it strikes all across the country a common bacterium with a deadly difference this one eats the body from the inside out it needs only three days to kill and as health authorities race to stop it spread even they can't be sure it's coming from or who it will strike next [Music] Harlingen Texas the year 2000 Marcella Lawler's 11 month old son Marian had been recovering from chickenpox when he suddenly took a turn for the worst burning with fever he would not stop crying Marcella called her pediatrician who told her to rush to the emergency room [Music] Advan Baptist hospital nurses were standing by they hurried Marion into the ER and took blood samples for testing the staff had no idea what was making the little boys so sick as they worked on her son all Marcella could do was watch feels is your completely anxious and you're you're scared to death because at that moment we didn't know what what the problem was but this baby had an extra Ally on his side his grandfather and namesake dr. Marion Lawlor was a cardiac surgeon at the hospital called in to examine his grandson the doctor was astonished and alarmed the baby skin was red and splotchy he had a high fever and appeared to be crashing dr. Lawler suspected his grandson had a serious systemic infection the little boy's organs were beginning to fail from the moment I first saw him I feared for his life his vital signs were terrible his heart was racing over 200 beats a minute his respirations were shallow 60 times a minute blood pressure was low is critically ill his grandfather hoped the blood results would help explain the mystery but it would take hours for them to come back hours his grandfather feared young Marian did not have [Music] dr. Lawler said just prepare yourself because he's gonna get a lot more sick and he's gonna take a lot more time for him to get better uh it's so event I knew that he was very very ill and that he was gonna think what good time for them to stabilize him dr. Lawler knew his facility didn't have the resources to treat young Marion by this time the young child's arm was beginning to turn blue from poor circulation he called the Texas Children's Hospital in Houston for help briefly describe his condition to them and they readily agreed that he needed to come up there as soon as possible every second would count the Children's Hospital sent a medical transport plane the medevac plane rushed to Harlingen to pick up the child it carried critical care nurses and pediatrician Cynthia peacock we talked to the intensive care specialists in the unit they felt that we were gonna have to do some initial work on him before we could actually get him back on the plane back to Houston I don't think they knew the extent of it we were worried but the infant was too sick to be moved right away with his blood pressure plummeting dr. peacock and her team worked to stabilize baby Mariam [Music] his illness defied all their attempts and they were running out of time [Music] they needed to get the baby to Houston I would say maybe the first hour hour and a half and everything we did from you know intubating putting on the ventilator playing a central line and I'm given a blood product he just wasn't responding and so it was like anything you could possibly think of to do at the time to get him out at the door that's how we had it in our brain was okay one step ahead we're gonna confront this monster at last they were able to move the baby out of the hospital but their hold was tenuous his breathing became shallow with dr. peacock TV I can't interrupt them to tell me where the baby was gonna get better and though she put her arms on my shoulders and said he was gonna get a lot forth with no time to waste the baby was loaded onto the plane it was like a mobile hospital loaded with supplies and equipment the tiny patient might require he would need all of it dr. peacock hoped he would have a chance but then the troubles intensified we weren't able to take off right away because then we had to do 15 or 20 more minutes working on in the back and a lot of it was can we go you know my my whole concern was oh my goodness we're going to have to turn around and go back to the hospital go back to the intensive care unit to work on him some more we can't go he won't he's not going to he's not gonna make it the crew finally managed to stabilize him enough to take off and the plane headed for Houston in flight the baby's condition was precarious with the slightest movement his blood pressure went into a downward spiral in order to save baby Marion they would need a clear path to Houston he since the fourth largest city in the United States so there's all kinds of planes coming in we're having to tell the tower and Houston that we're coming in and we're coming in low so you're gonna have to move all of your traffic out of the way with time running out for baby Marion Houston cleared all air traffic for the medevac plane [Music] [Applause] young Marian was rushed into the intensive care unit at the Texas Children's Hospital in Houston a swift-moving disease was ravaging the 11 month old his heart and lungs weren't pumping enough blood and oxygen through his body his vital organs were in jeopardy they thought he might be suffering from a strep infection but they had never seen one so severe