1. No-Name Slob
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    MRSA Staph Infection

    Discussion in 'Research' started by No-Name Slob, Jun 7, 2015.

    Has anyone ever experienced this type of infection? Of course, I could easily look on Web MD, and have many times, but I'd love to hear a first-hand account. Specifically:

    How long did it take before symptoms were full-blown?
    Do you think this is something you could have ignored, if you were very persistent in continuing daily activities?
    What symptoms are the hardest to deal with during the infection?

    If you don't want to discuss openly, feel free to PM!

    Thanks!
     
  2. GingerCoffee
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    There are two kinds of MRSA, hospital acquired and community acquired (also called hospital associated and community associated). Incubation period is short, only a couple of days.

    Community acquired is a pandemic of a particular strain, the USA 300, which has an enzyme that makes it more pathogenic. It's typical to get a skin infection, with multiple sites, often confused with spider bites.

    IV drug abusers often get MRSA abscesses at their injection sites.

    Still rare but threatening to become more common is a MRSA-Influenza co-infection. It has a high fatality rate and even though the organism responds to antibiotics, it causes a flesh eating type spread in the lung.

    Some people are colonized with MRSA in their throats. Colonized means it isn't causing disease.

    Community acquired MRSA is still susceptible to oral antibiotics, you just need the right ones.

    There is also something called MSSA- methicillin susceptible staph aureus.

    Then there is hospital acquired MRSA. That is a staph infection which can find it's way to infect a surgical wound or into a lung causing pneumonia. The high fatality rate is because the infected person generally has other serious health problems and the MRSA adds to the disease burden. HA MRSA is resistant to everything except IV vancomycin, and sometimes even that isn't enough.


    There are some much worse pathogens spreading now and MRSA almost seems like no big deal compared to other antibiotic resistant organisms we're facing.
     
  3. GingerCoffee
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    Let's see, your questions:

    How long did it take before symptoms were full-blown? Short incubation, but it can get worse at a variable rate.

    Do you think this is something you could have ignored, if you were very persistent in continuing daily activities? A lot of people ignore a lot of skin infections. Most people wouldn't ignore a skin infection that was getting worse and worse.

    What symptoms are the hardest to deal with during the infection? Ugly open weeping wounds on your skin are hard to ignore. You couldn't ignore MRSA pneumonia even if it wasn't the flu co-infection.
     
  4. No-Name Slob
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    Hmm, yes. I'm talking about communally acquired MRSA in an elderly man. Trying to figure out how quickly it could become severe if left untreated, and how he'd justify leaving it alone.

    He's exceptionally worried about everyone else, and pulled by them in every direction. He spreads himself thin at great costs, and has had multiple heart attacks because he refuses to rest and eat well, in order to treat his chronic high blood pressure and high cholesterol.

    Essentially, I'm trying to kill this guy quickly in the story by way of an infection that starts out minor, and turns severe as a result of his inability to take time for himself and get to the doctor.

    The problem is that MRSA can look pretty gross. Not something people would usually ignore, unless the other symptoms started first, before the decaying of flesh. I see him brushing it off as a cold until his rash turns nasty, and by the time he makes it to the hospital, it's too late to treat because his heart conditions pose contraindications to the heavy antibiotics.

    Too far fetched? I don't want the readers to be like, "Psh. That would never happen."
     
  5. GingerCoffee
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    A lot of people ignore skin infections. He could be putting Neosporin on it, (or some equivalent), instead of going to the doctor for proper treatment.

    Start with that and have it spread to his lungs turning into pneumonia.

    http://www.acep.org/content.aspx?id=26754

    The Panton-Valentine leukocidin is the property of the USA300 strain I mentioned. (I see it causes release of an enzyme rather than being an enzyme. Sigh, brain's just not what it used to be.)
     
    Last edited: Jun 7, 2015
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  6. No-Name Slob
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    I don't know why I was so busy researching all of the contraindications involved with the various antibiotics and anti-fungals used to treat MRSA, yet it never even occurred to me to kill him with a secondary infection.

