I can't help but think this is terrorist related.
Infection that killed Marine not identified
By Jeanette Steele and Cheryl Clark
UNION-TRIBUNE STAFF WRITERS
December 17, 2002
The death of an 18-year-old Marine from a rapid bacterial infection prompted a three-day halt to physical training at the Marine Corps Recruit Depot, which has been hit by an outbreak of streptococcus A.
One recruit remains in critical condition with a confirmed case of strep A-related infection, and 50 are hospitalized with various forms of pneumonia, officials at the depot in San Diego said yesterday.
K.C. ALFRED / Union-Tribune At a news conference yesterday. Maj. Gen. Jan Huly, commander of the Marine Corps Recruit Depot in San Diego, discussed the death of Pvt. Miguel Zavala. Base officials over the weekend were seeing that recruits and staff got antibiotics because strep A infections were showing up in greater-than-usual numbers at the depot.
The recruit who died, Pvt. Miguel Zavala woke up about 6 a.m. Sunday with a rash on his ankle that quickly spread across his body and killed him by 1 p.m., MCRD's commanding general, Maj. Gen. Jan Huly, said yesterday at a press conference.
Navy doctors who treated Zavala said the bacteria he contracted looks like strep A, though they are also considering the possibility of a meningococcal infection.
But what killed Zavala was not the flesh-eating bacteria called necrotizing fasciitis, said Capt. John Malone, medical services director at Naval Medical Center San Diego. In rare cases, strep A can cause necrotizing fasciitis.
Huly said Marine officials have ruled out biochemical terrorism as the source of the bacteria.
About 20 percent of Americans are infected with strep A bacteria at any given time but don't have any symptoms, said Dr. Victor Nizet, an infectious disease specialist. Others may develop throat infections. In rare cases, bacteria can penetrate from skin and mucous membranes such as in the throat to the bloodstream and on to destroy multiple organs.
Huly said Zavala's death is not linked to the recent deaths of two recruits who died after training Thursday and Nov. 23. Huly said those deaths were caused by lung and heart problems, respectively.
He said depot officials are taking the deaths seriously.
"These are the treasure of the United States of America," Huly said. "Mothers don't send their sons to the Marine Corps and expect them to become casualties in recruit training."
Marine and Navy officials said the strep A cases are confined to the base. More than 100 Marines were hospitalized Sunday and half have been released back to their units.
The depot's recruits don't leave the base and therefore cannot widely spread the bacteria, which is passed through close contact, Huly said. Family members of depot instructors and staff may come in contact with the bacteria, but it's also present in everyday life, he said.
The recruits affected arrived at boot camp within the past 30 days, Huly said. Recruits on a training rotation to Camp Pendleton do not seem to be infected and their training has not be altered.
About 3,500 recruits and staff at the depot got penicillin shots or oral antibiotics over the weekend to help combat the strep A infection, which began showing up at higher than normal levels early last week, Huly said.
The Marines did a screening Sunday, collecting 600 specimens from recruits for bacterial cultures. The results are not complete, but they already have found several strep A infections, Malone said.
The three-day hiatus from physical training including running, swimming and martial arts will help Marines rest and avoid getting sick. The halt started Monday and will not affect classroom activities or graduation schedules.
Zavala was the seventh San Diego recruit to die during or as a result of training since 1995.
At the Marine Corps' other recruit training depot, at Parris Island, S.C., eight recruits have died during training in the same period, an official there said. In a 2001 case possibly similar to Sunday's, a Parris Island recruit died from a toxic streptococcus bacterial infection.
In San Diego, Pvt. Neal Edwards of St. Clair, Mo., collapsed and died after finishing the base obstacle course late last month. Officials said yesterday that an autopsy revealed a cardiac arrhythmia that was previously undetected.
Last week, Pvt. Samuel Bruss of Kenosha, Wis., complained of chest pains and died after completing survival training at a base pool. Malone said the autopsy showed pulmonary edema, or fluid filling the lungs.
San Diego County health officials said yesterday they have no authority over military health matters and are not involved in the investigation of the recent outbreak.
"This is military and it's separate, although they inform us as a courtesy," said county epidemiologist Dr. Michele Ginsberg.
She said Marine officials assured her that none of the recruits or others affected had been off base during training, so the civilian community would not have been exposed.
Likewise, the Centers for Disease Control and Prevention in Atlanta said through a spokeswoman it was not aware of any incidents involving strep A and that San Diego Marine Corps officials have "enough experts in this issue that the CDC would likely not become involved."
Ginsberg said about 128 county residents with invasive streptococcus group A disease had been reported to county health officials during the first 11 months of this year. Five died.
Nationally, the CDC estimates 8,800 people become seriously ill with invasive streptococcus group A disease and 1,000 of them die each year. Federal regulations require that such cases be reported to county health officials.
Group A streptococcus is the same bacteria that causes strep throat and impetigo, a childhood skin infection manifested by blisters. But certain strains of the bacteria, combined with genetic markers in the immune systems of some people, can add up to a life-threatening combination.
How the bacteria produce so much damage is a topic of research projects throughout the world, said Nizet, assistant professor at the University of California San Diego School of Pediatrics.
"The riddle is to understand why the combination of a specific strain in a specific host leads to such an unusual outcome," he said.
One theory is that the bacteria produce several types of toxins, some of which directly damage human tissue, while others provoke an immune response that some peoples' bodies are not able to control.
"That uncontrolled inflammation itself produces damage to multiple organs in the body, a response often referred to as toxic shock syndrome, which causes such severe illness and sometimes death," Nizet said.