When the little girl with the electric smile and big bows in her hair finally wakes up, she’ll have to figure out how to dance again. But her mother has no doubt she will.



Tessa Puma, 6, of Northfield, a kindergartner at Nordonia’s Northfield Elementary School, lost part of her left leg to a rare infection over the weekend. Her parents have not been able to speak with her since Thursday, when she was admitted to Akron Children’s Hospital. She has been heavily sedated and has undergone a series of surgeries since then.



Tessa has a condition called necrotizing fasciitis, said Dr. Jim Besunder, pediatric critical care medicine specialist at Children’s. It is extremely rare and not contagious, Besunder stressed. It has an incidence of 1 per 1 million children per year.



It’s an infection below the skin in the fascia, the connective tissue that separates skin from fat, Besunder explained. When that layer gets infected, it’s hard to see any symptoms in the skin because it’s a deeper infection. It progresses, and in Tessa’s case, goes down through muscle and starts destroying it. It destroyed most of the muscles and tissues in her left leg below the knee, which is why doctors had to amputate part of it. The bacteria got into Tessa’s bloodstream and traveled to other areas of her body including her left arm, shoulder and back, Besunder said.



Tessa’s father, Matt, had strep earlier last month, so the rest of the family was tested. Tessa showed no symptoms but did test positive and was given a 10-day antibiotic, her mother, Tina, said Monday at the hospital.



The weekend of March 25 she was sick with flu-like symptoms, Tina Puma said. By March 27, Tessa’s parents brought her to the ER with a high fever and hallucinations, but Motrin brought it down and she went home.



“Wednesday she started to complain about [how] we couldn’t touch her skin,” her mother said. “Her right arm and her left leg we could not touch. It was hurting, it was painful.” By bedtime she was screaming in pain, and her mother took her to the Twinsburg Cleveland Clinic ER, the closest site to their home. Tessa tested positive for influenza A, which can cause muscular inflammation, and was transferred to Children’s.



Swelling begins



Thursday night her father, Matt, noticed her left leg was swollen and she was in pain.



“From her calf down, you could see it was swelling,” her father said. “Her ankle had creases in it, you couldn’t see her bone, and then we started seeing kind of like black lines throughout her skin area of her leg.”



“Her skin was starting to peel,” Tina Puma said. “Kind of like when a blister has been broken.”



By Friday afternoon she was in severe pain. After an MRI, she was diagnosed with necrotizing fasciitis, undergoing surgery to relieve the growing pressure in her leg. It was high enough to choke off blood supply to areas involved, Besunder said. Any tissue that looks dead is removed.



“Once they got in there they saw the entire leg had filled up with infection,” Tina said.



“The muscle was just gray,” added Matt. “The tissue was just pretty much all gone.”



The infection was in her leg, her hip, and spread up her body to her shoulder, her chest and her back, Tina said. Tessa will need skin grafts.



She came back to intensive care and was “quite sick,” Besunder said. Surgeons went back in Saturday, concerned her leg would not survive from the knee down. The tissue below the knee was dead. She went back to surgery Sunday, but it didn’t look like there was any further progression. Tessa will have to go back to surgery Wednesday to check again, Besunder said. After that surgeons might not need to go back in, but it depends what’s found.



During Wednesday’s surgery, doctors will “clean up” the amputation and start skin grafting, Tina said. They’ll form a stump for a future prosthesis.



Tessa does not know what’s happened.



“They’re trying to wake her up now,” her father said. She’ll flicker her eyes or respond to pain.



“There’s no bad news,” Matt said. “But we’re not out of the woods yet.”



Tessa’s road ahead is a long one.



“She will have a lengthy period of time for physical rehabilitation,” Besunder said.



The competitive dancer was the youngest to make the team at Center Stage dance studio at age 5.



“She practices every single day,” her father said. “She’s very determined.”



“I told everyone this is not going to stop her,” Tina said. “She’s going to get any training she can to continue. That’s her dream. She wanted to be a dance teacher when she got older. She’s a very, very active child. … She’s touched so many lives just by her smile, and she wears big bows in her hair every day.”



“Everyone knows her by her bows,” Matt said.



School supportive



Monday was Nordonia’s first day back from spring break. In Tessa’s honor, all the girls wore bows in their hair at school and at the dance studio, her parents said. The boys drew bows on their wrists. Brother Tyler, 9, is in fourth grade, which did Team Tyler, allowing the boys to wear jerseys to support Team Tessa. He also has had strep but is on an antibiotic. “Now we know what to look for,” Tina said.



Besunder cautions parents to be alert if their child has a fever and localized pain in an arm or leg.



“If that pain is getting a lot worse, or if they start to develop swelling in the area of pain or redness in skin overlying the area, they need to be seen right away,” he said.



The Pumas have tried to find the positive in their nightmare.



“She had everything going for her. She’s such a bright young girl with amazing abilities,” Tina said. “This is just a small setback, but I guarantee she will still be able to do her dreams because she’s a determined little girl who never gives up on anything she puts her mind to. We think this is just going to be part of her story.”



Monica L. Thomas can be reached at 330-996-3827 or mthomas@thebeaconjournal.com. Follow her on Twitter @MLThomasABJ  and www.facebook.com/MLThomasABJ.