    I have a tendency to overcomplicate things.

    Love it. Thanks!
     
  7. GingerCoffee
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    :D
     
  8. Sunny1000
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    Hey now I can help you! Sort of.

    I've had Golden Staph so my experience is definitely different to the antibiotic resistant strain and my "character stats" are different to your elderly gentleman: I'm a healthy adult who doesn't smoke or drink/eat to excess, exercise regularly and works in a relatively healthy environment. Even though mine wasn't antibiotic-resistant I can share my experience to some of your questions.

    How long did it take before symptoms were full-blown?
    TWO DAYS. I went from a slightly tender head to a head filled with a weeping mass of sores and itchiness in a VERY short amount of time and it just got progressively worse.

    Do you think this is something you could have ignored, if you were very persistent in continuing daily activities?
    Out of work obligation I did but I knew something was wrong and it just got worse and worse as the day progressed. In the end I couldn't ignore it. I would "dry" my head with a tissue and within seconds I would feel plasma running, trickling down my head. It was not something I could ignore. The tenderness also made it almost impossible to lie on my head, my hair matted together with all the weeping and I'm pretty sure my skin was falling off (well it probably wasn't but that's what it felt like).

    What symptoms are the hardest to deal with during the infection?
    The tenderness and irritation which lead to pain. The weeping was also decidedly unwelcome, it was like there was this never ending stream of liquid coming from my head! Like someone had bashed me over the head and I was just bleeding all the time, if I tipped my head forward I could feel it running towards my ears.

    Interestingly and not surprisingly they kicked me out of the clinic quick smart after I finished my appointment (I went to an after hours clinic after I couldn't stand it anymore).

    Hope this helps slightly :)
     
  9. No-Name Slob
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    Oh my gosh, that just sounds awful!!! :(

    Thank you so much for sharing. It does help a lot.
     
  10. GingerCoffee
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    "Golden" staph is merely a reference to "aureus" as in staphylococcal aureus.

    What you are describing is impetigo and the most common cause is Group A Strep, though sometimes staph aureus is the organism causing it. Streptococcal and staphylococcal bacteria are both common as normal flora and as pathogens.

    This site has a good explanation of the infection.
    While adults can get impetigo, and the most common location is around the mouth which few patients would ignore, it's not the most common presentation of MRSA.
     
  11. Thornesque
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    How long did it take before symptoms were full-blown?
    My infection started under my arm, as what, to me, appeared to just be an irritated blemish - it took about a week or two before it got to the point that I felt it was more than just that.

    Do you think this is something you could have ignored, if you were very persistent in continuing daily activities?

    Given the location of my particular infection? No. The swelling was so extreme, and because it was under my arm (my armpit) where there's obviously constant, continuous pressure, as well as a bit of battering from raising and lowering arms, the area because further irritated, as well as bruised. Simple movements of my arm became painful, and I would have had the matter taken care of sooner had I not been out of town at the time, and unwilling to go to a different clinic than the one associated with the hospital where I see my PCP.

    What symptoms are the hardest to deal with during the infection?

    In my particular situation, with the massive amounts of swelling and bruising that occurred was the hardest to cope with. For some reason, though (my PCP explained it to me, at the time, but I don't remember the reasoning, now) my first (I had a recurrence of the infection later, because I had an allergic reaction to the antibiotics they had me on and not being able to finish the prescription) infection didn't open up at all, so I never had an issue with that. Rather, the infection continued to swell to a quite large size (my PCP proper told me off for not getting to her, sooner) due to the growing infection and swelling due to the irritation. The second time that I got the infection, it opened (I think "burst" might be a better term) as a result of a quick arm motion - after that, of course, the pain was relieved because the pressure was gone, but the continuous leaking was extremely annoying. Still, I think I would take the leaking and constant need to clean the bandages over the pain that I experienced the first time around.
     
