Doctors Baffled by Superbug's Presence

How did the MRSA bug spread from hospital rooms into the community?

ByDan Childs<br>abc News Medical Unit
February 10, 2009, 9:07 PM

Oct. 18, 2007 &#151; -- More reports of the potentially deadly superbug are popping up around the country, just days after three teenagers died after developing the drug-resistant infection.

Public health officials say they are baffled as to why the bug, known as methicillin-resistant Staphylococcus aureus, or MRSA, has spread.

MRSA used to be found only inside hospitals, spread from patient to patient. Now it is infecting healthy people in their communities, homes or schools.

The Associated Press reports that officials at one North Carolina high school say at least six football players have been infected with the MRSA strain, and in West Virginia, at least seven students at three different schools have been diagnosed with MRSA.

And in Richmond, Ind., health officials spent the day disinfecting the locker room of the local high school after a student apparently came down with the infection.

Three children have died from MRSA in the last week: an 11-year-old in New Hampshire and a 4-year-old in Mississippi, whose names were not released, along with 17-year-old Ashton Bonds of Virginia.

A government study released this week says 90,000 people could get infected this year.

For those that contract the infection, health officials say the key is to catch it early.

To see 2-year-old Evan McFarling today, one could hardly guess he survived a battle against an invisible assailant — one that could have ended his young life.

But any doubt as to the magnitude of his struggle against the drug-resistant germ methicillin-resistant Staphylococcus aureus, or MRSA, disappears when Evan's shirt is removed, exposing the surgical scar on his chest he received when he was only 8 months old.

"He ended up having heart surgery over it," said Matt McFarling, Evan's father. "Somehow it got into his pericardium," he said, referring to the fluid-filled sack that surrounds the heart.

"There is no reason an 8-month-old should be having heart surgery. It's pretty scary," said McFarling, who lives in Corpus Christi, Texas.

The evidence of MRSA is more apparent in the case of 12-year-old Hunter Spence from Victoria, Texas. She fought off an MRSA infection in May. While she escaped with her life, she sustained significant lung damage, forcing her to go through several surgeries. Hunter may have to return to the operating room in January for another lung procedure.

"She's going back to school and starting back on a fairly routine schedule, but she had a lot of lung damage," said Payton Spence, Hunter's mother. "Her leg, where she developed the infection originally, is pretty much back, but it's not 100 percent."

"We really don't know how it happened and that's really another scary issue."

And as these reports emerge around the country, doctors remain largely puzzled as to why MRSA — an infection traditionally thought to only infect already sick patients while they lie in hospital beds — is threatening the lives of young, previously healthy children living in their own communities, not in a hospital.

"Some of us in pediatrics have been very concerned with this since the late 1990s and early 2000s," said Dr. Jaime Fergie, director of the pediatric infectious diseases unit at Driscoll Children's Hospital, in Corpus Christi, where he treated both Evan and Hunter.

"We began to notice MRSA causing illness in children who were healthy and who hadn't had any contact with medical services," he said. "We've dealt with a tremendous number of these patients, in the hundreds."

Despite this apparent rise, doctors and public health experts are still looking for answers as to how these infections arise and spread in the places that these children live and play.

"We don't know why this organism began to mutate in this way in the community. … This community onset is by far the concern for us."

Hospitals, in the meantime, are far more acquainted with the ability of this deadly infection to spread. For this reason, hospital systems around the country have been implementing measures to stem the spread of the disease.

And in New Jersey, the legislature recently passed a law requiring hospitals to conduct MRSA tests for all patients before they can be admitted into an intensive care unit.

Another example is the University of Virginia Medical System, which has appointed specialists who gather data from patients' charts to try to catch infections before they become a problem.

Medical centers from Massachusetts General Hospital in Boston to Seattle Children's Hospital have adopted stringent hand-washing and hygiene protocols. And the Methodist Hospital System in Houston has gone so far as to plant secret observers in different areas of the hospital to ensure compliance.

But so far, in affected communities, measures to stem the spread of MRSA have largely taken the form of damage control — school closures and intensive cleaning efforts to rid public facilities of the bug.

And while the efforts may indeed go a long way in sterilizing school environments, Driscoll Children's Hospital's Fergie says there is yet no firm evidence that such measures are really effective.

"There are some common-sense recommendations that have always been given to people," he said. "It makes sense. It may help, but we can't say it's protective."

In this sense, it may be the early detection of MRSA infection that is the most important step in saving the lives of those exposed. Dr. Vance Fowler, an infectious disease specialist at Duke University in Durham, N.C., told ABC's Diane Sawyer on "Good Morning America" today that these infections generally manifest themselves in the skin.

"For community-associated MRSA, in essence, think skin," he said. "Boils, abscesses, pimples. These are the vast majority of these community-associated infections."

But Fowler added that symptoms of systemic infection may take the form of fever, chills or flulike symptoms. And Fergie says that while rare, some instances of infection make a much more worrying debut.

id"The problem is, some life-threatening cases just begin suddenly, without any skin infection," he said.

But as mysterious and frightening as MRSA is, early detection and treatment can go a long way in safeguarding the health of children who contract the infection.

Even the littlest ones, like Evan McFarling.

"He's no worse for wear," said his father, Matt McFarling. "The only remnants of it are the scar on his chest, and we have to thicken his fluids because he has problems swallowing from the surgery. "

"But now he's as rambunctious and rowdy as the rest of them."

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