pediatrician dr. Larry Jefferson and his team went right to work when Marian ruled into our ICU we immediately could see he was in septic shock his body was swollen his face was swollen his face was red and we were concerned x-ray showed that the life-saving fluids pumped into young Marian's body were filling his lungs the doctors had to clear his airway when the blood test came back they were definitive baby Marion had a severe strep infection doctors thought this might be related to his bout of chicken pox the opportunistic bacteria had invaded his body through open blisters and traveled through his bloodstream for Marcela and her husband Marion Lawlor waiting for the prognosis was agonizing default I know for you is very difficult transport on base you know Marianas very unstable mentally stable the bachelor space is leaking problem to keeping his blood pressure up the fluid is leaking through his vessels into his lung and his tissue we're also concerned about seemed like it must have been 2 or 3 in the morning we were retrieved by dr. Jefferson was explained to us that Marion had chickenpox complicated by this invasive strep a bacteria which had sent him into streptococcal toxic shock syndrome and he'd explained to us that the antibiotics had began working but that the antibiotics had caused the bacteria to release a toxin that had basically perforated our son's vascular system and and I knew that that was not good at all baby Marion was given a less than 1% chance of survival and was of course [Music] when they they told us that he might not make it we immediately called our parents it said you know very they're telling us he's not gonna make it it's very serious and he probably would loving tonight and so that was at that moment he the doctors were nobody was finally everybody was dead serious and they were not giving giving us any sense of hope dr. Jefferson briefed the child's grandfather he told him that strep can take many dangerous forms he feared the infection in Marion's arm could turn to necrotizing fasciitis more commonly known as flesh-eating bacteria this disease is extremely rare and extremely deadly I went to the computer laboratory and looked up specifically the toxic shock syndrome associated with beta hemolytic streptococcal infection and that's when I really became frightened dr. Lawler had to do something [Music] Texas Children's Hospital is associated with nearby Baylor College of Medicine at Baylor dr. James Mercer had already studied a 1998 outbreak of invasive strap he knew the dangers of the bacteria all too well how it releases toxins into the blood attacking organs and eating away flesh it's sort of like having rockets coming at you each of which has a different toxin associated with it it's a very very clever organism very wily organism it's that facilitates these kinds of infections strep itself is all too common anyone who's ever had a strep throat has encountered it but sometimes in a few rare cases a virulent strain of the bacteria will cause severe disease perhaps the most terrifying manifestation is necrotizing fasciitis known as flesh-eating bacteria the disease that literally eats away human flesh dr. Edward Kaplan at the University of Minnesota keeps a database of strep a patients for the World Health Organization many of the patients who develop toxic shock and necrotizing fasciitis they've had some kind of injury it almost seems as if the organism tends to gravitate to areas of damaged tissue as baby Marian's condition worsened doctors feared there was little they could do to stop this terrifying disease from taking his young life in the year 2000 a toxic bacteria was threatening the life of baby Marion Lawlor as the child fought for his life Marian's parents could only watch and hope as the doctors did all they could do Jefferson came in and he said that he had been working with it that's a he had pushed an unbelievable amount of blood into him that his blood pressure was extremely low that his heart rate was extremely high that everything was was not the way it's supposed to be that he was not responding as Marion Lawlor clung to life doctors in Texas began to draw on information they had learned from dealing with this disease for over two years in 1998 Austin Texas saw an alarming number of severe strep infections cases of invasive strap are rare but when they show up it's usually in a cluster one of the largest and deadliest outbreaks ever had occurred in Austin Texas just two years earlier in 1998 Tom Hastings came to the emergency room of an Austin area hospital he had been suffering for two days with headaches exhaustion low-grade fever and a dry cough he thought he had the flu and went to the hospital only when he started spitting up blood and finding more blood in his urine by then he was already in serious danger doctors in Austin admitted him to the hospital and diagnosed him with a bacterial infection they began a course of antibiotics immediately but before the drugs had a chance to work his lungs began filling with fluid blood tests indicated he had something much worse than the flu an invasive strep infection was destroying his lungs causing a life-threatening case of pneumonia as doctors were trying to treat Hastings 43 year old truck driver Dan Cooper woke up to discover something