On April 28, Devin Adair, a healthy, 21-year-old tight end for the University of Tulsa's football team, mysteriously died after spending a week in the hospital.
While it was obvious that he was very ill, he had no visible wounds to help doctors ascertain what was wrong.
When the autopsy report came back last week, the pieces of the puzzle came together: Flesh-eating bacteria had killed him.
Also known as necrotizing fasciitis, flesh-eating bacteria are potent enough to turn a wound as minor as a pinprick or paper cut into a massive infection causing amputation or even death. In Oklahoma, Adair's death is the latest of about a dozen people who have died from the infection since 2003.
Nationwide, there are about 500 reported cases a year, according to the Centers for Disease Control and Prevention.
The infection is caused by bacteria, usually a type known as Group A Streptococcus (GAS), which thrive naturally on the throat and on the skin.
The good news: Few people in contact with GAS will develop an infection, and it doesn't appear to be very contagious. The bad news: No one yet knows why GAS sometimes becomes invasive.
"These infections are very sporadic and unpredictable, and pop up all the time," said Dr. John Shanley, director of Infectious Disease at the University of Connecticut.
'Changes Right Before Your Eyes'
GAS bacteria can enter the body through cuts, scrapes and even bruises. Sometimes, as in Adair's case, there is no identifiable entry point.
When the bacteria reach the blood, muscles or lungs, they can destroy muscles, fat and skin tissue -- hence the term "flesh eating."
"It is very aggressive and changes right before your eyes. It can start as a pimple on the leg and then involve the entire leg in less than a half hour," said Dr. Ferdinando Mirarchi, professor of emergency medicine at Drexel University in Philadelphia.
If left untreated, the infected area begins to swell and appear bluish, white or flaky. Once it has progressed to this point, amputation of the infected area and immediate antibiotic treatment usually are necessary.
As scary as this sounds, most experts agree that there is little that can be done in the way of prevention.
Some People More at Risk
"Just cleaning wounds with soap and water is your best shot, but is probably of little use in general," said Dr. Carl Schultz, professor of emergency medicine at the University of California Irvine.
Any type of abnormally painful inflammation of the skin could signal a possibly serious infection, said Dr. Pascal Imperato, professor and chair of Preventive Medicine and Community Health at the State University of New York.
Therefore, "early diagnosis is essential" to save lives, he said, although as Adair's case shows, this isn't always possible.
Flesh-eating bacterial infections are more common in people with weakened immune systems, diabetics, or intravenous drug users -- but healthy people also are vulnerable.
In fact, Mirarchi said "we are seeing an increase in number of cases throughout the years, but to what that is due remains unknown."
Is the Problem Getting Worse?
Since 2003, 10 people in Oklahoma have died from necrotizing fasciitis and the CDC states that approximately 660 infections were attributed to the bacteria in 2003. Deaths weren't available.
CDC officials also say that while cases can pop up in small clusters of people, it is important to remember that they will not spread across the country and that the GAS bacteria in general doesn't seem to be very contagious.
Also, some experts question whether the infections are becoming more common.
Dr. William Schaffner, professor and chair at Vanderbilt's Department of Preventative Medicine, said that this bacteria were "not epidemic or communicable in the conventional sense" and that perhaps "we are just better at making the diagnosis."
Still, the random nature of flesh-eating bacteria and its ability to infect both the healthy and sick is frightening. Shanley said this is evident in the nature of the treatment.
"Antibiotics alone are never enough, and extensive surgery is the rule."