Still Lisa: Strep infection turned childbirth into battle to survive

Photos by Laura Seitz
Deseret Morning News

Published: Sunday, March 12 2006 12:00 a.m. MST

Lisa's future was being measured in minutes: If she made it through this minute, she had a chance of surviving the next one. If she somehow made it one hour she might make it two — but with every organ in her body struggling, no one believed she'd survive the night. Even the whites of her eyes were swollen. She lay unconscious, her eyelids stretched so tight they couldn't close. Her skin was mottled, purple and blue and gray, as if she'd been beaten.

Later that evening, Lisa's mother, Dee Borowiak, arrived from Chicago. Susan took her upstairs to Lisa's empty hospital room, still filled with congratulatory balloons and Lisa's slippers, where nurses handed her Lily. OK, there will be no nonsense here, Dee told her tiny granddaughter. "You're going to eat and grow and get fat and happy, so that when your mother gets out of the hospital she'll know this was all worth it." Then Dee went downstairs to see her daughter.

Lisa is the youngest of Dee and Bill's four children, the one who always tested every explanation; the little girl who wouldn't stay away from the creek in their back yard in Lockport, Ill., even when her parents told her she was too small to be out there catching frogs with the big kids.

Dee sat down in a chair next to Lisa's bed, patted her daughter's swollen blue hand and began: "Our baby is beautiful," she said. "I can't wait for you to see her." Susan Heiner, uncertain that Dee understood the prognosis, warned her not to get her hopes up. "This is serious," she told her. Of course, said Dee. "But they don't know Lisa. Lisa won't stand for this."

· · · · ·

She was fighting a life-and-death battle against Streptococcus pyogenes — Strep A —a common one-cell organism that is mindless in its drive to survive. For that, it needs a human.

In winter months, about 1 in 20 adults and one-third of children carry Strep A in their noses, throats or on their skin at any time. It may hang around for a few days or even months, but most often it's benign. Since Strep A conjures the image of a sore throat, a mild skin infection, occasionally a more severe complication like rheumatic fever, it's easy to underestimate its destructive potential. There are about 150 different varieties, and it is singularly good at adapting to its circumstances.

In rare and horrifying cases — about 3.5 in 100,000, according to noted infectious disease expert Dr. Dennis L. Stevens of the VA Medical System in Boise — Group A Strep becomes vicious. Experts call it "invasive" when it works its toxic way into parts of the body usually out of its reach, like the blood, muscle or spinal fluid.

Invasive Strep A can directly cause necrotizing fasciitis, often simplistically called flesh-eating disease, although in reality it attacks connective tissue, destroying muscles and their underpinnings, not just flesh. One in five afflicted that way will die. It can also cause devastating syndromes, not by spreading bacteria but by releasing powerful poisons. The process can rage on after the bacteria itself has been killed — penicillin usually does the trick.

About a third of those cases turn into Streptococcal toxic shock syndrome (not associated with tampons). As blood pressure plunges, crucial organs like kidneys and lungs start to shut down. As many as 70 percent of patients die. Invasive Strep A may also jump-start a process of blood coagulation; the widespread clotting chokes off blood flow to the fingers and toes, arms and legs, strangling limbs. If the limbs die, they must be removed to save the rest of the body.

Lisa's strep chose three destructive paths, says Dr. Jeffrey R. Saffle, professor of surgery at the University of Utah School of Medicine and director of University Hospital's burn intensive care unit. It settled in the muscle and connective tissue in her abdominal wall, creating large abscesses. It triggered toxic shock. And it choked off circulation to her limbs.

· · · · ·

Lisa was unconscious as her organs died incrementally. The next day, doctors took out her ovaries and sections of her large and small intestines. On Day 5, surgeons removed her gall bladder and performed an ileostomy, which funneled her waste to a bag on her abdomen. Meanwhile, her liver couldn't keep up with the toxins that were forming in her body. And her limbs were darkening ominously.

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