terrible on his side strep toxins caused blood vessels under his skin to burst leaving a large blister Dan hurried into the ER the doctor immediately recognized the danger and his paint fences are okay looks like we're gonna have to do some surgery yeah antibiotics alone would not stop the runaway infection dan was quickly prepped for surgery he was diagnosed with a devastating strep infection that was eating away his flesh at the rate of an inch per hour the doctor would have to cut away the infected tissue before more of his body was destroyed once the strep bacteria infects the flesh the infected areas must be removed to stop its aggressive spread as the bacteria advanced towards Dan's genitals abdomen and trunk doctors kept cutting [Music] over the next five days he endured six surgeries between each one Dan spent time in the pressurized atmosphere of a hyperbaric chamber the same kind divers used for the bends they hoped that the pure oxygen of the chamber would inhibit the growth of the bacteria and the production of toxins as well as accelerate the healing process it was a last resort an attempt to stop the devastating effects of this predatory bacteria while doctors waited to see whether Dan Cooper would recover Tom Hastings who had come to the emergency room complaining of flu-like symptoms suffered fatal cardiac arrest [Music] the bacteria had lodged in his lungs causing severe pneumonia [Music] at the austin-travis County Health Department Betty Vickers had received other reports of sudden deaths we usually have one or two cases a year of this where people might die but we had two fairly healthy individuals that died within a short period of time of each other and we figured that there was something going on at that time this deadly disease was on the upswing and Betty Vickers needed to know why the State Health Department reported they had seen a rise in deaths due to invasive strep infections all across Texas we knew we had a problem there was no question about it at that time we had to do something to help protect a community Betty Vickers had to find out where the flesh-eating bacteria was coming from before she could hope to stop it he was fine at night he just broke vicar's tried to find a common connection between the victims by interviewing their spouses and co-workers what she found was a mystery begging to be solved we could not find any common commonalities among these cases they were different ages different parts of town different backgrounds different cultures we couldn't find any link between these people nothing and still the victims kept coming the Texas Health Department pored over the data on strep infections from hospitals across the state between December 1997 and mid February 1998 the Health Department confirmed 27 cases of invasive group a strep 10 Texans had died if the cases clustered in Central Texas near Austin still no connection could be made between the victims the disease was striking young and old a little girl in the Austin area also succumbed to the strep bacteria nurses went to the little girls day care center to take throat cultures of the other children and staff to see if they carried the deadly bacteria they provided antibiotics to anyone who came in contact with the child I've been in the business for a long time many years and usually there's a vaccine or something you know how you can protect yourself but you could go to the grocery store and not know if you were exposed or not and it was it was scary the bacterium causing the disease was extremely common at any given time up to 20% of the population anywhere may carry the streptococcus a bacterium without any symptoms at all the danger arises when the strep mutates and becomes invasive Texas health officials raced to find out why this deadly mutation was hitting their state so hard the community had questions to public health officials set up a hotline and fielded thousands of calls the public was in a panic one day we had over 500 phone calls in our poor support person was all they were able to do is to give me your name and phone number and I'll have a nurse call you back at Baylor College of Medicine in Houston microbiologist James Mercer analyzed bacterial samples collected from victims all across the state he was looking to find out what was making this common bacteria turn into a killer he identified many different strains of group a strep popping up all over Texas but the most lethal ones were found in the Austin area musters team began trying to crack the genetic codes of the deadly forms of strength the strategy of genome analysis is a crucial strategy now in our studies of how group a streptococcus causes human disease it's now important to investigate many of the other common serotypes that cause both invasive disease and group a strep in order to determine exactly what factors are specific to the strains that cause the flesh-eating syndrome each strep bacterium contains one point nine million pairs of chemical bases the genetic instructions for its behavior the strains of killer strep and the harmless forms are more than 90 percent identical musters research focused on the other 10% the genetic material found only in the deadly strains most important were the genes that held the bacterium's orders to kill musters goal was to stop