  12. CGB
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    To kill an older person much faster with an infection acquired in the community would be something like Strep. pneumoniae, especially in an unvaccinated individual (and there are many who don't get Pneumovax). It is the most common causative agent of pneumonia in adults over 65.

    for physicians who read your book, none of them would have a hard time believing a generic case of pneumonia kills someone over 65 especially if you show they required hospitalization. 37% of elderly adults sent to the ICU with pneumonia die.
     
    Last edited: Jun 26, 2015
  13. GingerCoffee
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    What makes you think it's faster depending on which of these two pathogens as opposed to the location of the infection?
     
  14. CGB
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    I mistyped. I meant "more believable."
    It depends what form the infection takes. If it is MRSA-associated pneumonia, and you want it to be bad enough to kill him, then it is likely a necrotizing form, in which case it would in no way feel like a minor cold.

    Most community-acquired pneumonia in the elderly is caused by S. pneumoniae.

    Now if you want something along the lines of a sore throat that someone will just leave alone thinking it will go away, then you can use S. pyogenes-associated toxic shock syndrome. In fact this is exactly how Jim Henson died, he let what appeared to be a run-of-the-mill sore throat alone for too long and he became septicemic

    https://en.wikipedia.org/wiki/Jim_Henson#Illness_and_death
     
  15. GingerCoffee
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    I'm pretty sure Jim Henson died from Group A Strep, a streptococcus pyogenes strain**. Strep pneumoniae is a different strain.

    Streptococcus

    **There's a technical difference between species and strain but it's not relevant in most discussions.
     
  16. CGB
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    Thats what I said in my post.
    "...you can use S. pyogenes-associated toxic shock syndrome. In fact this is exactly how Jim Henson died,"
    Group A is S. Pyogenes.

    I am a 3rd year M.D. student. These are exactly the types of question on the U.S. Medical Licensing Exam, which I just took a week ago.
     
  17. No-Name Slob
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    Thanks for your response. May I PM you?
     
  18. GingerCoffee
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    I saw you'd been talking about Strep. pneumoniae and the vaccine earlier and didn't read your subsequent post closely enough. My bad. Good to see we're on the same page. ;)

    While I'm a nurse practitioner and not an MD, I've had my own practice in occupational infectious disease for 23 years and I'm board certified in infection control as well as family practice and occupational health. :)

    Nice to meet you. :supercool:
     
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  19. No-Name Slob
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    :superyesh:
     
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  20. CGB
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    Sure

    No problem, my head is just full of these factoids right about now. I can see the Gram (+) cocci in my sleep, it is horrifying.
     
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  21. psychotick
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    Hi,

    First, ignore the methicillan resistant part of the acronym. That's only of concern when it comes to treating the condition. You're basically talking about a simple staph infection.

    Typically most people when they get a staph infection, fight it off through their own natural immunity. Boils, impetigo etc are examples of naturally self limiting staph infections.

    For some people however, perhaps because their immunity is compromised in some way - due perhaps to age, disease, smoking or poor health, suffer a disease where the bacteria progress beyond a limited skin infection. Where the bacteria penetrate the skin and enter the blood stream etc. One of the most common forms of this is the cellutlitis where the bacteria enter the layer under the skin and then spread. I've had one of these myself.

    When that happens you'll experience fever (high in my case) and redness spreading out from the site of the initial injury - though often there is no obvious sign of injury. In my case I experienced an initial fever as my first sign that something was wrong, and in a matter of six hours or so my entire leg had become red, swollen and hot. I went to the doc, and was put in hospital for a week after that. IV antibiotics - initially - fluclox were the front line antibiotic. They stopped the infection fast, but I developed an allergy to the drugs and had to switch to oral erythromycin six days later.

    Death by staph infection is uncommon but happens. It's usually because while the bacteria are in your body multiplying out of control, they're releasing a bunch of toxins (staphs and streps both produce any number of different toxins). Those toxins affect various organ systems in the body and can overwhelm them. Toxic shock syndrome (staph aureus aka golden staph - and group A strep) for example, affects the lungs, liver and kidneys, and people will suffer very high fever and low blood pressure. Do enough damage to the organ systems and you'll die.

    Despite the common beliefs TSS is not only associated with tampon use. In fact less than half of all cases are. Deep wounds are a common cause.

