Deadly Superbugs
They
can be transmitted by a hug or a handshake, on a playground or in a locker
room. And can kill within 72 hours.
By Lisa
Collier Cool
From
Reader's Digest August 2007
Photographed by
Thomas Broening
'People
are bent out of shape about bird flu, but CA-MRSA
is here, second only to HIV as a public health threat.'
Full of Life
Drew
Griggs was full of energy on
January 31, 2005, as he headed to the gym. The 16-year-old was a starting
kicker on his
Dublin,
Georgia, high school football team, the
Fighting Irish. But the gridiron
season was over, and it would be fun to join his friends for a Monday night
pickup basketball game. After shooting hoops for a while, he went home
feeling a little ill and told his parents, Bonnie and Paul, that he might be
coming down with the flu. Although the brawny young athlete wasn't one to
complain, his mom checked his temperature. It was 99. Nothing to worry
about. He'd probably be fine in a day or two.
On Wednesday,
Drew woke up with a stuffy nose, a cough and a mild fever. He stayed home
from school. In the afternoon, while Bonnie was picking up her son's
homework, her cell phone rang. "Mom, I can't breathe," Drew gasped. "Dad's
taking me to the doctor." Bonnie rushed to the MD's office, where an x-ray
showed that the teenager's lungs were congested. Suspecting pneumonia, the
doctor sent the family to the ER, where doctors slipped an oxygen mask over
Drew's face. When that didn't help, he was transferred by ambulance to a
larger hospital, in
Macon, Georgia, while Bonnie and
Paul followed in their car.
"I thought they'd give him antibiotics, and that would fix it," says Bonnie,
a physical education teacher. At the second hospital, doctors tried one
treatment after another, with no success. At 1:30 a.m., they had to put Drew
on a respirator. But even on life support, his oxygen level kept dropping.
By morning, it was so dangerously low that there was only one option left:
moving him to a medical center in
Atlanta to be hooked up to a
heart-lung bypass machine. "When we saw him at the third hospital, he'd
started to turn blue. They gave him a 30 percent chance of living, because
his lungs were shutting down from extreme infection," says Bonnie. "That hit
us so hard, we were in complete shock."
But why was Drew so sick? Tests, including cultures of his phlegm, revealed
that he had pneumonia triggered by a sometimes fatal bacterial infection
known as methicillin-resistant Staphylococcus aureus (MRSA). "I
thought only sick people in the hospital got that," says Bonnie. For
decades, that was true: MRSA was dubbed a superbug because many common
antibiotics couldn't eradicate it. The bug prowled medical centers and
nursing homes, typically targeting elderly, debilitated and chronically ill
patients. Now an even more dangerous form of staph infection, known as
community-associated MRSA (CA-MRSA), is striking otherwise healthy people
who haven't been in a hospital, with an unusual number of outbreaks among
athletes on sports teams. And kids are at particular risk, although no one
is sure why.
CA-MRSA: An Epidemic
"Over the past three to four years, CA-MRSA has become an epidemic that's
sweeping the country," says
Robert Daum, MD, an
infectious-disease specialist at the
University of Chicago Comer Children's
Hospital, who was one of the first researchers to discover and
study community strains. (There are more than a hundred of them.) "This
isn't something unleashed in hospitals. Community strains are genetically
distinct from hospital staph, and even more virulent." Unlike the hospital
bug, they produce toxins that kill white blood cells -- the body's main
infection fighters, says
Dr. Daum. "That makes them a
double threat. It's not just a question of giving the right antibiotics.
We're seeing aggressive, rapidly progressing cases. A child can be healthy
and playing with his toys in the morning, and dead from this infection that
night."
MRSA is so widespread that 2.3 million Americans carry the bacteria in their
noses without symptoms, the
Centers for Disease Control and Prevention reported in 2006.
CA-MRSA carriers can infect others, or suddenly become ill themselves if the
bacteria burrow past the body's defenses. Any break in the skin's protective
barrier -- a razor nick, a scratch, even nose picking (which may injure
nasal passages) -- can set the stage for a staph infection.
Getting the flu can also allow the bug to jump from the nose to the lungs,
says
Blaise Congeni, MD, director of
infectious diseases at
Akron Children's Hospital in
Ohio. "During the flu season, we
frequently see severe CA-MRSA infections,"
Dr. Congeni says. "Because kids'
resistance is down due to the flu, they can't fight off the bacteria, which
can sometimes lead to potentially fatal pneumonia."
Months before
Drew Griggs got sick, he had
developed a skin infection after a scrape during football practice. Experts
reviewing his case now think that infection may have been an undiagnosed
bout of CA-MRSA, which can sometimes clear up on its own in mild cases. Drew
appeared to be battling the flu when staph-induced pneumonia set in.
