Raymond Evans
Flesh Eating Virus Kills Cruise Ship Passenger
Costa Cruise Lines Costa Concordia March 7, 2009
Editor's Note:
While the mainstream media and the governments involved have protected the name of the ship and cruise line involved in this case, a Cruise Bruise investigation was able to gather this information and more that shows this passenger did not received the correct treatment for this disease.
The number one factor in survival is how fast the diagnosis is obtained and how quickly antibiotics are given intravenously, not with injections of antibiotics into the skin, as was done in this case.
Raymond Evans, 58, of Fairfield, Aberystwyth, West Wales in the United Kingdom embarked on a Mediterranean cruise aboard Costa Cruise Lines' (Carnival Corp) Costa Concordia never dreaming he would catch a rare virus aboard and die from it. But, that is the conclusion an Aberystwyth inquest panel.
Mr. Evans flew to Rome on February 22, 2009 to embark on a 12-day Italian cruise aboard Costa Concorida and was to return to Rome on March 5, 2009. Costa Concorida left Civitavecchia (Rome), Italy then sailed to Savona (Genoa), Italy; Katakolon, Olympia, Greece; Pireo, Greece; Izmir, Turkey; Greek island of Rhodes (Rodi); Limassol, Cyprus; arriving in Port Said, Alexandria, Cairo, Egypt. After Cairo, the ship was suppose to be at sea for two days before returning to Rome.
While on the cruise, Evans injured his knee in port at Izmir, Turkey on Friday February 27th. He saw the ship's doctor the next day. "The ship's doctor gave him an antibiotic shot and said that he needed a course of these injections for five days," his wife Mary Evans said.
About The Disease
"Flesh-eating bacteria” is a misnomer as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors), which include streptococcal pyogenic exotoxins.
Necrotizing Fasciitis infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent.
Patients usually complain of intense pain that may seem in excess given the external appearance of the skin. With progression of the disease, tissue becomes swollen, often within hours.
Diarrhea and vomiting are also common symptoms. In the early stages, signs of inflammation may not be apparent if the bacteria are deep within the tissue.
The first sign of infection may be a small, reddish, painful spot or bump on the skin. This quickly changes to a very painful bronze- or purple-colored patch that grows rapidly.
Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues. The center may become black and die off. The skin may break open and ooze fluid. The wound may quickly grow in less than an hour.
Patients with necrotizing fasciitis typically have a fever and appear very ill. Mortality rates have been noted as high as 73 percent if left untreated. Without surgery and medical assistance, such as antibiotics, the infection will rapidly progress, and will eventually lead to death.
Had Mr Evans been treated immediately by a competent medical professional, he would have likely survived. Patients are typically taken to surgery based on a high index of suspicion, determined by the patient's signs and symptoms.
According the U.S. Government U.S. National Institutes Of Health, in necrotizing fasciitis, powerful, broad-spectrum antibiotics must be given immediately through a vein (IV). Surgery is required to open and drain infected areas and remove dead tissue. Sometimes donor immunoglobulins (antibodies) are given by vein to help fight the infection.
Noteworthy Flesh-Eating Disease Survivors
Lucien Bouchard, former premier of Québec, Canada, who became infected in with necrotizing fasciitis 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness and survived due to proper medical care.
Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, lost his left arm and shoulder to the disease in 2004.
Jan Peter Balkenende, Prime Minister of the Netherlands since 2002, was infected in 2004. He was in the hospital for several weeks, but recovered fully.
Alan Coren, British writer and satirist, announced in his Christmas 2006 column for The Times that his long absence as a columnist had been due to contracting the disease while on holiday in France.
Prevention
According to the U.S. National Institutes Of Health, an agency of the US Department of Health and Human Services, thoroughly cleaning any site of broken skin during an injury to the skin is the only known prevention.
According the U.S. Government agency, U.S. National Institutes Of Health, "in necrotizing fasciitis, powerful, broad-spectrum antibiotics must be given immediately through a vein (IV)."
"Surgery is required to open and drain infected areas and remove dead tissue. Sometimes donor immunoglobulins (antibodies) are given by vein to help fight the infection."
Mary Evan said that her husband was confined to a wheel chair and did not get better. Saturday night, Evan's did not get any sleep, so he went to the ship's doctor again on Sunday.
Evan's son Andrew said that by the time the Evans got back to their cabin on Sunday, his wife noticed that the back of his knee began to blacken. Within hours, that same black appearance spread to his chest, elbows and fingers and purple marks appeared all over his body.
Since these physical signs of the flesh-eating disease present themselves within a few hours of infection, it is assumed Mr. Evans contracted the disease sometime late on Saturday or early on Sunday.
On Monday Raymond Evans was transferred to intensive care in a German hospital in Alexandria, Egypt, after Costa Concordia docked in Alexandria. He stayed in intensive care and died on March 7th at 0230 hours. His body had gone into septic shock.
Pathologist Christopher Simpson told the inquest that Mr. Evans had contracted the high mortality, flesh-eating bug necrotizing fasciitis. Simpson said, "He was very severely ill when he was first admitted to the intensive care unit.
According to Simpson, the flesh-eating bug enters the body "from an inconspicuous portal in the skin. I have no way of saying how it got in but, presumably, at some point in the leg."
Simpson was clear, the virus could not have gotten into the leg while Evans was in port. It had to have been contracted on the ship. "It could not have been anything to do with his initial knee injury because this [disease] progresses within hours.", Simpson testified.
Simpson was quite sure about when the flesh-eating bacteria entered Evan's body, "Whatever it was it was several days after he had his problems with his knee." This would put the time of infection while aboard the Costa Concordia.
He said the condition had caused multiple organ failure in Mr Evans within hours.
The technical cause of death was systemic condidaisest treating necrotizing fasciitis of the thigh.
