More than Just a Skin Infection: A Science Journalist Describes her Family’s Encounter with MRSA

The term “skin infection” doesn’t set off alarm bells for most people. They’re pesky, perhaps embarrassing, but with the right ointment or medication it shouldn’t be much of a problem. But that’s not the story Sonia Shah tells, a career science journalist and mother of two. In her recent book “Pandemic: Tracking Contagions from Cholera to Ebola and Beyond,” and in an interview with NPR, she describes something else entirely; something that few of us would imagine.

Sonia Shah

Sonia Shah

Ever-so-innocently it began: her son’s complaints about that frayed knee bandage, well-earned by his Huckleberry Finn-style outdoor adventures. The red stain in the middle of it probably meant the scab re-opened—the boy just needed to slow down. But when Sonia saw him limping a few days later she peeled off the bandage and: “We found a mountain range of pus-filled boils. One peak summited at over an inch – an inch! – and had wept a sickly stream of liquid into the gummed-up bandage.”

Down at the pediatrician’s office came the diagnosis of a methicillin-resistant Staphylococcus aureus (MRSA) infection, a barrage of heavy duty antibiotics, and instructions to carry out “a brutal regime in which we’d have to force the pus out of the boils using hot compresses and vice-like squeezing. This would be … excruciatingly painful, since the layer of pus extended deep into the tissue … Each drop would have to be meticulously captured and disposed of, lest it find its way into a microscopic fissure in our skin or worse, embed itself in our rugs, sheets, couches, or counters where it could lie in wait for up to a year.”

Which meant the family was at risk: her other son, the father of her two children, and Sonia herself. They probably hadn’t seen the last of this as they were told of whole families who came down with MRSA continually re-infecting each other for years. Another physician warned that her son could have lost his leg.

They acted fast: “We washed. We laundered. We maintained a sterile box with hand sanitizers, disposable gauzes, and antiseptic sprays. A set of cast-off pots lived on the stove for boiling bandages and compresses, which we did religiously. One doctor recommended twice-weekly 20 minute baths in a bleach solution – ½ cup per bath – for months or even years. You know, we first started fighting them with lots of antibiotics and getting them lanced and doing all this stuff with – you know, going to the doctor for them all the time, and then it turned out that if you just sort of stopped everything, they kind of went away on their own.”

But none of the various physicians, Sonia believed, quite knew how to prevent the infection from re-occurring, or from spreading to the rest of the family.

Sure enough, her son’s second bout hit a few months after the first, requiring another round of semi-toxic antibiotics.

A third MRSA infection appeared on the inside of his elbow after another few months. By this time, Sonia says, “There was no doubt: MRSA lived inside his body. Because there was no fissure in this protected bit of skin that would have allowed an external invader to creep in. My husband squeezed five tablespoons of pus from the swollen lesions.”

Then MRSA jumped to Sonia herself. Six months after her son’s boils healed a burning spot appeared on the back of her thigh. “I could see a small spider bite, one that felt as if a torch were being held to my skin. At the doctor’s office she took her scalpel to it and started to dig. Half an hour later I staggered home in tears with a giant wad of gauze to soak up the MRSA-infested pus that poured out for days.”

A pattern emerged: An eruption of boils in random places, popping up unexpectedly, they’d last for weeks, slowly get more and more painful, and it would debilitate movement: “Like, I would get a lot on my legs so it would be hard to drive, it would be hard to bend down; sometimes it was hard to walk.”

Sonia said something else was happening too: “The lack of a clear consensus [how to stop it], the open-minded time frame, and the repellant nature of the treatment began to shake our resolve. We started to wonder: Are they making it up [as they go along]?” (My emphasis.)

In other words, MRSA, even at the level of a “skin infection,” undermines the body and the mind—even the mind of Sonia Shah, who, you would think, is as fortified as they come. Both her parents are doctors. Sonia has a BA in neuroscience. She just published, “Pandemic,” (above), her third book in 10 years about disease-causing bugs. She has given two TED Talks on the subject, and has lectured at universities across the country, including Harvard and MIT. The father of her children and the man with whom she lives is a PhD in molecular biology whose research focuses on pathogens, how they spread disease, and the implications for antibiotic resistance and treatment.

Yet their resolve and faith in medicine has been shaken. So if it would do that to them, what would it do to us? What does it do to the more than 80,000 people who are felled by a “severe” MRSA infection every year, as the Centers for Disease Control calls them?

