In the beginning, the only signs that something was dangerously wrong with Rob Erke were the pain and a small bump on his left shoulder — there was no wound, no scratch, no insect bite.
But a week later, the 51-year-old Langley, B.C., man was rushed to hospital, where he needed two emergency surgeries to remove large chunks of flesh from his shoulder. He had somehow contracted necrotizing fasciitis, otherwise known as the flesh-eating disease.
He's spent the last week on heavy painkillers at Royal Columbian Hospital in New Westminster, where doctors are carefully monitoring the progress of the disease, worried it could reach his heart, according to his wife, Eilish. It might have already made its way to his left knee, which is swollen and painful.
Group A streptococcus, a common cause of flesh-eating disease, has been on the rise in B.C. in recent years, and Eilish is hoping to spread the word about what's happened to her husband so others know to watch for the symptoms.
"I don't want to panic anybody … but people need to be aware that it is actually more common than people think," she told CBC.
"It literally can happen to anybody."
'It's a surgical emergency'
The disease is caused by a number of different bacteria, and can be fatal if it's not dealt with quickly. Seriously ill patients may require limb amputation to control the spread.
It often starts with the infection of a small cut or bug bite, but a break in the skin isn't always necessary, according to Dr. Monika Naus, medical director for communicable diseases and immunization service at the B.C. Centre for Disease Control (BCCDC).
"Sometimes it's as minor as a paper cut or a prick from a rosebush, sometimes it can be blunt trauma like a bruise or a compression injury," she said.
The infection causes swelling and fluid accumulation, which leads very quickly to tissue death — gangrene, essentially.
"It is a surgical emergency. It's not enough when it gets to that stage to treat them with antibiotics," Naus said.
Last year, there were 28 cases of flesh-eating disease in B.C. linked to group A streptococcus, the only bacterial cause tracked by the BCCDC. Naus said there's been an increase in cases in the last two years throughout North America, a trend that has continued into 2018, but no one has a good explanation for why.
Group A Streptococcus, shown in orange in this image from an electron microscope, is a major cause of flesh-eating disease. (National Institute of Allergy and Infectious Diseases/Associated Press)
In Rob Erke's case, the infection seems to have started after a day of work on Canada Day. The Erkes run a mobile repair company, fixing semi-trailers on the road.
A doctor prescribed anti-inflammatories and a painkiller, but testing didn't turn up signs of an infection, according to Eilish. Within a few days, the pain was so severe that Rob couldn't move his arm.
'They don't go in unless they're dying'
On July 7, he woke up with a temperature of 39.7 C. Eilish said she tried to get the fever to come down, but she watched as his shoulder kept swelling and began turning purple.
Rob fought against returning to the hospital, but when he fell asleep at around noon, Eilish rang for an ambulance.
"My husband was very stubborn and he even said, 'It's a guy thing, they don't go in unless they're dying.' That's not a joke, because it's pretty much what he did,'" she said.
Luckily, after more than two decades together, she knows when something is seriously wrong with her husband. She says she hopes other people will pay attention to changes in their bodies that signal a dangerous infection.
The wound in Rob Erke's shoulder is packed with foam and a vacuum tube. (Submitted by Eilish Erke)
The surgeries have left Rob with a massive hole in his shoulder — his friends joke that it looks like a shark bite, Eilish said.
And he's not out of danger. The infection is in his blood, which means it could spread to any part of his body.
Eilish has nothing but praise for the doctors who've treated Rob, first at Langley Memorial Hospital and then at Royal Columbian, but said they haven't been able to tell her what will happen next.
"They just tell me that it's a long process, a long recovery, even after they get rid of all this," she said.
In the meantime, she's dealing with a broken arm and is depending on friends and family to help with the business, as well as the care of their 16-year-old son, who has epilepsy. She says she's too overwhelmed right now to deal with the emotional impact of everything.
"I haven't really sat down and thought much about it, just because I need to keep running," Eilish said.
Friends have been raising money to help the family.
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