Monday, July 1, 2013

Series Post: Ask Dr. Dina - Infection Part I: Bacteria

DISCLAIMER: I am not a doctor, nor do I play one on TV. I do not hold a current medical license or certification (I let them lapse because I no longer work in the medical field and don't intend to ever again). What I do have is an extensive medical background in various fields. Everything you read here is the result of either education, training, research and interpretation, or personal experience. The information in this post is not to be taken as a substitute for professional medical advice or examination. Seriously, if you're having an immediate medical problem and you're reading this blog for help, get off the damned computer and call an ambulance! 



Now we have come to the infection portion of our "Ask Dr. Dina" series. This piece is going to be broken into a few parts because there are many, many different types of infection and I'm not going to write a book on the subject.

These parts will be –

I – Bacterial
II – Viral
III – Fungal
IV - Treatment

As it's the most common type of infection, bacteria get the first crack at this subject.

When most people think "infection," they think of a cut that's red and swollen and full of pus, and they would be correct. Any open wound – from a paper cut to a gunshot – is capable of getting infected. Any opening in the skin (I'll leave it to your imagination…there you go….) is capable of acquiring an infection, especially if those openings are dark, moist, and warm. As the human body tends to run anywhere from 96-99 degrees Fahrenheit on average and most of our holes are where the sun don't shine, this makes for an ideal environment for all sorts of bacteria looking to set up housekeeping.

It's commonly thought something needs to be dirty in order to introduce infection. Technically true, but, a brand new nail from the hardware store is just as likely to introduce bacteria to the wound when it pierces your foot as a rusty one that's been left out in the dirt for years. It might not be the same kind of bacteria, but it's still just as likely to cause infection. This is why it's important to have your tetanus shot updated. Tetanus is caused by a bacteria called Clostridium tetani, and that little bastard is not only everywhere, it likes wounds of any kind, especially punctures. Tetanus not only hurts like a motherfucker, it's fatal 40% of the time. I don't know about you, but 40% is too close to 50% for me. More than one-third but less than half. So basically, over one-third but less than half of the people who get tetanus die.

And this is 2013.

I'll leave you to ponder those odds. Then call your doctor and get your damned tetanus shot updated if you haven't had one in the last ten years.

Moving on.

As bacteria goes, Clostridium is a bitch. There's over 100 species of that asshole, some of which I'm sure you've heard of –

- Botulism. (C. botulinum) Some idiots shove botulism in their faces for the paralytic effect. They call it "Botox." It's fucking botulism, people. FOOD POISONING. Botulism is why you don't give honey to a child under a year old. Botulism is bad shit. I don't care if your forehead sags, and I don't care how nice they've dressed it up; unless you've got a legitimate medical reason do to this (and there are a few, believe it or not), don't put food poisoning UNDER YOUR SKIN. Fuck!

- Gas gangrene. (C. perfringens) You've heard of gas gangrene, yeah? That lovely putrefaction/death of tissues, skin-splitting-from-bloating thing that happens to corpses and soldiers in historical romance novels? Well, this is another lovely aspect of Clostridium. (Gas gangrene is not to be confused with "dry" gangrene, which is caused by insufficient blood supply/ischemia and is often found in diabetics, the elderly, and people with circulatory issues such as frostbite victims.)

And more. Loads, loads more of Clostridium types. But like I said, I'm not writing a book here, let alone one on microbiology.

Still, bacterial infections are the ones responsible for those lovely pus-filled wounds your character might sport. Even the little ones like a stye in the eye. Styes are infections of the sebaceous glands of the eyelid. They hurt like a bitch and there's nothing you can do about them except wait for them to go away. Oh, sure, there's some over-the-counter bullshit ointment you can use, but really these are just mineral oil and white petroleum (aka "Vaseline") that make you feel better but don't actually do anything to hurry things up.

Other bacterial infections you may have heard of –

-      Acne. Now, we've all had pimples (zits). If you've never had one, congratulations! While not all acne is caused by an infection, there is a bacteria called Propionibacterium acnes that's widely thought responsible for certain types of it. This type of acne is basically a skin infection caused by bacteria. (No, not chocolate, though things like chocolate can exacerbate [this means "make worse"] the oil production in the pores that in turn gets infected by the bacteria that causes the acne.)

- Staph (Staphylococcus). There are some forty strains of staph, and not all of them are bad. We all have staph living on our skin (S. epidermidis). It's part of our natural flora. But when it gets out of hand for one reason or another (disease, immuno-compromised individuals), it gets ugly and a tiny little nick while shaving leads to a Staph infection (including but not limited to cellulitis). Others like MRSA (Methicillin-resistant Staph. aureus) can kill, because they're big, bad, and think your little antibiotics are for pussies. MRSA is most commonly found in hospitals and is a complete bitch to get rid of once it makes itself at home. Keep this in mind if your character ends up in the hospital. Or prison. Prisons are hell for MRSA.