those orders but even as muster work to understand the bacteria the public continued to become ill the killer strep could invade the body through a scratch or abrasion caught early enough it could be treated with antibiotics but it was seldom caught in time in Texas victims continue to pay with love and limb as health officials work tirelessly to stop its spread the killer bacteria continued its advance against a helpless population despite the doctors best efforts a third victim died of catastrophic organ failure as the group a strep bacteria swept through his body this killer seemed unstoppable and despite the hours that researchers were putting in no one had any idea of where to start invasive group a strep had taken hold of Texas and one of its tiniest victims was putting up the biggest fight eleven month old Marion Lawlor the fourth suffered the many horrors of strep infection not only was the enduring strep induced toxic shock but he also fought a case of streptococcal pneumonia he was not oxygenating your blood sufficiently and they placed him on a special a respirator called the oscillating ventilator that breeze six hundred forty breaths a minute and even the initial days of that the pressures were high and the oxygen level was low and he was barely hanging off with that Bell later doctors pumped the child full of fluids to try to combat the infection the drastic life-preserving methods rendered the infant unrecognizable even to his father it was terrible he was already grotesquely disfigured from the volume overload we could not recognize him he looked to be three times the size that he was before and it was purple as young Marion Lawlor lingered near death he had an ally his grandfather a physician reached out for help he contacted Denis Stephens at the VA hospital in Boise Idaho over the years Stevens had become the leading authority on invasive group a stress he knew exactly how dangerous this adversary was he was one of the first to recognize deadly new strains one of the first to declare it a potential time bomb the organism has the ability to adapt it has the ability to acquire new virulence factors group a strep doubles about every 23 minutes its ability to adapt as hundreds if not thousands times greater than that of the human host dr. Stevens recognized the gravity of young Marian's condition he was the first to alert the medical community that strep bacteria could cause toxic shock in healthy young people in his 20 years of experience with the disease he had seen a growing number of cases in patients around the world the reason that people developed these deep-seated infections are that they encounter an organism to which they don't have natural resistance they don't have antibodies against the organism itself or some of the toxins it produces but dr. Stevens had also begun to develop a way to combat the disease it all started with an Idaho boy named Brad Andrews Brad Andrews was a very healthy young man played handball and racquetball he acquired an abrasion on his elbow and about 24 36 hours later he developed a tremendous swelling about the elbow with red skin and streaks up his arm Brad didn't realize it but he was seeing the first signs of the potentially fatal infection I went to work and it was probably three to four hours later and the symptoms were continually getting worse he drove himself to the hospital and was immediately admitted [Music] [Music] the first night I was in the hospital they told me that they were my blood pressure dropped very low and I asked him I said what's what's going on and he said because I don't know but you're if you don't get your blood pressure up you could die [Music] Brad was fortunate that his wife worked for dr. Stevens she knew how bad the disease could be she also knew that the doctor had begun developing a new drug treatment for the disease Brad would be one of the first to try it out we looked at the ability of clindamycin to suppress toxin production in in vitro in test tubes and it was a very potent inhibitor of the toxin and we thought that that might be a reasonable agent to use to treat these potent toxin producing strains of group a strep Brad was switched to the antibiotic clindamycin to stop the toxin and combat the lethal infection and within days he began to get better the treatment given early had worked dr. Stevens told Marian's grandfather about clindamycin dr. Lalla realized every piece of information he gathered could save his grandson's life the young boy's father was desperate for anything to help his son really we were living every second of every single day for our son any any change and his blood pressure one degree or the other change in his temperature in his urine output and his breathing capabilities we were really hanging on by a thread at that point first week or two the news just kept seemed to be getting worse and worse and worse Varian was now being kept under a heated blanket to try to stabilize his body temperature and combat further infection he was in desperate need of a medical miracle at the Texas Children's Hospital in 2000 little Marion Lawlor was in danger he had been medevac to Houston rushed into intensive care only for his parents to learn he faced a life-threatening infection the invasive form of strep a but now the research of