"Zombies Medical Mystery .... or Reality" was an educational exhibit showcased in October 2013 at the University of South Florida Shimberg Health Sciences Library. I researched three diseases and three disease pathogens that present with "zombie" symptoms such as decaying flesh, missing brain mass, and catatonic affect.

1. SHIMBERG LIBRARY PRESENTS
Created by: Lauren Adkins

4. NECROTIZING FASCIITIS
1871
Confederate army surgeon Joseph Jones first
described the disease during the Civil War.
1918
Cause of the disease was identified as a
bacterial infection.
1980s – 1990s
Worldwide increase .
1952
Named "necrotizing fasciitis“
Necrosis: death of a portion of tissue
Fascia: fibrous tissues that enclose and
connect the muscles.
19th – 20th Century
occurred sporadically and usually remained
restricted to military hospitals during
wartime, although some civilian population
outbreaks also occurred.
1991 – 1995
Increase in group A streptococcus (GAS) from
0.085 to 0.4 per 100,000.
1990 and 2006
0.18 to 1.68 per 100,000 increase in New
Zealand.
2006-2013
600 cases of NF annually in the United States.

5. Deep tissue infection spreads along fascial planes caused by bacteria.
Top 3 bacteria: polymicrobial, group A streptococcal, and gas gangrene.
Symptoms(24hours)
1. Skin trauma.
2. Pain grows.
3. Flu like symptoms.
4. Severe dehydration.
AdvancedSymptoms
(3-4hours)
1. Swelling, purple rash.
2. Large dark marks, filled
with black fluid.
3. Bluish, white, or dark,
mottled, flaky
appearance.
CriticalSymptoms
(24hours)
1. Blood pressure drops.
2. Body goes into toxic
shock.
3. Unconsciousness.
Courtesy University of California San Diego Catalog of Clinical Images, 2005

6. A 23 year-old woman
developed a left facial
cellulitis which
progressed
relentlessly with
necrosis.
Debridement was
performed on several
occasions to halt the
spread of the
necrosis. The
Ophthalmology
Unit, Universiti Malay
sia Sarawak
(UNIMAS).

7. Anterolateral thigh
flap. A and B, After
serial radical
débridements and
amputation of the
index and middle
fingers for severe
necrotizing fasciitis
following a spider
bite, soft tissue
coverage of both
the dorsal and
palmar aspects of
the left hand was
required.
Wolfe: Green's Operative
Hand Surgery, 6th ed.
Copyright © 2010 Churchill
Livingstone, An Imprint of
Elsevier.
Courtesy of MD Consult.

8. Necrotizing fasciitis in a later stage with skin necrosis. In early stages the patient may have only pain, swelling, and erythema.
(From White G, Cox N: Diseases of the skin: a color atlas and text, London, 2000, Mosby.) via MDConsult

9. NODDING disease
(SyNDROME)
1960s
An epidemic illness characterized by head
nodding associated with onchocerciasis has
been described in Tanzania, by L. Jilek-Aall.
2003
Term Nodding Disease was first applied in
Southern Sudan.
2001-2002
World Health Organization starts
investigations into the disease in Sudan.
2000
HN attacks were mentioned
explicitly in an area highly endemic for O.
volvulusin West Uganda.
2009
CDC led multifaceted investigation to assess
epidemiological and clinical illness, 14 children
with the disease. Findings: Nodding
syndrome is an epidemic epilepsy associated
with encephalopathy, with head nodding
caused by atonic seizures.
2013
A clinical trial to investigate the effects of
therapeutic levels of vitamin B6 among
children with the syndrome is set to launch in
2013.
2013
Cause remains unknown.

10. Nodding Syndrome
 Over 3,000 people have been
infected; Mortality rates growing.
 Believed to be a new type of
epilepsy.
Symptoms include: nodding of
head, mental retardation, and
stunted growth.
Mainly effects children 5-15 years
old.
 Present in Uganda, South Sudan,
and Tanzania.
 Treatment: Sodium Valproate.
Cause remains unknown.

