On Saturday, 11-year-old Brantice Spencer was taken to Sinai Hospital with a bruised and swollen ankle. The next day, she was dead, the victim of a rare flesh-eating bacterial disease that infects up to 20 people a year in Maryland and kills one out of five.
Medical officials said the case does not present a public danger but does illustrate how lethal this rare and toxic strain of streptococcus bacteria can be.
Brantice Spencer died of complications from necrotizing fasciitis Sunday at Sinai Hospital, a spokeswoman for the state medical examiner's office said.
Hospital officials declined to discuss the case in detail yesterday but issued a statement saying that Brantice was given "appropriate care" and that the hospital is working with state health officials on an investigation into the death.
"Our thoughts are with Brantice Spencer's family during this extremely difficult time. The hospital believes that appropriate care was provided on June 10 and June 11 given the symptoms with which Brantice presented upon arrival," the statement said
The family was unavailable yesterday, but Brantice's grandmother, identified as Wanda Geter, told WBAL-TV that she took the child to Sinai Hospital with a badly bruised ankle a few days before she died. Geter said doctors took the girl's temperature, X-rayed her and sent her home.
Brantice was rushed back to the hospital Sunday morning after she collapsed, the station reported.
The hospital statement indicates that the child was treated on two successive days. Jennifer Sizemore, a hospital spokeswoman, declined to elaborate.
There was no answer at Geter's door in West Baltimore yesterday, and phone calls were not returned.
Necrotizing fasciitis is a bacterial condition usually caused when a rare and particularly toxic strain of group A strep enters the body through an opening in the skin, such as a cut or blister, experts say.
Although it is not regarded as highly contagious, it can be transmitted by respiratory droplets or by direct physical contact with someone carrying the toxic strain.
A similar, virulent strain of strep infected puppeteer Jim Henson in 1990 and caused the pneumonia that killed him, doctors reported at the time.
Typical group A strep typically causes a sore throat and is easily treated with antibiotics, doctors say. But the strain that killed Brantice is highly virulent, and a patient does not have to have a compromised immune system to be susceptible. Sometimes doctors amputate a limb to stop it from spreading.
"It can kill you in a matter of a couple of days," said Dr. Harold Standiford, medical director of infection control at the University of Maryland Medical Center.
Standiford said many people carry the common form Strep A without knowing it because they never show symptoms. The strain that killed Brantice Spencer was different.
"It's not just any group A strep; it's the one that has this added feature, these added toxins," Standiford said. "It is scary, but fortunately, everything has to come together in just the exact formula for this to happen."
The disease can be treated with antibiotics but is hard to detect until a cascade of symptoms develops, Standiford said.
Early signs of the disease include flulike symptoms, intense thirst and pain disproportionate to the cut or bruise. Eventually, the injured area begins to swell and the body goes into shock from the toxins in the bacteria.
"The symptoms do develop rapidly," Standiford said.
To prevent infections, the National Necrotizing Fasciitis Foundations recommends using antibacterial soap, washing the hands frequently and covering the mouth when sneezing. It also recommends cleaning and covering all cuts with sterile bandages.
The number of cases is difficult to estimate, health officials say.
According to the federal Centers for Disease Control and Prevention, the nine regions that actively track the disease reported a total of 74 cases in 2004.
They included the metropolitan areas of Baltimore, San Francisco, New York, Denver, Atlanta and Portland, Ore.; Minnesota and New Mexico; and an 11-county area of Tennessee.
In Maryland, 10 to 20 cases of necrotizing fasciitis are reported each year, and about 20 percent are fatal, said John Hammond, a spokesman for the Maryland Department of Health and Mental Hygiene.
Hammond declined to comment on the nature of the investigation into Brantice Spencer's death or on whether an investigation was taking place.
"We are aware of the case, but we cannot discuss it," he said.
Sun reporter Jonathan Bor contributed to this article.
Symptoms of flesh-eating disease
Victim begins to feel annoying discomfort in the area of a cut, bruise or scratch, with pain increasing out of proportion to the injury.
Flulike symptoms, such as fever vomiting, diarrhea, dehydration, general malaise, weakness, muscle pain and fever.
Large, dark boil-like blisters in the affected area.
Thirst and dehydration occur.
Blood pressure drops severely, and heartbeat is rapid.
Toxic shock shuts down bodily organs.
[Sources: National Necrotizing Fasciitis Foundation, WebMD.]