ANAHEIM — What started as a twisted ankle Sunday has turned into a fight for survival for a 30-year-old Anaheim woman stricken with the deadly "flesh-eating bacteria."
Since Ana Maria Garcia was admitted to AM Medical Center in Anaheim early Tuesday, doctors have amputated both of her legs and part of her right hand to try to halt the spread of the virulent microbe, streptococcal necrotizing fasciitis.
"We don't know if we have gotten it all yet," Mary Ann Adams, the hospital's infection control coordinator, said Thursday night. "She's in very critical condition. Her prognosis is very, very guarded right now."
The bacteria, which prey on small cuts or other injuries, are a rare and extreme form of the same bacteria that cause strep throat.
"You can't compare this to anything," Adams said. "It's very, very difficult to treat."
But, she added, "this is extremely rare. We don't want to panic the community."
"Severe Group A" streptococcal infections eat away at the filmy tissue layers surrounding muscles. Officials estimate that there are 10,000 to 15,000 cases around the nation each year, with about 10% to 15% of patients experiencing gangrene.
Adams said Garcia and her family, who moved to Anaheim from Guanajuato, Mexico, seven years ago, "are very, very poor" and have few relatives in Orange County. Hospital coordinator Mindy Halpern said the family "is going to need all the help they can get." Garcia's husband of eight years, Roberto Serrano, is on disability from his job at a recycling plant, and Garcia is a homemaker.
Serrano said he gave his wife pain pills and massaged her left ankle after she hurt it about 11 a.m. Sunday. Later, she felt an uncomfortable tingling, like ants crawling on her leg, he said Thursday night through an interpreter, Mary Austad, principal of Abraham Lincoln Elementary School, where two of the couple's three sons go.
Their oldest son, Fidel, 9, said the family grew worried when his mother's leg turned red, then purple. Adams said when the disease takes hold, it turns the infected areas into dead limbs with no circulation.
Serrano said he could almost see the infection spreading; the effects didn't take weeks or days, but hours.
"It happened so rapidly. In minutes, it jumped from one leg to another," he said.
Garcia's pain and her family's concern grew so great they called an ambulance about 1 a.m. Tuesday. Three hours later, the hospital called Serrano for his approval to amputate.
"It wasn't a matter of saving her leg. It was a matter of saving her life," he said.
Doctors gave her little chance of survival, Serrano said, and a priest gave her last rites.
"He thought he was going to lose her," Austad said. "She asked him to continue caring for the boys like they've been doing."
But after more operations and treatments, Garcia has stabilized, Adams said. Hospital officials warn she is still in danger, though.
"The doctors are cautiously optimistic, and we have all been amazed at the strength she's shown," Halpern said. "Right now, the family is hopeful."
As with most of these cases, doctors are unable to tell where the strep first entered Garcia's body, because it destroys such evidence when it destroys the tissue, Adams said.
"It's probable it was there" lying dormant, she said, "and it just went crazy at the point when she injured her [ankle]."
Adams said the disease has always existed. It has gained more notice lately only because doctors have been able to recognize it more readily, Adams said.
For example, previously they might have diagnosed extremely painful swelling and poor circulation in an arm or leg as a blood clot, and amputated the decaying limb. If that stopped the advance, doctors might never have known it was the flesh-eating bacteria, she said.
Now blood samples from patients with these symptoms are checked for streptococcus.
The bacteria is "everywhere," Adams said. "All of us have had it at one time or another," but not in this extreme form.
If she survives, Garcia will face multiple surgeries and extensive therapy, Halpern said.
The hospital and the Anaheim Firefighters Assn. have created a fund for the family at the Anaheim Area Credit Union, 2390 E. Orangewood Ave., Suite 106, 92806.
"This case has touched all of our hearts," Adams said. "That husband is such a brave, strong man, and they're such beautiful children, it just broke our hearts."
Serrano has stayed by his wife's bedside, Austad said. "He has no transportation, and he doesn't want to go home and get a call that she has taken a turn for the worse."
At least four deaths have been linked to the bacteria in Orange County over the last four years, according to county health officials. During the first half of 1997, 27 cases of the Group A infection were reported locally. In all of 1996, 26 cases were reported.
In May, Santa Ana resident Jody Greenlish, 38, died a week after doctors discovered a pimple-sized lesion on her buttocks, which grew to the size of a grapefruit.
Other victims have fully recovered.