- Strep throat, impetigo, scarlet and rheumatic fever, and toxic shock syndrome are all caused by a bacterium called Streptococcus pyogenes. If you give your character strep throat, well, now you know how they got it.

- Salmonella. There are over 2500 types of this bad boy, but the one most people think of is Enteritis salmonellosis, usually S. enterica, aka "food poisoning." This is the one comes from tainted food, mostly. Raw eggs, improperly handled raw chicken, stuff left out too long (real mayonnaise made with eggs at picnics and so on) – all can be blamed on Salmonella. As can lovely things like typhoid fever. This is a fun one to torment your character with.

- Escherichia coli. Or, more commonly known as E. coli. I'm sure you've all heard of this one. There are some particularly bad strains of this one, but they all come from the same place – shit. No, I mean it. E. coli is found in the intestinal tract of living organisms, and if something was infected with E. coli, that means there's been some kind of fecal contamination, usually via the oral route. Meaning yes, they ate shit. (And since some strains will kill you quick, it kind of gives a whole new meaning to the phrase, "Eat shit and die," doesn't it?) Now, E. coli is a very nice thing to have when it's where it's supposed to be. E. coli helps you with all kinds of things to do with digestion, but when you try and digest it, there's going to be problems. E. coli doesn't like being eaten and is going to fight you on it. This is why it's a very bad idea to shit in your drinking water, yet people do it all the time.

- How about a fun one? Let's talk sex! What? No? Come on! How about a nice dose of Neisseria gonorrhoeae (gonorrhea)? Treponema pallidium (syphilis)? Fine. Chlamydia tractomatis (chlamydia, but you knew that one, right?). Well, okay then. Sexually transmitted bacterium might not be your thing, but that doesn't mean you can't have a party all by yourself with a touch of Candidasis. Wait, that one is a fungal infection. We'll talk about those later, in part three.

- Urinary tract infection. Usually we have Pseudomonas aeruginosa to thank for these. Pseudomonas is also responsible for most burn infections. Remember last time when we talked about burns? Yeah. They get infected too, and Pseudomonas is usually to blame (sorry, Pseudomonas, you bastard). "Blood poisoning" is the colloquially accepted term for "sepsis (or septicemia)" and again…usually (but not always) Pseudomonas. This guy is a real pain in the ass, because it lives everywhere on everything. I SAID EVERYWHERE! EVEN THERE! This boy is badass. But don't hold that against him. I'd be pissed too if my name meant "fake unit."

- Meningitis. Yeah, you've heard of this one. But did you know there are different types? The bacterial one I'll talk about here is the BAMF. This one is the killer. Bacterial meningitis is fast, highly contagious, and deadly. Remember gonorrhea (N. gonnorhoeae)? Yeah. Meet its big brother, Neisseria meningitides. Remember our old friend Strep? He's good friends with N. meningitides. Between N. meningitides and S. pneumoniae, they account for over 80% of the bacterial meningitis cases in adults.

And there are many, many more.

See what I'm saying here? Infection doesn't have to mean a pus-leaking ingrown toenail or a weepy cat scratch or a dirty bandage over a knife wound. It can be an ear infection, food poisoning, or STD.

Now I don't want you going around thinking all microbial life has it in for you. Some bacteria are great. Wonderful even. Necessary for living. Some help you digest food. Some bacteria kill others that would normally kill you (or parts of you). Others make excellent vaccines that keep you from getting infected with other bad things.

Hell, some infections are even beneficial. Infection means just that – something has been infected with something else.

This concludes Part One of the Infection Sequence of the Ask Dr. Dina series. Join us in a couple weeks for Part Two – Viral.

Questions about medical issues with your writing? Leave them in the comments below and I'll get back to you as soon as I can. (THESE MUST APPLY TO FICTIONAL SITUATIONS ONLY. I AM NOT YOUR DOCTOR, NOR A SUBSTITUTE FOR ONE.)


  1. Just to clear up a possibly confusing thing - the symptoms of botulism are not actually caused by infection with the C botulinum, they're caused by the toxin that organism produces. Most cases of botulism do not involve an active infection, which is why they don't respond to antibiotics. The bacteria grows in oxygen poor environments, like canned foods that weren't heated high/long enough to kill all the bacteria.
    So Botox is not the injection of live bacteria, it's the injection of diluted toxin - and as with all drugs, the difference between 'medicine' and 'poison' is dose.

  2. In rethinking my previous comment, I should also point out that the problem with tetanus is the toxin... again, that's a big part of the low response to treatment you mentioned. Though typically with tetanus, there is an active infection and the toxin is produced in your body, so treatment with antibiotics stops toxin production by killing bacteria, it just doesn't eliminate the existing toxin. That's in contrast to botulism, which usually involves ingestion of pre-formed toxin and not live bacteria.

    They're a nasty little family group, C tetani and C botulinum, you can choose painful muscle rigidity or suffocation through flaccid paralysis. Yay?


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