Last month, a few minor blisters turned into a flesh-eating nightmare for hiker Wayne Atkins, who developed a dangerous bacterial infection after climbing Mount Garfield, a 4,500-foot peak in New Hampshire. Atkins survived, but barely: He spent 2 1/2 weeks in a medically induced coma while doctors pumped him full of antibiotics and removed chunks of his flesh to get rid of the infection.

And Atkins was lucky, relatively speaking: Infection with flesh-eating bacteria is considered a surgical emergency, and can require limb amputation. One in four people with necrotizing fasciitis dies.

But is there any reason for the rest of us to be concerned? Or was Atkins’s case a bacterial lightning strike?

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Here are five things to know about flesh-eating infections:

1. What causes the infection?

Multiple types of bacteria can cause so-called flesh-eating infections, also known as necrotizing fasciitis, but Atkins fell victim to Group A Streptococcus, which Dr. Bernard Camins, an infectious disease specialist at the University of Alabama at Birmingham, considers “the quintessential flesh-eating bacteria.”

Group A strep may sound familiar: It is the same bacteria that causes strep throat.

2. Where does a person catch that bacteria?

Around 3 percent of healthy adults and 5 to 15 percent of healthy children have Group A strep bacteria colonies in their nose and throat or on their skin. When people develop necrotizing fasciitis, it’s usually because Group A strep already on their skin get inside a wound after an injury or surgery, though a needle prick or blister could be enough. From there, the bacteria quickly start destroying skin, fat and muscle, and eventually work their way into the bloodstream.

3. Why does a generally harmless bacteria turn deadly?

According to Camins, Group A strep bacteria are very unpredictable, and scientists don’t know for sure. They can turn deadly once they breach the body’s natural barriers and reach the superficial fascia, a layer of connective tissue just underneath the skin. From there, they start spreading rapidly into the surrounding tissues, releasing destructive toxins along the way.

This is more common in people with weakened immune systems whose bodies can’t fight off the bacteria as effectively. The Centers for Disease Control and Prevention estimates that only 700 to 1,100 cases of necrotizing fasciitis occur every year in the U.S., and most occur in people with diabetes, kidney disease, cancer, or other conditions that weaken the immune system.

4. What are the symptoms?

A necrotizing fasciitis infection can develop within a few hours, and is difficult to diagnose, especially early on when patients may have vague symptoms, such as pain or soreness at the injury site. Early symptoms can also include reddish or purplish areas of swelling that spread rapidly, and Camins said one giveaway is when people have “pain that is out of proportion to what the wound looks like.” Later symptoms include fever, chills, or vomiting. Doctors generally treat the infection with a combination of strong antibiotics to knock out the bacteria and surgery to remove dead tissue.

5. How can I avoid it?

To avoid infection, Camins recommends washing wounds with soap and water, applying antibacterial ointment like Polysporin, and checking wounds on a regular basis. And if you are in huge amounts of pain from a wound that otherwise looks OK, get yourself to a hospital ASAP.

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