Health

By LAUREN GROVER
Staff Writer

Staph is nothing new, but its evolving nature is puzzling even to doctors.

That's what infectious disease specialist Dr. Richard Wallace said this week in response to the burst of attention the bacteria has received this month.

Wallace, a microbiologist at the University of Texas Health Center at Tyler, has more than 30 years of experience studying and treating mycobacterial infections.

He said Staphylococcus aureus (staph) and methicillin-resistant Staphylococcus aureus (MRSA) have been around for more than 50 years.

"Penicillin was first introduced around 1940 - it was a miracle drug for staph infections which were already a problem in and out of the hospital," Wallace said. "Within about 10 years, the strain was no longer sensitive to newer classes of penicillin. Methicillin was a class example, and this new group of bacteria was resistant to it."

For decades, communities all over the U.S. saw random cases of staph. Prisons and military bases fought staph outbreaks, where close contact encouraged the skin-clinging bacteria to jump from person to person. Likewise, MRSA found its own breeding ground.

Hospitals are the rare setting where a myriad of antibiotics - which encourage staph's resistance - is combined with weakened immune systems, susceptible catheter lines, open wounds and the scalpels and saws of the operating room.

"That's where MRSA shines," Wallace said.

A GENE CHANGE

For decades, the "super bug" was only found in the hospital.

Then something changed.

In the late 1990s, MRSA began appearing in the community - on playgrounds, basketball courts, kitchen counters - and its resistance to antibiotics wasn't hospital-bred, Wallace said.

It had evolved from the same staph that's always been in the community, he said.

And, in some ways, this community MRSA is scarier.

"Something's happened to them," Wallace said. "It's acquired something special that makes them want to jump on (otherwise healthy) people's skin and produce these big abscesses."

It is this MRSA that has frightened parents, coaches and teachers in recent weeks.

Health officials say this community MRSA caused the deaths of a 12-year-old in Brooklyn, N.Y., and a 17-year-old in rural Virginia this month.

And, for the first time, national statistics on staph in the U.S. were released, establishing a baseline for assessing the disease's trend.

The Oct. 16 report, by the Center for Disease Control and Prevention, estimated 94,000 life-threatening cases of MRSA occurred in 2005 and nearly 19,000 deaths from MRSA that year.

But only a few of these cases were related to MRSA in the community, or to young people.

Eighty-five percent of cases were associated with hospitals.

And life-threatening cases -often invasive infections of the bloodstream, lungs or at a surgical site - were highest among people age 65 and older.

Wallace said very few healthy people are dying of MRSA.

"Very ill patients are associated with high mortality rate," Wallace said. "The mortality rate for MRSA is about 20 percent overall and almost every one is in the hospital."

But, are people dying of community MRSA too?

Yes, Wallace said, but it's rare.

And it's attributed more to the prevalence of staph infections than the bacteria's potency.

"The risk of getting a serious, life-threatening infection is about 1 in 1,000, or 1 in 1,200," he said. "But if we have thousands and thousands of people getting infected, some are going to get really sick and some are even going to die."

Statistics show staph and MRSA cases have increased in the past 10 years.

UNDERSTANDING MRSA

MRSA is often misconstrued as something unstoppable.

It's no different than staph except it doesn't respond to methicillin-type drugs, Wallace said, and "it's just more difficult to treat."

Stronger IV antibiotics, such as vancomycin and Cubicin, are proven to treat MRSA.

But MRSA skin infections often don't require antibiotics, Wallace said, and lancing the infection's boils or sores is a cure for most cases.

"The treatment for (skin-level) staph takes several weeks, and signs of the infection should be gone within a month," he said.

Invasive staph or MRSA can lead to serious blood infections, pneumonia and lung infections.

These must be treated with strong antibiotics, he said.

One in three people carry staph on their skin, most of whom won't ever be infected.

The moist outer portion of the nose often serves as a hub, Wallace said.

Spreading it can be as easy as snuggling, sharing a shirt or wrestling on a gym mat.

Certain people are more prone to developing staph infections than others, he said, a puzzling factor for doctors.

Often, community staph and MRSA occurs without an obvious skin-break.

"(These susceptible people) have an alteration in their immune system. We don't know how to test for it, and whatever it is, it's relatively minor," Wallace said.

The increase of infections since the late 1990s portrays a bacteria that adapts for survival, Wallace said.

"They have been able to change their genes for survival," he said. "Maybe this is part of the normal evolution of staph, and we're at the wrong place and the wrong time."

Hospitals are slowly gaining technology to screen for MRSA, one way to protect against its spread and its capacity to kill.

But, in the community, it's often the responsibility of individuals who are infected.

"Bandages, wounds, be very careful with those," Wallace said. "Prevention depends on how much people are willing to do these things."

CLEAN-UP: Juana Diaz, a custodian at Bell Elementary School, washes the desks to prevent the spread of germs on Wednesday.
((Staff Photo By Tom Turner))