As for the future, Sonia says, “I think we might always have MRSA. It’s not really known, and this is sort of the problem.  Whether it’s going to come back and be a problem again. If we had surgery, if we had, you know, an accident, would it spread to other parts of our body? It’s like, we really don’t know the answers to those questions. For now we’re fine, and, you know, this is the world we live in. So it’s just a risk you have to live with.”

For life.

Life is Counterintuitive

Quick – which has more bugs, a man’s shaggy beard or a man’s clean-shaven face?

A man’s beard typically has more than 100 different kinds of bacteria rummaging through it. But beards are actually less likely to harbor infection-causing and antibiotic-resistant bacteria than a clean-shaven face. In fact, not having a beard actually increases your chances threefold of having methicillin-resistant Staphylococcus aureus (MRSA) on your face, according to a recent study.

Guess which face is more likely to attract MRSA?

Guess which face is more likely to attract MRSA?

There seems to be two reasons for this. Micro-abrasions caused by shaving – tiny cuts in the skin – are thought to better support bacterial colonization and proliferation. Second, when you get a competitive environment like a beard where there are many different bacteria, they have to fight for food resources and space, so they produce their own antibiotics in order to kill off the competition – i.e., other bugs.

So how do we get these critters off of our freshly-shaved faces? We know that good hygiene is the best way to shed bugs and prevent the spread of bacterial infections, so we will want to wash our face with the new-age antibacterial soaps. After all, our grandparents used just regular soap and water and surely we’ve come a long way since then.

Well, not so fast, because studies are saying that our grandparents had it right: so ditch the antibacterial soaps and disinfectants and get back to good old-fashioned soap and water. The reason is that soap and water clean by loosening and lifting dirt, oil, and microbes from surfaces so they can be easily rinsed away with water.

Antibacterial products, on the other hand, leave surface residues – bugs. But not the usual ones. The ones left over – the survivors — constitute a small subpopulation of the original group. And they survived because they were armed with special defense mechanisms. These guys then reproduce as their weaker relatives perish, until they fill all the space previously occupied by the now dead bugs. And that’s how you end up with a face full, or a countertop full, of antibiotic-resistant bacteria like MRSA.

Scientists have identified two antibacterial agents in particular that they think select for antibiotic-resistant bacteria – triclosan and triclocaraban: so you want to stay away from any product that contains either one.

Stuart Levy, MD, of the Tufts University School of Medicine and author of The Antibiotic Paradox, sums it up this way: That antibacterial soaps and disinfectants select for bacteria that survive their onslaught illustrates yet another counterintuitive proposition: “What doesn’t kill you makes you stronger.”

 

MRSA in Motion

Ever wonder what MRSA bacteria do all day?

The traditional answer is they sit around, eat, and, especially, multiply (exponentially).

And until last month it was also thought that they remained in one spot because, well, no one had ever seen them move and, besides, they have no “legs,” the tail-like flagella that are typically used to propel bugs. Then the University of Nottingham published a study that says MRSA not only move, they move over distances that are incredibly vast compared to the size of the individual cells.
Humor - BT

Apparently they get around in large groups and leave behind a trail of MRSA bacteria as they go. Visually, it looks like a comet moving across the night sky. Interestingly, they also seem to have some ability to navigate because they are capable of avoiding other bacterial colonies. But it remains a mystery as to how they’re able to move: they don’t have flagella (tails) and no other means of propulsion were discovered.

The study has important treatment implications because pathogen movement determines how it colonizes its host – that would be us — and this in turn determines how much harm it can do. For instance, if you know your enemy is then you know where to target, but if it moves about that complicates things.

And finally, it raises this question: If MRSA can move, does that mean other bugs can as well? Because if that’s the case, it tells us we have a ways to go before we arrive at optimal treatment for infectious disease – which is both good news and bad.

Here’s a video provided by the researchers showing MRSA in motion. Warning: it’s not quite as exciting as watching a comet zip across the night sky:

Overcoming Antibiotic Resistance: We’re All In It Together

The Americans and the Brits are leading the worldwide fight against antibiotic resistance. And just today, Britain’s Chief Medical Officer, Professor Sally Davies, and her colleagues, published a 4-minute video (below) asking us to play our part in overcoming this problem. And that’s the point: WE created the problem, and WE – you and me – and not just the medical community, have to do the right thing to overcome it.

What makes this medical issue different than most is that when we misuse antibiotics we don’t just jeopardize our own health, we also jeopardize the health of others, particularly those we live with. Professor Davis explains: “When we use antibiotics when we don’t need them, or when we don’t finish the full course when we are given them, this gives bacteria in our bodies the opportunity to develop resistance to antibiotics. These bacteria that are resistant then multiply and spread so that the next time someone [else] needs an antibiotic to treat a bacterial infection, they don’t work.”

