DAILY MAIL REPORTER 7th September 2009
Britain is facing ‘a new horror’ from a flesh eating superbug which killed a father just within four hours of him arriving in hospital with leg pains.
Richard Johnson, 54, had been given painkillers for what doctors thought was arthritis.
But when it was realised that he had the infection necrotising fasciitis surgeons amputated his left leg in a bid to save him.
Hospital: Where Richard Johnson, 54, died after having his left leg amputated
They then watched in horror as black areas spread to his abdomen while they were operating, an inquest heard.
Mr Johnson, a shop manager from Crediton, Devon, died just a week after he complained of a sore throat.
A coroner has urged family doctors to be given more information necrotising fasciitis as a result of the case.
The disease, which is becoming more common, is an infection which sweeps through the body, internally and externally, so quickly that it can actually be seen spreading.
Mr Johnson had first been prescribed painkillers by his family doctor Jan Shorney.
He then developed a pain in his left ankle which Dr Shorney and an out-of-hours doctor believed to be arthritis.
His condition deteriorated so quickly that by the time his family rushed him to the Royal Devon and Exeter Hospital at 3.10 am it was too late to save him.
He was rushed straight into the operating theatre where surgeons tried to cut away the diseased tissue but found the infection was spreading too quickly to control.
Greater Devon coroner Dr Elizabeth Earland recorded a verdict of natural causes on Mr Johnson, who died at 7.00 am on November 18 last year.
A post mortem examination showed he died from septicaemia as a result of the necrotising fasciitis.
She said: ‘My intention is to write to the hospital to confirm the gravity of this case. Information about it is being disseminated and I recommend that is pursued.
‘This is a new horror reaching us and arising in out thoughts and it is important as many GPs are made aware of it as soon as possible and perhaps an early reaction can be stimulated.
‘I do not have any evidence that earlier action would have made a difference in this case.
‘Mr Johnson began to suffer a sore throat in mid November which developed into fulminating necrotising fasciitis.
‘The family have my deepest sympathies for this tragic loss.’
Family doctor Dr Jan Shorney said Mr Johnson visited her on November 11 with a sore throat and she advised him to take painkillers.
He asked for a home visit on November 17, less than 24 hours before he died, and complained of a left ankle which was sore despite having suffered no injury.
There was only slight swelling and no redness and his pulse and temperature were normal and she prescribed stronger painkillers and an anti-inflammatory drug.
She advised him to go into surgery for a blood test if it did not clear up.
He called 45 minutes later to say the pain was not going away and was told to carry on taking the medicines.
He was in so much pain that by 9.30pm his family contacted the out-of-hours service and took him to the walk-in centre at the hospital in Exeter where he was seen by on-call GP Dr Patrick Fingleton.
He examined the swollen ankle and saw no breaks in the skin. He diagnosed arthritis and prescribed oral morphine.
He believed the earlier painkillers had not worked because the patient was also suffering from diarrhoea and vomiting.
He said he was shocked to hear of Mr Johnson’s death and had met the consultant microbiologist at the hospital Dr Marina Morgan to learn more about necrotising fasciitis.
He said: ‘I have been a doctor for 12 years and a GP for five or six years and I have seen a lot of painful ankles and lots of cases of diarrhoea and vomiting but I had never seen a case of necrotising fasciitis.’
Mr Johnson’s condition deteriorated so quickly that his family took him back to the accident and emergency department of the same hospital five and a half hours later.
Consultant plastic surgeon Dr Andrew Watts said he carried out the amputation above the knee but feared it was too late to stop the spread of the disease.
He said: ‘It was clear he was very sick. There was widespread mottling of the abdomen and chest and to some extent the right leg.
‘I discovered he had died at approximately 7.00 am. Unfortunately the outcome is what had been predicted from shortly after he was admitted.’
What is necrotizing fasciitis?
Necrotizing fasciitis is a rare infection of the deeper layers of skin.
It can be caused by many types of bacteria, which usually enter via an open wound, for example following surgery.
Despite being known as a ‘flesh-eating’ bug, the bacteria do not actually eat the tissue.
They cause the destruction of skin and muscle by releasing toxins.
Symptoms usually begin with patients complaining of intense pain in the area where the infection began.
In the early stages, signs of inflammation may not appear.
Redness and swollen or hot skin will show up quicker if the bacteria is closer to the surface of the skin.
As the disease progresses, skin colour may change to violet and blisters may form, with tissue then turning black as it dies.
Patients with necrotizing fasciitis typically have a fever and appear very ill. Diarrhoea and vomiting are also common symptoms.
Mortality rates have been noted as high as 73 per cent if left untreated.
Once the disease is diagnosed it is almost always necessary to cut away the infected tissue to stop it from spreading.
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