's emergency room Saturday night when the pain on his left side wouldn't let up, she said.

The left side of his chest started to swell and bruise, she said. "It looked like someone beat him up," she said.

Doctors performed exploratory surgery and discovered the dead tissue, she said. They removed some, stabilized him and transported him to Harborview. In the time it took to get there, it had traveled down his arm and killed the tissue, Peggy Kopfman said.

The couple had been married 10 years.

"He was my rock," she said.

Sonia Krishnan: 206-515-5546 or skrishnan@seattletimes.com

Copyright © 2006 The Seattle Times Company

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