That’s why Davis’s message is aimed at parents. Because if parents get it wrong with one of their children they are also jeopardizing the health of their other children, and themselves.

The number one rule in all of this is: Please Stop Asking for Antibiotics! For instance, they don’t work for the common cold or the flu. Trust your doctor to know when you and your family will need antibiotics. You don’t need to ask for them. But if you are prescribed antibiotics make sure you finish the course – don’t save them – to make sure you kill off the infection.

A New Twist on Germ Warfare: The U.S. Government’s Pathogen Predators Program

The context is new but we’re familiar with the theory: The enemy of your enemy is your friend.

Using germs to fight germs is the idea behind the Pathogen Predators program of the US Defense Advanced Research Projects Agency (DARPA), which began last May. It’s based on the way bacteria behave in nature. As they compete for resources such as food and living space, bacteria fight a war against each other and have been doing so since their inception – 4 billion years ago. Those that survived have evolved ways of attacking other bacteria. In response, the defenders with stronger protections were favored, and the assailants, in turn, evolved even better weapons, and so on.

This digitally colorized electron micrograph shows your immune system in action: A white blood cell (blue) attacking MRSA (yellow). But when the immune system fails – the usual case with resistant germs - and antibiotics continue to loose their effectiveness - then what?

This digitally colorized electron micrograph shows your immune system in action. A white blood cell (blue) is attacking MRSA (yellow). But when the immune system fails – the usual case with resistant germs  like MRSA – and antibiotics continue to loose their effectiveness , then what?

Studying that arms race and picking and choosing what may work for us is the focus of the research. For example, Bdellovibrio bacteriovorus, is found in the soil. It attacks prey bacteria by embedding itself between the host’s inner and outer cell membranes, and begins to grow filaments and replicate. The host bacterium eventually explodes and releases more B. bacteriovorus into the environment. In another case, a team has engineered the gut bacterium Escherichia coli to produce peptides that kill Pseudomonas aeruginosa, a microbe that causes pneumonia.

But researchers warn that the enemy of your enemy isn’t always your friend. Some of these predators will attack you too, just as MRSA does. So they have to tease out which ones are toxic to us, and which pathogens (prey) the predators are effective against.

One more thing. From the perspective of bacteria, antibiotics, most of which come from the soil, are simply another front in their battle against one another. We tend to think of ourselves as Lords of the Universe, but when it comes to germ warfare we are relative newcomers dating back mere decades to the advent of the era of antibiotics in the 1940s. In other words, in this war, our ‘enemy’ has had a 4 billion year head start. So by using our know-how to harness theirs, DARPA wants to treat not just battlefield infections, but especially those that are stubbornly resistant to antibiotics – a problem that concerns all of us.

 

 

 

 

 

 

 

 

The Placebo Effect

Uh-oh: more strange news about Humans – apparently we’re very placebo-susceptible.

According to Jerome Groopman, MD, Chair of Medicine at Harvard Medical School, in his New Yorker piece, “The Most Notable Medical Findings of 2015,” (there are seven), placebos - placebos – are very real, very powerful, and, he says, may change how we think about medicine. For example, when it comes to taking an inert sugar pill – something that should have zero effect — research tells us otherwise:

Placebo effect“In most cases, the larger the pill, the stronger the placebo effect. Two pills are better than one, and brand-name pills trump generics. Capsules are generally more effective than pills, and injections produce a more pronounced effect than either. There is even evidence to suggest that the color of medicine influences the way one responds to it: colored pills are more likely to relieve pain than white pills; blue pills help people sleep better than red pills; and green capsules are the best bet when it comes to anxiety medication.”

Which may explain why 97 per cent of UK doctors admit to administering ‘impure’ placebos. These are unproven treatments including antibiotics for suspected viral infections, such as the cold or flu, on the basis that they “clearly believe that placebos can help patients.” Of course, technically speaking, there is a downside to this: the spread of antibiotic resistance which is predicted to kill more people than cancer.

But placebos don’t really help infected patients do they? Well, according to this study, the antibiotic amoxicillin is no better than a placebo for most sinus infections. Not only that, the placebo comes without side effects!

So where does this leave us? Since it’s the day before New Year’s Eve we’ll turn to a well-known home remedy – humor. The New Yorker just published “Our Fifteen Most-Read Blog Posts of 2015.” The best of the bunch may be courtesy of humorist Andy Borowitz with his little gem: “Scientists: Earth Endangered by New Strain of Fact-Resistant Humans,” best read in its (brief) entirety here.

