Staph Reported In Four Polk County Schools
10/30/07
GUIDELINES HAVE been drawn up to help doctors identify a new strain of toxic superbug that attacks healthy young people, amid concerns it could spread in the UK. While MRSA is usually associated with frail, elderly patients in hospital settings, a decade ago a Chicago doctor identified the first cases of a different type of the superbug, which had been acquired in the community.
Since then it has spread across the United States, Australia, Canada and parts of Europe, including Scandinavian countries which have been almost free of hospital-acquired MRSA.
The community form of the superbug (CA-MRSA) usually causes infections such as boils and abscesses, but also produces a toxin known as Panton-Valentine leukocidin (PVL) which can be deadly if it gets into the bloodstream. Three years ago, 18-year-old Royal Marine recruit Richard Campbell-Smith died from the bug after scratching his leg while training in Devon.
The prevalence of CA-MRSA infection in the UK is currently said to be "very low or unknown", but experts fear that it has the potential to spread more widely. Draft guidelines that advise doctors how to identify and treat CA-MRSA infections have been published this month by an expert group on behalf of the British Society for Antimicrobial Chemotherapy (BSAC).
Group chair Professor Dilip Nathwani, consultant physician and honorary professor of infection at Ninewells hospital in Dundee, said it was hoped the advice would raise early awareness of a "significant public health concern".
"We are now beginning to witness an emerging problem throughout the world, primarily a problem that has occurred in Australia and North America and is now emerging within certain European countries," he said.
"MRSA infections we have traditionally seen in the community are in people who are in contact with a healthcare facility, usually a hospital.
"But these are people who are generally younger, who are well and who often have certain other risk factors - for example, it has very high transmission within households."
Nathwani said early detection by doctors and nurses was vital not only to treat the infected patient, but also any close contacts who might be carrying the bug without any symptoms.
"GPs and community nurses need to understand the importance of this," he added. "Only by understanding and being aware of it will they begin to consider the potential for diagnosis."
Among those who are thought to be most vulnerable to CA-MRSA include children under the age of two, athletes involved in close-contact sports such as rugby - who can contract it through cuts and grazes - and those living in close proximity, such as students.
Although it has been more easily treatable than the hospital-acquired form of the bug, last month scientists warned that CA-MRSA is becoming increasingly resistant to antibiotics.
Unlike hospital-acquired MRSA, there is no obligation to report cases in the UK, but according to the Health Protection Agency around 100 cases of CA-MRSA have been identified so far.
Dr Jacqui Reilly, consultant epidemiologist at Health Protection Scotland, said no data was currently held on the situation in Scotland, because it was a relatively new issue.
But she added: "It is something that we are beginning to develop a research study on, in order to try and get an estimate of the burden of it in Scotland."
Hugh Pennington, emeritus professor of bacteriology at Aberdeen University, said lessons had been learned from the failure to halt the spread of MRSA in hospitals. But he pointed out that dealing with the superbug could be even more problematic in the community environment, which cannot be controlled.
"We really didn't take hospital acquired strains of MRSA seriously enough at the beginning - now we are paying a heavy price for it because they have become so well established," he said. "It is going to be much more difficult to know what exactly what to do about community MRSA.
"It is very sensible to take it very seriously and hope for the best but assume the worst."
