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Superbug that eats flesh is on the loose


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Superbug that eats flesh is on the loose

Potentially lethal bacteria infects hundreds in Tucson


Tucson, Arizona | Published: 12.04.2005

As if threats of pandemic superflu weren't enough, yet another new and potentially fatal "superbug" is spreading worldwide — including in Tucson.

No mere threat, this bug has infected hundreds of Tucsonans already and hospitalized dozens, some with life-threatening illness.

Appearing at first as just a pimple, maybe a small cut, the infection often is mistaken by many victims — and their doctors — for a spider bite, delaying vital treatment.

Known as MRSA — methicillin-resistant staphylococcus aureus or "mersa" — it is in fact a highly contagious bacteria that has developed strong resistance to most antibiotics, making it hard to treat and setting the stage for dangerous invasive disease.

Mersa itself is actually nothing new. This resistant form of staph bacteria has been around for decades, but was limited mostly to outbreaks in hospital and nursing-home patients.

What's alarming doctors and public-health officials now is that mersa has moved into the general public — often infecting young people who have been nowhere near a hospital.

Infection begins on the skin, triggering inflammation, boils or nasty abscesses that can take weeks of treatment to stop — including surgery and hospitalization. But if it moves to the bloodstream, mersa can cause bone infection, lung-damaging pneumonia, organ damage, even fatal toxic shock syndrome.

Several Tucson emergency rooms report treating some 500 cases of mersa this year — triple the number seen just two years ago.

"It is absolutely the new superbug, and everyone is worried about it now," said Dr. Sean Elliott, a University of Arizona pediatrician who handles mersa in young patients.

"What is significant is that we are seeing lots of healthy individuals from the community who have developed severe skin disease, with more and more ending up as surgical cases, and some progressing to severe invasive disease."

In the past month, Elliott has treated five children with this form of life-threatening mersa. All have survived.

He has seen patients end up with chronic lung disease or disabled limbs after a mersa battle. He has handled nearly 30 entire families affected by it this year.

"This is a big one," he said. "It's not a cause for panic yet, but it's a bad player."

Unlike past years, mersa now can strike anyone anywhere, without warning or risk — an unexplained phenomenon occurring in developed countries worldwide.

However, no one yet knows the magnitude of mersa's spread. Exploding only in the past two years, "community-acquired" mersa has been reported in clusters in cities throughout the United States. But cases are not required to be officially confirmed to the government.

Trying to get a fix on mersa's march through Arizona, state health officials a year ago started tracking laboratory-confirmed reports of the most severe, invasive cases, and now are seeing 125 a month statewide. To date, 1,305 invasive cases have been reported, with 132 in Pima County. Deaths have not been tracked.

"That's probably a pretty significant underestimate," Elliott said. "This is going to have to change — it probably should be a reportable disease, if we're going to evaluate what's really going on."

A single emergency room, at Tucson Medical Center, has treated 541 cases this year — triple the number TMC saw in 2003.

"It's just floored us all, how much is showing up in the community, and how aggressive it is," said Connie Glasby, director of infection control at University Medical Center, where 483 mersa cases have come through emergency or urgent care in the past year.

Though mersa warnings have been sent out by federal and state health officials, Elliott, an infectious-disease specialist, still gets calls from doctors around Tucson asking about strange spider-bite cases that don't respond to treatment.

Several patients have reported small skin pimples that their primary-care doctors have diagnosed as insect bites, and treated with standard antibiotics. Only after the lesion has erupted, spread, caused severe pain, and sometimes fever up to 103 degrees has mersa finally been correctly diagnosed.

Though mersa is resistant to most standard antibiotics, there are a couple of drugs that still work. Those drugs, plus surgery to remove infected tissue — with one patient having his entire leg cut open, thigh to ankle, to get at it — are considered the most effective treatment. And that's for the less serious, non-invasive cases.

Some Tucsonans have missed up to two weeks of work trying to get over this "milder" form of mersa, which can take months — and can recur later — according to their doctors.

One Tucsonan, Janene Urias, has only now fully recovered — five years after nearly dying from a virulent mersa infection that hospitalized her for two weeks, then kept her on intravenous antibiotics for six more weeks, requiring a home nurse.

Even after the mersa infection finally cleared up, three months later, her out-of-balance body sank into chronic-fatigue syndrome for two years.

"This is a horrible disease, and people need to know about it," said Urias, 35, who now warns anyone she talks to of the dangers of contaminated surfaces in public places — where mersa bacteria can linger.

"If I go into a grocery store, I never touch my face until after I wash my hands. I carry hand sanitizer with me all the time," she said. "If I use a public restroom, I don't touch the doorknob on the way out — I use a paper towel to handle it. This thing lives on surfaces, and many of us are carriers of it and don't know it."

The most common cause of skin infections, staphylococcus aureus — including the drug-resistant mersa form of it — is everywhere. Some 30 to 40 percent of us carry it in our noses and on our skin, without ever developing symptoms.

Scientists do not yet fully understand what triggers mersa to set off a bad skin infection, or move on to severe, possibly fatal disease. They only know that mersa can develop what is known as "virulent factors" — toxic proteins that make it extremely dangerous — and that it is spread through skin-to-skin contact or by contact with contaminated surfaces.

Mersa clusters have broken out on athletic teams — including the NFL's St. Louis Rams — and in prisons and among military recruits.

Clare Kioski, an epidemiologist with the state Department of Health Services, said there have been cases of invasive mersa in every Arizona county.

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A new superbug comes out every year. Remember SARS?

I think we should get all the superbugs together, put them in a steel cage, and let them battle it out for the Undisputed Heavyweight Superbug of the World. Then we will all know what "superbug" we should actually worry about.

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