So let’s review: we are not a fact-susceptible, placebo-resistant species. Nope. With us, it’s the other way around.

And so with that – Happy New Year!

 

 

 

“If these patients were our loved ones, would we still not … take proper precautions?”

People don’t have to die or become disabled anywhere near as much as they do. We can smoke less, exercise more, eat better, pass appropriate gun safety laws, and so on. But what’s less understood and really quite surprising is that this also applies to cancer. Doctors, apparently, know how to reduce deaths by cancer by as much as 100,000 patients a year in the U.S., yet fail to do so. That’s the point of a new book, The Death of Cancer, by Vincent DeVita, Jr, MD, who is a professor of medical oncology at the Yale School of Medicine and former head of the National Cancer Institute.

It's time to move on

It’s time to move on

Devita is “one of the critical figures in twentieth-century oncology [who] unloads a lifetime of frustration with the … closed-mindedness of his profession,” writes Malcolm Gladwell in his review of the book for The New Yorker.

That “closed-mindedness” is in part due to the “incredibly promising therapies not used to their full potential,” but DeVita’s core criticism of his profession, says Gladwell, is reserved for its inert bureaucracy that refuses to be flexible and adapt to the ever-changing world of cancer medicine.

A case in point is the downside of treatment guidelines: those protocols and standards of practice that treatment providers must follow. Devita believes that “Guidelines are backwards looking. With cancer, things change too rapidly for doctors to be able to rely on yesterday’s guidelines for long. These guidelines need to be updated frequently, and they rarely are, because this takes time and money . . . . Reliance on such standards inhibits doctors from trying something new.” All to the detriment of the patient.

It’s that very inability to try something new that betrays not only cancer patients but patients of infectious disease as well. For example, hospitals typically don’t treat someone who’s colonized by methicillin-resistant Staphylococcus aureus (MRSA), thus increasing their risk of acquiring a serious infection.

And the risk is a big one: Studies estimate that between 1 in 4 and 1 in 7 people who are colonized by MRSA go on to become infected. Once infected, you’re looking at multiple hospital admissions, infection-related complications, surgery, the need for care in an ICU, and even death. Moreover, you can give your MRSA to others.

The merits of decolonization have once again been confirmed, this time by a 4-year study published this week in the journal Antimicrobial Resistance and Infection Control. It says that with proper decolonization protocols MRSA infection rates can be drastically reduced and in some cases brought down to zero.

Given that in the U.S. alone over 11,000 people die each year from MRSA and over 80,000 more become seriously infected by it, the failure to adopt this effective preventive measure is puzzling. Whether, in the words of Dr. DeVita, this is another case of an “incredibly promising therap[y] not used to [it’s] full potential,” either because of the “closed-mindedness” of the profession or because the new measure would take “time and money” to implement, is best left for others to judge.

We do, however, have a suggestion about how to make that judgment a wise and humane one. It comes from Arlene Wilgosh, a former frontline nurse and CEO of the Winnipeg Regional Health Authority, in her address last year to a packed house at “Bug Day,” the national conference on infectious disease held annually at Winnipeg’s Health Sciences Centre. Lamenting the fact that hospitals know what to do to prevent these infections yet fail to follow through with proven protocols, she posed this question to the audience: “If these patients were our loved ones, would we still not … take proper precautions?”

With respect to another area of human concern it has been said that “The path ahead is not just about politics [and policy], it is a change of heart and mind that starts with each and every one of us.”

It seems to us that that is exactly what Ms. Wilgosh and Vincent DeVita are calling for.

And we commend them for it.

Northern Exposure: Climate Change and the Migration of Infectious Disease

Lindsay Lohan didn’t have to go to French Polynesia to catch the once tropical-only virus chikungunya (pronounced chicken-goon-ya). Florida, as of last year, would have done just fine, according to the US Centers for Disease Control and Prevention.

Chikungunya isn’t alone among northern migrants. Dengue fever has moved into Florida and south Texas; and typhus, Chagas disease, West Nile virus, Lyme disease, and others are also moving into new and newly warmer territory.

Once an Evergreen forest

Once an Evergreen forest

The explanation is straightforward enough: as the planet warms, animals and insects that carry disease are able to survive in places where they previously didn’t or can thrive longer than they were able to before.

The trend isn’t limited to “imports.” Our warming climate also enables the rise of domestic pathogens. For example, a study that looked at seasonal variation in hospital admissions found that for every 10-degree Fahrenheit rise in temperature, there was a corresponding rise in infections: MRSA rose 2.2 %, E. coli infections rose 12.2 %, Pseudomonas, a cause of bloodstream infections, rose 28.1 %, and Ancinetobacter, associated with urinary tract infections, rose by 51.8 %.