his grandfather and the lessons learned from other strep patients would begin to pay off the baby was given a full spectrum of antibiotics including clindamycin to fight the lethal bacteria finally the infant began to stabilize with streptococcal invasive a the most important thing is that they make it the first 72 hours so for us to make it those those three days was you know we were actually happy you know he made it he's gonna get further and then his kidney shut down and he gets at the pneumonia we think he might lose the arm it took the constant vigilance of the Lawlor family and an army of doctors and nurses to keep the infant's body functioning at its most basic level there were about 19 different pediatric specialists that were involved in his evaluation or his in treatment in some capacity the federal Centers for Disease Control and Prevention had found that of the more than 100 strains or variations of the group a strep two were found to be most life-threatening M 1 and M 3 the CDC found that these strains were more likely to be fatal more likely to cause dangerous clusters of cases like the one in Austin the Austin area had become a boomtown and public health nurse Betty Vickers feared the unusual strep was the downside of the city success at that time this area was having a significant growth population increase we don't know if that's how it was introduced or not but you can kind of suspect or think that way public health officials believe the influx of new residents from across the country might have introduced the new strains of strep the locals have no resistance this is how the scientists believed that victims like Dan Cooper and baby Mary and Lawler had become infected but despite having some luck with treatments they were still looking for a cure the doctors continued to gather research from all over the world information on a new form of treatment came from thousands of miles away doctors in Canada were reporting they could reduce invasive strapp fatalities in Toronto Kathy Melville led a busy life with her husband and young daughter she seldom let a cold bother her but one morning in 1994 she felt particularly ill I went to Bent one night after having some family over for a birthday party and woke up in the morning feeling as if I had the flu and I also had a really severe pain in my right arm to me and actually felt like it was it also down part of my back [Music] Kathy hoped it would pass but by the next day she only felt worse [Music] pain relievers weren't working on her sore arm she grew concerned that she was suffering from more than the flu Kathy went to the doctor but her strange collection of symptoms did not present a clear diagnosis the physician said that she couldn't find any reason for the extreme pain that she was concerned about it so she said you know if you wake up in the middle of the night and you're afraid go to the emergency department and explain to them what's been happening to you over the last few days that night she went to the hospital by the time she got to the emergency room her kidneys were shutting down her white blood cell count rose indicating a severe infection as her throat and chest began to swell she was rushed to the ICU diagnosis massive infection and cause unknown apparently the resident who was on duty called around the country trying to figure out what was wrong with me and got in touch with dr. lo at Mount Sinai Hospital the resident described the symptoms to strep expert Donald lo who suspected that Cathy's toxic shock might have been caused by group a strep if that were true her prognosis looked grim we told the family that could factor the likelihood of her dying from this illness was about an 80% chance we wanted her transferred to Mount Sinai Hospital so not only could we Institute the appropriate therapy but also carry out the appropriate surgery on dr. Loes orders Cathy was rushed to the better-equipped hospital they had to remove the infected flesh before the deadly bacteria spread too far but surgery was just the beginning with Cathy's life on the line dr. LOH decided to try a brand new treatment they had been experimenting with it was called immunoglobulin therapy delivering a concentrated version of the body's own antibodies the therapy was thought to inactivate the dangerous strep toxins [Music] Cathy would be one of the very first to get it for invasive strap once we recognized that Cathy likely had streptococcal toxic shock we instituted the appropriate antibiotics that is penicillin in clindamycin and we also instituted high dose antibodies that is intravenous immunoglobulin intravenous immunoglobulin was a therapy that had been used to treat other illnesses but had barely been used for streptococcal toxic shock but even if the treatment worked the bacteria already had too much of a head start no life-saving drugs could reach her already dead tissue surgeons continue to cut out the infected portions of her flesh in a race to stop the spread of the strep toxins and all they could do was hope the immunoglobulin therapy would work in Texas little Marion Lawlor had been critically ill for several weeks diagnosed with invasive strep given a less than one in 100 chance of survival he was treated with massive doses of antibiotics and slowly he began to pull through [Music] after a month of intensive care he was taken off the ventilator and began to breathe on his own and then the day of course he was off the ventilator it was just a wonderful very happy very happy baby marian was on the road to recovery but even if you recover invasive strep can leave its mark Kathy Melville had endured eight operations to remove the invasive strep that had devoured the tissue of her arm and shoulder but each surgery revealed that the bacteria had spread much more than suspected originally they've been just going to him to the front of my one arm and what they did is they made an incision from the base of my elbow all the way up the back of my arm across my armpit and then halfway over to my spine and what they found in there was eleven necrotic muscles so eleven rotten muscles and they removed all of those and then took out half of my shoulder blade as well by the time the necrotizing fasciitis was identified it already had a three-day head start luckily dr. Loes innovative immunoglobulin therapy pumping up the body's own defenses turned out to work well and Kathy began to recover too dr. LOH catching an invasive strep infection early on is vital to a successful recovery one of the great difficulties with this disease is making an early correct diagnosis and often when physicians first see a patient they don't suspect the illness in fact 30 percent were misdiagnosed today that problem still exists because the symptoms are so nondescript and often associated with a flu-like illness pain myalgias sore joints fever that group a strep is not even suspected as a cause of their symptoms dr. Donald Lowe's research team in Canada dedicated themselves to early detection and learning how the disease gets passed from one person to another a carrier might not even realize he or she is infected in Kathy Melville's case family members carried the same dangerous strain of group a strep while presenting different symptoms or no symptoms at all always one of the questions is what's the likelihood of someone else who's had contact with a patient with severe streptococcal disease what's the likelihood that they'll come down with infection family members patients that were in contact with family members or other individuals for more than four hours a day in the previous week they were in fact at greater risk of developing severe streptococcal disease in trying to determine how she caught the disease Kathy recalled a small cut on her little finger hardly noticeable but an open invitation for the bacteria to invade the theory is that one of the children coughed got bacteria on their hand and then held my hand the bacteria worked its way in through the cuts and then up into the soft tissue in my shoulder where I'd perhaps torna muscle using this new ski machine and that's where all the damage began today Kathy Melville is living a full and healthy life she started an organization to help spread the word about the dangers of the strep bacteria her organization produced a brochure called a life guide to help people recognize the symptoms and severity of the disease and to persuade their doctors to consider it as a possible diagnosis a parent or a patient or a husband or spouse can go into a physician and say this is what we're experiencing right now is it possible that this person has necrotizing fasciitis and for a physician to recognize the necrotizing fasciitis is very difficult if they've never seen it before they will think that you have a pain of some sort and that you have the flu and they will send you home but the life guide you can count on whether or not that's what you have patience in Texas have benefited from Kathy's experience and dr. Loes immunoglobulin therapy [Music] dan Cooper has made a full recovery dan and little Marion were among the lucky ones in just the first five months of 1998 Texas had 232 cases of invasive strep a in less than six months 33 people died a third of them were children [Music] today the CDC reports as many as 1500 deaths are caused yearly by the invasive group a strep bacteria to prevent this type of devastating outbreak dr. James Dale and his team at the University of Tennessee are working to create a vaccine he is combining proteins from 26 different strains of group a strep thanks to research in genomes dr. Dale and others can select the bacterial proteins that will it's hoped cause antibody production without causing illness and guard against the disease this vaccine was designed to protect against eighty to ninety percent those serotypes that are responsible for serious invasive disease and also 80 to 90 percent of those types that cause uncomplicated strep throat we believe that the vaccine will have a significant impact on the entire burden of streptococcal disease the vaccine could prevent thousands of cases like that of baby Marion Lawlor now for he has made a complete recovery and enjoys a happy healthy life in my work is a cardiovascular surgeon when I do a bypass or other surgical procedure it's generally on someone 60 or 70 years old and so I may provide them an additional 10 12 15 years of life but when you save a child 1 year old you're giving him his entire life the bacteria still mystifies the disease still threatens but now that gift of life may be within our grasp [Music] you [Music]