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The Honolulu Advertiser
Posted on: Thursday, April 6, 2006

Spill may have led to critical sickness

By Beverly Creamer and Loren Moreno
Advertiser Staff Writers

Johnson

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WHAT INFECTED OLIVER JOHNSON?

Three bacteria types identified in Oliver Johnson’s infection include:

• Vibrio vulnificus: A potentially deadly marine bacterium that lives in brackish seawater, but usually in small quantities. Under certain conditions, such as when extra nutrients are available, the water is dirty or temperatures increase, its numbers can multiply. The bacteria create toxins in humans that cause a flesh-eating cascade in the body.

• Aeromonas: Another virulent group of bacteria that can be devastating if they find their way into the bloodstream. Can create disease rapidly, including flesh-eating symptoms that kill tissue. They also can be contracted from eating shellfish, and restaurants have been known to warn people with significant liver disease or who are immuno-suppressed against eating shellfish.

• Enterococci: These bacteria are found in sewage, and tested regularly as a measure of contamination. Can cause gastrointestinal illnesses.

Source: state Department of Health, University of Hawai'i scientists

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Friends are praying for Oliver Johnson, 34, who is fighting a flesh-eating infection after falling in the Ala Wai Yacht Harbor on Thursday.

Zobel Dela Cruz photo

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GOT EVEN A TINY WOUND? STAY ASHORE

Anyone with injuries or wounds that provide germs with easy entrance into the body should clean the wounds well, said a state Health Department official.

"It goes back to using common sense for wound care," said Dr. Sarah Park, deputy chief of the department’s Disease Outbreak Control Division.

"If you’ve got an open wound, be aware and take some time to think about whether it’s worth exposing yourself to danger."

Wounds should be washed thoroughly with soap and water, Park said. It doesn’t need to be anti-bacterial soap, she said.

If you must take risks — such as being in water with an open wound — make sure it’s covered well with a waterproof dressing.

But first, said Park, "think twice about water exposure."

"Whether it’s a small nick or a huge cut, it doesn’t matter. It’s still a break in your skin."

And, "if a wound is red, warm, swollen or painful, go see your physician."

— Beverly Creamer

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Experts say a massive sewage spill could have combined with brackish conditions in the Ala Wai Yacht Harbor to create a bloom of virulent bacteria that has Oliver Johnson fighting a flesh-eating infection.

Johnson, 34, a Honolulu mortgage broker, remained in extremely critical condition in intensive care last night at The Queen's Medical Center, said Queen's spokeswoman Monica Ivey.

Friends of Johnson said he was unconscious and on life support.

Police said Johnson reported being assaulted and thrown into the harbor Thursday night.

By Sunday he was in Queen's with severe leg pain and swelling. Doctors have amputated his left leg and were concerned that all four limbs would have to be taken to save his life. Yesterday, friends said his condition has barely improved.

While a state health official said it's unclear whether the 48 million gallons of raw sewage that poured into the Ala Wai Canal more than a week ago contributed to Johnson's medical condition, University of Hawai'i scientists said the sewage could have played a part.

Dr. Sarah Park, deputy chief of the state Health Department's Disease Outbreak Control Division, said there's no way to know if the sewage caused or affected Johnson's infection.

"Is it because of sewage? We don't know," Park said. "No one can answer that."

However, UH scientists note that the raw sewage that flowed out of the canal, and into the boat harbor and the ocean, would have provided nutrients for the deadly bacteria to suddenly flourish.

FLESH-EATING EFFECT

Two bacteria Vibrio vulnificus and aeromonas identified in Johnson's wounds, according to the Health Department are potentially deadly, and both can cause a flesh-eating effect.

"That would be an organism that can kill very quickly," said Roger Fujioka, a UH microbiologist familiar with the vibrio bacteria that grow in seawater. "It gets into the bloodstream."

It's the same bacteria that killed a man on the Big Island in 2001, after he swam in brackish hot springs.

Fujioka said the bacteria are in the water all the time, but in very low concentrations.

There aren't enough bacteria to create infections, he said, "until something unusual happens like the sewage spill."

Dr. Alan Tice, an infectious disease specialist with UH and Queen's, said several conditions combined in Johnson's case to increase the danger: the bacteria bloom because of the sewage spill; wounds Johnson suffered beforehand, giving bacteria easy access; and the fact he had been drinking, which could have reduced his liver's ability to filter them out.

But Fujioka said that safety need not be an issue for most people concerned about going into the water.

Fujioka said he doesn't see a danger for coastal waters but believes signs should be posted at the harbor and the canal.

"Now that we know it's there, signs at this point would be appropriate," he said.

While most of the pollution warning signs along Waikiki beaches have been removed, some remain along the Ala Wai Canal, at the harbor and at Magic Island Lagoon.

Tice agreed with Fujioka about the role the sewage could have played.

"The Ala Wai likely had these organisms, but when you put sewage in, it's a nutrient for the organisms and they grow more and become more concentrated," Tice said. "These organisms don't cause disease or infections unless there's some unusual exposure."

But once that occurs, these bacteria "can cause a tremendous amount of disease very rapidly," Tice said.