The extent of the forest destruction

The extent of the forest destruction

While the explanation for warming temperatures and disease increase may be straightforward it’s not necessarily persuasive. To really see the connection we can to turn to an analogous – and dramatic – example: the relationship between warming temperatures, the northern migration of the mountain pine beetle, and their destruction of millions of acres of forests.

The sickly-looking brownish-red trees in the picture above are Evergreens. They are supposed to be green, as their name implies. But they have fallen victim to pine beetles that used to be controlled by bitterly cold winters where temperatures used to fall to 40 degrees below zero in the mountains every few years, killing off many beetles. However, that just doesn’t happen anymore and so as the climate warms the pines of the northern and central Rockies are dying off from Arizona up to the Canadian border.

Here’s a fuller discussion of climate change and its effect on the forest and our lives:

Let’s Talk Turkey

In this era of antibiotic resistance and foodborne illness, getting Thanksgiving right means more than just deciding who to invite for dinner. These days, it means proper preparation and cooking of the turkey to prevent food poisoning. The good news is that it can be easily accomplished; but first, some background.

Outbreaks of food poisoning occur most often in November and December. Meat and poultry account for 92% of outbreaks with an identified single food source – and turkey has become one of the usual suspects.

Turkey 2For example, just last month a report came out that found MRSA in 3 out of 10 turkey farms: and 5 of 11 farmers on those 10 farms were MRSA-positive, as well as 2 of 32 family members, and 15 of 49 samples from the home residences. Worse still, is a report by CBS that dangerous bacteria were found on 90% of ground turkey.

Now for the good news: proper preparation and cooking of our Thanksgiving turkey will virtually eliminate problems with these pesky pathogens; so says the US Centers for Disease Control and Prevention, who recommend this 4-step plan:

  1. Thawing the turkey. No, not on the counter silly! Because when the turkey is left out at room temperature for more than two hours, its temperature can creep into the danger zone between 40°F and 140°F, where bacteria can grow rapidly. Ergo, thaw thy turkey in the fridge!
  2. Handling the turkey. Thoroughly wash your hands, utensils, and work surfaces to prevent the spread of bacteria to your food and family. Okay, that’s easy.
  3. Stuffing the turkey. Do it just before Use a food thermometer to make sure the stuffing’s center reaches 165°F. Bacteria can survive in stuffing that has not reached 165°F, and possibly cause food poisoning. So, remember 165°F because it will come up again!
  4. And finally – Cooking the turkey. Set the oven temperature to at least 325°. To make sure the turkey has reached a safe internal temperature of 165°F, check by using a food thermometer inserted into the center of the stuffing and the thickest portions of the breast, thigh, and wing joint.

Of course, the CDC aren’t the only ones to consult for our Thanksgiving dinner. This one seems particularly yummy:

Quiz Time!

The World Health Organization needs our help.

Here’s the issue: “The rise of antibiotic resistance is a global health crisis, and governments now recognize it as one of the greatest challenges for public health today. It is reaching dangerously high levels in all parts of the world,” says Dr. Margaret Chan, WHO Director-General, in a statement released on Monday.

Margaret Chan, MD: We need the public in on this

Margaret Chan, MD: We need the public in on this

The thing is, when we hear such statements from on high we think there isn’t anything we can do. To the contrary, says Dr. Chan: “There’s an urgent need to improve our understanding of antibiotics and how our misuse of them contributes to the rising plague of antibiotic resistance.”

In kicking off World Antibiotic Awareness Week, which runs November 16 – 22, the WHO has released its just-completed worldwide survey that identifies four areas where we, the public, need to change our behavior:

1. This is the Big One: 64% of respondents believe antibiotics can be used to treat colds and flu, despite the fact that antibiotics have no impact on viruses.

2. 43% think it is acceptable to insist that your doctor give you the same antibiotics, if you are sick and antibiotics helped you get better when you had the same symptoms before.

3. 32% of people surveyed believe they should stop taking antibiotics when they feel better, rather than completing the prescribed course of treatment.

4. 25% of respondents across the 12 countries included in the survey think it is acceptable to use antibiotics that were given to a friend or family member, as long as they were used to treat the same illness.

Now for the fun part. To help explain these issues the WHO has put together a neat little 6-question quiz. As we enter cold and flu season it makes for timely lunch time office conversation. Be sure to click on “Check your answers” to get helpful user-friendly explanations that tell you everything you need to know about using antibiotics the right way. Cheers:

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