Labeled a lethal menace in 1999, after four children in
North Dakota and
Minnesota died of it, the
superbug is now responsible for 59 percent of skin and soft-tissue
infections seen in emergency rooms, researchers reported last year. "This is
an astonishingly high case rate," says
Henry Chambers, MD, chief of
infectious diseases at
San Francisco General Hospital.
He and other experts advocate increased government funding for the
development of new antibiotics or, better still, a vaccine. "People are bent
out of shape about bird flu, but CA-MRSA is already here and, in my opinion,
ranks second only to HIV as a public health threat,"
Dr. Chambers says. "The drugs
we've relied on to treat common infections no longer work. And if we're not
smart about using the few weapons we have left, this superbug will
definitely morph again, to become resistant to even more antibiotics."
Doctors are already finding the bacteria hard to defeat. CA-MRSA infection
has a nasty habit of recurring, adds
Dr. Congeni. "Just this week, a
patient came in with his seventh episode. People are scared and frustrated
because they can't get it out of their homes. Sometimes one family member
will get it, then another."
Unimaginable Tragedy
CA-MRSA typically causes
boils, pimples or pus-filled swellings often mistaken for spider bites. It
can trigger large abscesses that need to be surgically drained, and in
extreme cases, it can lead to life-threatening joint, lung, muscle or bone
infections, says
Dr. Daum. "We're also seeing
alarming syndromes, particularly in kids, including bloodstream infections
and flesh-eating bacteria that leave the lungs riddled with holes, like
Swiss cheese."
That's what happened to two-month-old
Madeline Reimer and
Andy Zack, 11. Both kids started
off with seemingly minor problems. Madeline had a runny nose and a cough.
Andy fell off his bike, banging his hip. A couple of days later, the sixth
grader from
Youngstown,
Ohio, had a fever of 104 and was
in such excruciating pain that he could barely walk. The baby girl from
Plainfield,
Illinois, turned pale and limp,
says her mom,
Beth Reimer. "I called 911, and
they told me to do CPR. At one point, her eyes closed, and she lost all
muscle tone. I thought she'd died in my arms. My husband and I were in
hysterics, trying to get her to breathe."
Paramedics revived Madeline, who was airlifted from one hospital to a
second. She was put on life support and vancomycin, a powerful IV antibiotic
often effective against MRSA.
Andy, an energetic boy who loves to play soccer and ride his mountain bike,
was hospitalized with a massive infection, says his dad,
John Zack, a software engineer.
"When they said he needed a hip operation to drain pus, I was crying because
I was scared that he'd never walk or play again. I quit my job to stay at
the hospital and take care of him."
As Andy lay in bed, with an eight-inch surgical incision in his thigh, he
suddenly got short of breath. A scan showed fluid buildup in his chest. "The
doctor said the infection was eating holes in the lower lobe of his lung and
that if he didn't have another surgery, he'd die. I'd never been so
terrified in my life," says John. "I couldn't believe one little bump on his
bike could unleash an infection like this."
Beth
Reimer got even bleaker news. CA-MRSA
had destroyed one of her daughter's lungs and was starting to attack the
other one. "I knew in my heart that she wasn't going to make it. Her little
body faded so quickly. On her last day, July 22, 2005, the whole family was
there to cherish every moment with her. We sang ‘You Are My Sunshine.' Just
before her final breath, she opened her eyes and looked right at me -- that
was such a blessing."
After Madeline's death, her twin brother, Luke, came down with a runny nose.
"I was beside myself with fear that I was going to lose another child," Beth
says. Although Luke tested positive for the superbug, as did his mother, he
recovered in a few days, while Beth had no symptoms.
Weaned Off Life Support
As a precaution, the entire family, including an older son and Beth's
husband, Kenneth, were treated with heavy-duty antibiotics and a nasal
ointment. "I'm haunted by the thought that I might have innocently passed
this on to my baby," says Beth. However, doctors never pinpointed the source
of her daughter's infection.
John, too, worries that he may have infected his child, given the elder
Zack's history of boils, one of
which swelled into a softball-size abscess. But he's never been diagnosed
with CA-MRSA, since his doctor didn't do any cultures. How the bacteria
invaded Andy's body isn't entirely clear either; the accident didn't leave
any visible wound. But the youngster had cracked a bone in his foot in
another bike mishap, two weeks earlier. Both injuries may have been
contributing factors, says
Dr. Congeni, Andy's doctor. "It's
easier for this infection to occur in traumatized tissue."