"The toxins will rupture the cells and shut down blood vessels and stop the circulation," he said. "Bacteria grow in dead tissue like wildfire."

Early yesterday, doctors told Johnson's friends and family that amputation of his right leg and arms may not be necessary after blood flow had improved, said retail consultant Stephany Sofos, a close friend of Johnson's.

But Zobel Dela Cruz, another friend who spent several hours yesterday at Queen's, said doctors reported in the afternoon that it may still be necessary to amputate the right leg.

"Every day, his condition changes. That's the problem," Dela Cruz said.

POLICE INVESTIGATION

City officials said they could not comment on this case.

"We remain concerned for the health of the public, and again urge people to heed the signs the city posted warning them to stay out of waters that may be contaminated," said Bill Brennan, city spokesman.

The events leading to Johnson's infection are sketchy, but Honolulu police spokeswoman Michelle Yu said yesterday that officers responded to a "medical assist" call at Johnson's Tradewinds apartment on Ala Moana at 6:30 p.m. Friday.

Johnson told police he had been assaulted the night before and thrown into the Ala Wai Yacht Harbor. Police have opened an investigation, Yu said.

Dela Cruz, 35, said Johnson told her an altercation occurred, but she was unwilling to share details so as not to compromise possible criminal investigations.

Friends pieced together these events leading to Johnson's hospitalization, based on bits and pieces he had related to them:

On Thursday night, Johnson went to a bar near the Ala Wai Yacht Harbor. That night he was drinking with people he had just met and was later assaulted. He was thrown into the waters in the harbor and then climbed out.

Johnson returned to his apartment, where Dela Cruz said he took a shower and went to bed.

When Dela Cruz saw him on Friday, "He had scratches all over him," she said. "His feet you could pretty much tell he was stepping on coral or something."

'EXCRUCIATING PAIN'

According to the police report, Johnson called for emergency help on Friday night and was to be taken to Straub Hospital. Dela Cruz said he was instead transferred to Queen's because of his injuries.

She took him home from the Queen's emergency room around 10:30 p.m. Friday.

"He left the hospital without any antibiotics or painkillers," Dela Cruz said. She said she suspected that Johnson did not inform emergency room personnel that he had fallen into the harbor.

"Maybe if they would have known, they would have treated him differently," she said.

The next day, Johnson told friends he was still feeling sick.

Dieter Giblan, 34, one of Johnson's close friends, was supposed to go out with him on Saturday night. But when Giblan called to confirm their plans, Johnson told him he had injured his leg.

"I told him to give me a call if he needed anything," Giblan said. "So he did and I went down there and gave him some Motrin."

Giblan said Johnson had scratches and cuts on his legs and feet and complained about excruciating pain.

Johnson even suggested that he might lose his leg, Dela Cruz said.

"By Sunday his legs had ballooned, he was in excruciating pain," Sofos said.

He was rushed to the Queen's emergency room by ambulance. There, his kidneys shut down, his liver failed and he had full-blown pneumonia, doctors told his friends.

Friends later were told that Johnson's body was being attacked by a flesh-eating bacteria.

ORGANS SHUT DOWN

Doctors told friends that he was experiencing septic shock an overwhelming infection that shuts down organs and also had three different bacteria in his body.

While laboratory reports did not show the presence of type A strep that is usually associated with flesh-eating, Johnson's friends insisted yesterday they were told differently by doctors.

Friends said Johnson is an outgoing, athletic guy who is always the life of the party.

"Oliver is what you call a connector," Giblan said. "He is just a dynamic person who brings different people together."

Johnson kept friends in many different circles including colleagues. Dela Cruz, also a mortgage broker, met Johnson 2 1/2 years ago when he first moved to Hawai'i and was working as a loan officer.

"We used to surf Bowls and Kaiser together," Dela Cruz said. "We were pretty close."

Sofos said Johnson taught her to surf and that he loved the ocean.

"This is really hard, really tough on all of us. It's been such a roller coaster ride. All we can do is hang in there and support each other," Sofos said.

Johnson is originally from North Carolina but grew up in Florida, said Dela Cruz. He moved to Hawai'i after visiting a few years before.

"He fell in love with Hawai'i and he wanted to fall in love with an island girl," she said.

Giblan said this incident has brought all of Johnson's friends together, many of whom never knew each other.

"There are few people who can have no family in Hawai'i but still have 20 people sitting in a waiting room hoping for the best," Giblan said.

Johnson's mother arrived from Florida on Monday.

"She's a strong woman. She's hanging in there," Dela Cruz said.

His father is expected to arrive today, she said.

Johnson's mother declined to talk to media yesterday.

Reach Beverly Creamer at bcreamer@honoluluadvertiser.com and Loren Moreno at lmoreno@honoluluadvertiser.com.


Correction: Monica Ivey's name was misspelled in a previous version of this story. Information that Oliver Johnson was unconscious and on life support was given to an Advertiser reporter by friends of Johnson, not by Queen's. Also, the bacteria Vibrio vulnificus does not carry cholera. Information in a previous version of this story was incorrect.