April 12, 2005
What happens when the antibiotic-resistant superbug gets loose on the streets? It's out there, and has, oddly, received not a lot of attention in the media. Now, several reports and an editorial in the New England Journal of Medicine, may change that. It is methicillin-resistant Staphylcoccus aureus (MRSA), and while once it was restricted to hospitals, several cities in North America and Britain have seen it among street people and even locker rooms in athletic stadiums. The variant is called community associated. It is rare, but not unheard of for this infection to kill or hospitalize its victims. Included in the category is the famous and very serious flesh-eating variety which requires fast surgery. For some reason, the Canadian media has been way ahead of the U.S. media on the story until now, with much of the best work coming out of the Canadian Broadcasting Corp. (CBC). Partly, thats because MRSA has popped up frequently in Calgary, but the CDC has traced outbreaks among healthy athletes in Colorado, Indiana, Pennsylvania and California. It begins as a skin condition, usually a boil, and can spread through the bloodstream from there. If not treated quickly and well, it can kill, usually as a form of pneumonia. In the case of one young man in Calgary, it only took four days. In Colorado, it struck members of a fencing club and their families. Football players, including at least five of the St. Louis Rams of the NFL, as well as amateur wrestlers, also have been hit with the infection, sometimes requiring hospitalization. Children in day care and prisoners also are particularly vulnerable. MRSA has reached epidemic proportions in Chicago, particularly among children, and at least one child has died. It took 16 hours from first symptom to death. Unlike the hospital variety, standard antibiotics such as methicillin dont work with the community version. Generally, labs have to analyze each case and then determine which, if any, of the available antibiotics will kill the bugs--usually it's vancomycin. Someday the bacteria may be entirely invulnerable, even to vancomycin. One of the jokes they tell in medical schools is that people become dermatologists because there is never an emergency in dermatology. There are now. Oh, by the way, one way to avoid spreading MRSA is not to pick your nose. (You have to admit you dont get information like this in most places.)
UPDATE: Two more cases have been reported in western Manitoba and one of the two has died.