After doctors drained fluid from Andy's chest, his breathing quickly
improved. Ten days after being admitted to the hospital, he took his first
shaky steps, and five days later, he went home, limping a little. "Seeing my
son walk again was like having a thousand-pound weight lifted off my
shoulders," says John. Seven weeks later, in October 2006, Andy had
recovered enough to return to school. Although the limp has disappeared, the
doctor says it might take years for his lungs to fully heal. "He's maybe 85
percent as healthy as he used to be, and gets winded more easily, but he
still runs around and rides his bike. You just can't keep that kid down!"
These days, the parents of
Drew Griggs, the high school
athlete, also have a lot to cheer about. After 18 days in an induced coma,
first on a bypass machine, then a regular respirator, he improved enough to
be weaned off life support. "We were so elated when the doctors said he was
going to make it," says Bonnie. "At first, he was so weak that when we asked
him questions, all he could do was nod."
After a month, Drew left the hospital in a gurney and spent a week in a
rehab facility. "His muscles had just wasted away," his mom says. The
six-foot-one-inch teenager's weight dwindled from his normal 159 pounds to
118. "He was just skin and bones." At 16, he had to relearn how to walk,
dress and feed himself.
As the Griggses drove their son home from rehab on March 9, 2005, they
spotted handmade signs his friends had placed along the sides of the road.
One word at a time, the signs formed a message: "Welcome home, Drew! It's
been a long way, but you finally made it back home." At his house, over a
hundred people were waiting to greet him. Buoyed by the outpouring of
support, Drew battled his way back to fitness and started playing football
again in the middle of the 2005 season. When he kicked off in his first
game, he got a standing ovation. The
Fighting Irish went on to win the
state championship in 2006.
Now that Drew is healthy, he's determined to stay that way. Before a game,
he sanitizes his helmet with disinfectant wipes and suits up in a freshly
laundered uniform. "I clean my gym locker every day and am very particular
about hygiene," says the soon-to-be freshman at
Valdosta State University, where
he's got a spot on the football team. Drew takes two showers a day and
washes his hands at every opportunity. "This germ hit me out of nowhere and
could have taken my life. I tell people that you just can't be too careful.
This thing is out there, and you don't know where it might be hiding."
How to Protect Your Family
CA-MRSA is usually spread by skin-to-skin contact with infected people
(while playing sports like football or wrestling, for example, as well as
giving hugs and handshakes). Doctors recommend these steps to lower your
risk:
Keep your hands clean. Washing with soap and warm water
several times a day is the single best way to combat staph. Teach kids to
rub their hands briskly under running water for at least 15 seconds (about
the amount of time it takes to recite the alphabet). Carry alcohol-based
hand sanitizer for times when soap and water aren't available. It's also
helpful to keep kids' fingernails short and to discourage nose picking.
Cover cuts and scrapes. Any wound should be washed with
soap and water, then covered with dry, sterile bandages until it heals.
Apply a clean dressing daily. Pus from infected sores can contain CA-MRSA,
so it's also important to wash your hands after changing bandages to avoid
spreading staph.
Don't share personal items. Tell your kids not to use
friends' and teammates' towels, washcloths, clothing, uniforms or razors.
People who appear perfectly healthy can still be CA-MRSA carriers. Shared
sports equipment, such as helmets and gym mats, should be cleaned with an
antibacterial solution after every use.
Sanitize gym clothing and linens. If anyone in the family
has a cut, sore or infection, wash bedding and towels in hot water with
added bleach. Wash sports clothing and washable athletic gear with laundry
detergent after each use. Drying laundry in a hot dryer, not on a
clothesline, also helps kill bacteria.
Remember flu shots. Since the flu lowers resistance to CA-MRSA,
getting vaccinated every year helps protect against both diseases. The best
time to get the shot is in October or November. Flu shots are approved for
kids over six months of age.
Get tested. If you have a skin infection that needs medical
treatment, ask the doctor to check for CA-MRSA, which responds only to
certain antibiotics. Many MDs prescribe the wrong drugs because they don't
do a test. That can worsen the infection. Until recently, diagnosis
typically involved doing a culture. But it takes up to 48 hours to grow the
bacteria in a lab, meaning that people could continue to spread the
infection while waiting for lab results.
In April of this year, the
FDA approved the one-hour Xpert
MRSA test, which uses DNA technology to check the nose for the superbug.
That gives hospitals a fast, reliable way to screen patients for MRSA before
admission. Next year, the test's manufacturer,
Cepheid, expects approval of a
DNA test for use on tissue samples from infected areas, giving doctors
another tool for rapid diagnosis.
Be sure to take all your prescribed medication -- even if
your skin heals. Bacteria you leave alive today can morph into tomorrow's
superbugs.
Last Updated: 2007-07-11
