Minnesota health officials believe the men -- ages 23, 60 and 78 -- may have contracted a form of clostridium, a rare but serious germ, and they have asked hospitals and surgical centers to stop performing elective knee procedures while they investigate the deaths.
All three men had been healthy before their operations. But soon after, they were overcome by symptoms of an apparent infection that quickly and steadily worsened, officials say. According to one health official, all three died of septic shock.
Minnesota officials have also warned neighboring states to be alert for an outbreak of surgical infections, although there is no evidence yet that the problem has spread beyond Minnesota or even beyond the two hospitals.
The Minnesota Health Department says two deaths occurred Nov. 11 at St. Cloud Hospital, while the third occurred three days ago at Douglas County Hospital in the town of Alexandria, which is about 70 miles west of St. Cloud. Two of the operations were for hip replacements, while the third was a cartilage procedure.
Minnesota officials say preliminary tests on the 23-year-old patient, who had undergone knee surgery at St. Cloud Hospital Nov. 7, were positive for clostridium, a relative of the bug that causes botulism, gangrene and other grave illnesses.
State disease investigators and the Centers for Disease Control and Prevention are now analyzing tissue samples from two of the victims, and Minnesota officials have alerted local doctors to report any similar illnesses.
Minnesota health officials would not return repeated calls for comment. However, Larry Schireley, the state epidemiologist with the North Dakota Department of Health in Bismarck, says he was contacted yesterday by Dr. Harry Hull, his counterpart in Minnesota, who told him that the 23-year-old victim appeared to have contracted Clostridium sordellii, and that all three patients died of septic shock.
Investigators have been able to test samples from two of the men, but the third victim was embalmed shortly after death, Schireley says.
Schireley says there's nothing about knee surgery in particular that would make patients more susceptible to C. sordellii. "The subsequent investigation may find the cause, and it may or may not be related to some of the things they do at the knees. It may be the facility or contamination" from an unrelated source, he says.
Still, his state issued an advisory to its physicians and hospitals today, warning them about the Minnesota cases and suggesting that surgeons delay elective knee procedures until more is known about the rash of deaths.
Herb Bostrom, director of the bureau of communicable diseases at the Wisconsin Division of Public Health in Madison, says his state has so far seen no deaths linked to infections after knee surgery, and has no plans to suspend such operations in light of the Minnesota cases.
"I wouldn't want to say [clostridium] is unheard of, but it is not a normal complication of knee surgery," Bostrom adds.
Dr. Joseph Silva, Jr., dean of the school of medicine at the University of California at Davis, who has studied clostridium, says the C. sordellii strain is so unusual in people that the three cases probably share a single "point source," such as a person or device, somewhere along the line.
Silva calls this strain "a ferocious toxin producer" that typically causes more disease in stock animals than in people.
What To Do
For more on clostridium infections, try the Oregon Health & Science University.