Q-Tips, Enlightenment, etc.

Thursday, August 17, 2006

mrsa mrsa mrsa ----------> (rant/educational essay)


What you are looking at in the photo to the left is a skin abscess caused by MRSA (multi-resistant staphylococcus aureus). MRSA is mutant staph bacteria that has evolved quickly to outwit 2/3 of modern medicine's antibiotics. It's been well-known since the '90s that there have been problems in hospitals with resistant staph, which soon spread to prisons, and to locker rooms. This form of MRSA is known as HA-MRSA (hospital acquired).

Not content to merely flourish in institutional environments, this hardy microbe has mutated even more and now freely roams the general community striking perfectly healthy people of all ages. This form of MRSA is known as CA-MRSA (community acquired). There are actually 2 defined strains of CA-MRSA in the U.S. known as USA300 and USA400. The USA400 strain is more potent, containing an exotoxin known as
Panton-Valentine leukocidin), whose aggressive action can cause abscesses like the one in the photo.

MRSA infections start out looking like a spider bite and depending on the strain of MRSA involved and the amount of infection it's able to inflict before the antibiotics kick in, can manifest as a boil or an abscess or a lesion. Boils are red raised bumps, with a black spot in the middle and are painful to the touch. A badly infected boil can reveal an abscess underneath when a doctor lances it. Lesions take place on flat skin in the form of "weeping wounds".

Although most antibiotics are ineffective in combatting MRSA, there are still a few that work - sulfa compounds, for example. However, these still-effective antibiotics must work awfully hard and long to accomplish the job. Instead of a typical 10-day course for a simple infection, antibiotic courses to treat MRSA typically last 30-60 days. It seems that pharamaceutical companies haven't been terribly interested in developing a new generation of antibiotics - the big money has been in other kinds of drugs. And MRSA is an under-the-radar epidemic, especially in states like Texas, Missouri, California, New York, Georgia, Maryland and Minnesota.

Despite recent media attention in publications such as
The Globe and Mail, USA Today, Time Magazine, The Los Angeles Times, websites such as CNN.COM, and local TV station KNBC (just in the last 3 months), public awareness of this superbug is scant. Mention bird flu, which is not even here in the U.S. (yet) and everyone knows what you're talking about. There is a fairly severe MRSA problem in British hospitals, and in France, Japan and Australia, among other places.

Sometimes the aforementioned still-effective antibiotics only manage to suppress the bacteria, rather than kill them (which of course is the goal). Upon cessation of the antibiotic regime, the bacteria (which has been battered around perhaps, but still staggering) is once again free to create a new infection. It is not at all uncommon to have recurrences after an initial healing. Such stubborn cases are referred to "ID" (Infectious Disease) doctors, specialists in such matters who receive referrals when the general practitioners, family practitioners, internal medicine doctors and pediatricians have thrown in the towel. An ID doctor may recommend what used to be called "the antibiotic of last resort", vancomycin, administered intravenously. This method has proven to be fairly effective except in the last few years a new strain of staph called VRSA has appeared which is resistant to, you guessed it, vancomycin. There are newer compounds, such as zyvox and daptomycin which have been found to be of some use in specific circumstances.

For those who despair of the western allopathic approach, there are all kinds of homeopathic, herbal (both Chinese and western), and naturopathic products that many claim to be effective in treating MRSA and even killing the bacteria for good. One highly-touted compound is allicin, which is the extracted antibiotic component of garlic, used in "high" doses. Of course, no dosage standards exist because these are not FDA-approved substances. A good bet is to engage in whatever strengthens the immune system.

The prevalance of this superbug is due to modern Western society's extreme overuse of antibiotics which have given these bacteria ample opportunity to evolve, even speeding up that process. And evolve they do. So, if you think you have a spider bite, but don't remember seeing the spider, please see a doctor. If it only turns out to be a nasty spider bite, drinks are on the house!

What you are looking at in the photo to the left is a healed MRSA abscess, 57 days after initial outbreak. Note the "normal" skin tone in the lower and upper right. The skin discoloration around the former infection fades over time.

Many other issues surround MRSA such as the need for national policy in setting standards for institutional cleanliness, managing contagion, educating the public. The CDC does not consider MRSA to be a reportable disease, which causes the demographics of MRSA outbreaks to be known only through the compilation of local studies. In other words, there's no unified, co-ordinated strategy to deal with the superbug at present, really. But nevertheless, it is here among us now. Whenever it becomes widespread enough to become a discernible blip on the national public health radar, maybe then good old American ingenuity will produce breakthroughs. Until then,
caveat emptor. And,
at vero accusamus dignissimus...

More info:
Some light reading from the Journal of Clincal Microbiology