11. The smaller patient has Nodding syndrome and is the same age as the taller adolescent who is of the same age, but does not have
nodding syndrome. (Photograph by courtesy of Stella Chungong) Afr Health Sci. 2012 September; 12(3): 242–248.

12. Children such as 12 year old Nancy Lamwaka of Uganda, are tied to trees because their diminished mental capacity makes them prone to
wandering and accidents such as drowning. CMAJ, August 7, 2012, 184(11).

13. Magnetic resonance image of a 13-year-old boy in Uganda with nodding syndrome. Image shows prominent cortical atrophy.
Courtesy CDC 2013.

14. Methicillin-resistant
Staphylococcus aureus
(MRSA)
1959
Methicillin, the first beta-lactamase-resistant penicillin,
was licensed in England.
Late 1980s–1990s
Infrequent hospital outbreaks of MRSA in
Western Europe and Australia.
1960
First MRSA isolates identified in a British
study.
1968–mid 1990s
MRSA gradually recognized as an endemic pathogen in
hospitals, especially in large urban university
hospitals.Percent of Staphylococcus aureus infections in
hospitalized patients that were caused by MRSA increase.
1960-1967
Infrequent hospital outbreaks of MRSA in
Western Europe and Australia.
2001
Shift from USA400 to USA300 as predominant
strain of CA-MRSA in the United States
Mid-1990s
Scattered reports of CA-MRSA infections in
children in the United States.
2007
95,000 invasive MRSA infections occurred in
the United States in 2005. 19,000 deaths.
2012
MRSA infections cause people to go to
hospitals; hospital stays less commonly cause
MRSA infections.

15. Nose
Armpits
Groin
Psoriasis
Colonized is when a person
carries the bacteria but
shows no signs of infection.
Average
Hospital
Stay
MRSA Hospital
Stay
Symptoms
• Rash
• Small bumps
• Lesions
• Open skin leaking pus
• Swollen, tender.
• Fever
• Chills
• Low blood pressure
• Joint pain
• Headaches
• Hospitals
• Athletic settings
• Military Barracks
• Prisons
• Schools
DRUGS
Penicillin
Methicillin
Dicloxacillin
Oxacillin
Amoxicillin
Nafcillin
Cephalosporin
Vancomycin

16. Magnified 20,000X, this colorized scanning electron micrograph (SEM) depicts a grouping of methicillin resistant Staphylococcus aureus (MRSA) bacteria. (CDC, 2013).

17. Cutaneous abscess caused by MRSA. (CDC, 2013).

18. Cutaneous abscess located on the thigh of a prison inmate. A clinician had lanced the lesion in
order to allow the pus to drain. (CDC, 2013).

20. Vibrio vulnificus
1976
Vibrio vulnificus was first discovered .
1988 and 2006,
CDC received reports of more
than 900 V. vulnificus infections
1992-2007
459 U.S. cases reported by the FDA.
51.6% Mortality rate.
1981–1993.
690 Vibrio infections reported in Florida.
1996
Vibrio vulnificus outbreak in Israel fish market
1995
Vibrio vulnificus documented on southern
coast of Sweden.
1985
V. vulnificus infection in a patient with
septicemia and leg gangrene in Kaohsiung
County, Taiwan.
2011
207 cases in the U.S.
35 cases 10 deaths. Florida.
2012
207 cases in the U.S.
35 cases 10 deaths. Florida.
2013
26 cases have been reported since
January in Florida. 9 have resulted in
death.

21. Vibrio Vulnificus
• V. vulnificus lives in warm seawater. Contaminated seafood and open wounds that are
exposed to seawater can lead to infection.
• Sepsis can occur. With progression to sepsis-associated organ failure (ie, severe sepsis)
or hypotension (ie, septic shock) mortality increases.
• Treatment: tetracycline and third-generation cephalosporin.
(Am Fam Physician 2007;76:539–44,546.) Copyright © 2007 American Academy of Family Physicians.

22. (A)
Cellulitis and hemorrhagic bullae.
(B)
In Vibrio vulnificus
infection.
Am Fam Physician. 2007 Aug 15;76(4):539-44.