    Cheers, Greg.
     
  22. GingerCoffee
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    Actually, it's a tad more complicated than that. The Panton-Valentine Leukocidin endotoxin is the more important component than the drug resistance when it comes to community acquired MRSA (CA MRSA). The PVL toxin allows the staph to more readily invade the tissues. So where other staph infections needed a portal of entry that usually required skin injury, the USA300 strain of MRSA with PVL needed nothing more than a hair follicle or sebaceous gland pore to initiate an infection. It allowed the strain to become a worldwide pandemic. Now there are two clades causing most of the community acquired MRSA cases.

    It started with hospital acquired strain of MRSA (HA MRSA) that was resistant to all but Vancomycin. HA MRSA is still around and still a serious issue in hospitalized patients. But now we have several worse drug resistant pathogens to worry about. Vying for top offender status currently is carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae and the gene that creates the resistance escaping into the microbial world.

    Health officials are watching in horror as bacteria become resistant to powerful carbapenem antibiotics — one of the last drugs on the shelf.
    Then there is the growing threat of extensively drug resistant TB. And those are just two of the growing antibiotic resistant threats.

    Don't lose any sleep over this, though. There's still time/hope for humanity to save itself. :p
     
  23. psychotick
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    Hi,

    Most staph's produce toxins, and PVL is certainly not a new one. I believe it was first identified around 1900. A lot of the toxins also attack neutrophils. The fact that it seems to travel with community borne strains of the methicillan resistant staph is a worry. But equally the fact that it doesn't seem to be associated with hospital borne strains, confuses the picture. In addition to which there have been a number of outbreaks but in no case has it gone on to cause a pandemic suggesting that this is just another virulence factor. Most people who carry MRSA on their bodies will not go on to experience an illness associated with it.

    In fact the main pain people experience with MRSA is those who gain employment in hospitals and have it identified as part of their employment medical and then have to go through an entire regimen of treatments to get rid of it before they can start work.

    The Klebsiella pneumonaie is a little more of a concern, because it is very much more associated with hospital infections and can move through a ward quite easily. I have had to trace one of these outbreaks, and the experience was far from pleasant. The initial case was a surprise as he was a forester in reasonable health. But he did smoke and was greater than 45 years. The two subsequent cases were his fellow inmates in the ward where he was being trated for pneumonia, both of whom had the same risk factors, indicating just how dangerous this bug can be in a clinical setting when it hasn't been identified.

    However, that was fifteen years ago, isolation provisions for patients have been upgraded immensely since then, and the rapid spot testing of patients for bugs has changed the entire clinical scene.

    Of the bugs you mentioned the drug resistant TB is the most problematic for two reasons. Firstly TB is highly infectious in an enclosed setting like a home. And second it is mostly treated in the community. Worse it has become a problem across the entire world, particularly eastern Europe / Russia, and may account for 5% of all cases.

    Cheers, Greg.
     
  24. GingerCoffee
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    Most staph do not produce toxins. If they did we'd be in trouble given how common they are in and on our bodies.

    You are right, PVL isn't a new toxin.
    According to Wiki (which I have no reason to doubt):
    But what is new is the USA300 MRSA strain of staph. These organisms are constantly evolving, with particular strains expanding and ebbing in a continual flow. We are currently in the midst of a pandemic with the two clades of the USA 300 strains and their descendants.
    USA300 abroad: global spread of a virulent strain of community-associated methicillin-resistant Staphylococcus aureus
    It's nothing to panic over. I'm not implying that by any means. But it does have specific properties and the PVL is one reason it appears to have an invasive edge over its competitors.

    As for staph toxins, they are many and varied and well beyond the topic of this thread.
    Staphylococcal Enterotoxins
     
  25. GingerCoffee
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    No, this is outdated and a long way from being currently true.

    Sadly, infection control is inconsistent at best.

    I'm not sure where you have gotten your information from. But some of it is out of date and some is inaccurate.

    I think we're getting too far off topic though and I'd rather not hijack the thread.
     

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