23. A. Skin lesions in patient with liver cirrohosis septic shock developed.
B. V. vulnificus bacteremia developed one day after a fish bone injury.
C. Gram-negative curved bacilli isolated from a blood sample.
CDC Emerging Infectious Diseases Volume 10, Number 8, August 2004.

24. Hand under attack by an infestation of Vibrio
Vulnificus bacteria. The cross cuts were performed
to relieve pressure resulting from the swelling hand.
Photos by Dr. Russell Romero.
Copyright © 1996-2013 Loyola University New Orleans. Loyola Center for Environmental Communication.
Post infection.

25. Naegleria fowleri
(Primary Amoebic Meningoencephalitis)
1909
Specimen in museum histologically indistinguishable from
published cases.
1962 - 1965
16 cases of amebic meningoencephalitis
occurring between 1962 and 1965 in northern
Bohemia.
1965
First report of naturally occurring infection by
free-living amoebae by Fowler and Carter
from the Adelaide Children’s Hospital in South
Australia .
1937
Case in Northern Ireland.
1966
4 cases reported in the U.S.
1970
Named N. fowleri
1962
First infections in U.S . In Florida.
1962-2012
128 cases of PAM. Only one
survivor
July 2013
12 year old girl contracts
parasitic menegitis. Arkansas.
August 2013
12 year old boy contracts primary
amoebic meningoencephalitis. Florida.
October 2013
Naegleria fowleri amoeba have been
reported this year in water in Louisiana.

26. The feeding structures of the amoeba Naegleria fowler.
D.T. John & T.B. Cole, Visuals Unlimited. National Geographic 2013.

27. A cytospin of fixed CSF showing a Naegleria fowleri trophozoite (arrow) stained with Giemsa-Wright amidst polymorphonuclear
leukocytes and a few lymphocytes. Within the trophozoite, the nucleus and nucleolus can be seen. Magnification: 1000x. CDC
2013

28. Contrast-enhanced CT brain scan shows right basal ganglia infarction. (Arrowhead, B) Enhancing exudates in the perimesencephalic
cistern. CT: computed tomography; PAM: primary amebic meningoencephalitis.
Amebic meningoencephalitis: Spectrum of imaging findings. Am J Neuroradiol 2006; 27:1217;

29. Extensive hemorrhage and necrosis is present in the brain, mainly in the frontal cortex. Due to Naegleria Fowleri.
CDC 2013. Centers for Disease Control and Prevention. National Center for Emerging and Zoonotic Infectious Diseases
(NCEZID)
Division of Foodborne, Waterborne, and Environmental Diseases (DFWED)

30. Treponema pallidum
(syphilis)
1492 (Syphilis)
Origin unknown. Hypothesized Columbus
brought it back from voyage to the Americas.
Or it was already in Europe and became
prevalent after that year.
1932–1972
Tuskegee Study of Untreated Syphilis in the
Negro Male.
1999
National Syphilis Elimination Plan
11,181
2011
13,970 diagnosed.
National Syphilis Elimination Plan
2013
55,400 people in the United States contract
syphilis every year.
2007
13,970 diagnosed.

31. Spirochete Bacteria.
Hazel Appleton, Centre For Infectionshealth Protection Agency. 2013.

32. Primary syphilis manifesting as a painless tongue ulcer with indurated raised borders and clean base. Logical Images 2012 via MD Consult

33. Multiple slightly scaly erythematous papules are present on the trunk of this
patient with papular secondary syphilis.
Maculopapular rash on the palms, which rarely can be pustular, in a
patient with secondary syphilis. Patients can be quite contagious at
this stage.
The Skin and Infection: A Color Atlas and Text, Sanders CV, Nesbitt LT Jr (Eds),
Williams & Wilkins, Baltimore, 1995.

34. Tertiary Syphilis
Erythematous plaques
with well-defined
ulcers with crusted
surfaces on the face.
European Journal of Dermatology. Volume 9, Number 5, 371-3, July - August 1999, Cas clinique

35. ACKNOWLEDGEMENTS
I would like to thank the following for their support.
Rose bland
Samantha Stewart
Larry Cramer
Rick haley
Jeffrey honker
SHIMBERG LIBRARY 2013