Doctors: MRSA, Staph Cases on Rise

By JOE SIMON and BRENDA J. LINERT / Tribune Chronicle
POSTED: May 31, 2009

The scary thoughts racing through the mind of Youngstown State University wide receiver Ferlando Williams when he discovered he had a staph infection wouldn't have been nearly as frightening 15 or 20 years ago.

That's because the development or ''mutation,'' as Dr. Anthony Cutrona of Youngstown called it, of staphylococcus has been quite extraordinary.

The bacteria has been affecting people, especially athletes, since before antibiotics were around. Cutrona said staph has caused pimples and many other common skin infections for years, yet its consequences become fierce when an open wound forms because it then invades the blood stream.

The severity of such an infection has become much more destructive over the years. As doctors have developed antibiotics to combat the effects of staph, innovative strains of the bacteria have evolved and become resistant to the medicines.

''Initially, in the early '50s, staph was sensitive to penicillin,'' said Cutrona, the chief infectious disease doctor at St. Elizabeth Health Center, Youngstown. ''Then in the '60s it became resistant to penicillin and we derived a synthetic penicillin that it was sensitive to. Then in the '70s it became resistant to that, and we named that type of staph MRSA.''

This new, more complex type of staph known as MRSA (methicillin-resistant Staphylococcus aureus) was mainly found in hospitals, Cutrona said. MRSA has the same effects as a regular staph infection, but it is more difficult to kill because of its resistance to medicines.

Staph continued to fend off the different antibiotics and advanced into yet another form around 1992, called USA300.

''It was a little different than the (MRSA) we see in the hospitals,'' Cutrona said. ''It had this virulent (poisonous) potential. It could invade and destroy tissue. Initially it started out in pediatric cases. Kids that developed pneumonia with MRSA ... it killed them. Then we saw outbreaks in different places. We saw it in prisons, we saw it in daycare centers, schools, locker-room facilities. And usually, this particular USA300, that was MRSA but from the community (not hospitals), when it started out, people thought they had insect bites.''

Instead, though, these small, reddish bumps sprouting near cuts and scrapes were the early signs of a vicious bacteria. From 1990 through 2000, this USA300 strand was very rare, Cutrona said. Yet since the turn of the century, it has become much more prevalent. Cutrona said he saw it ''two or three times a month'' at one point. The dangerous part of this strain is what happens if not treated.

In November, YSU's Williams had noticed a pimple-like bump on his left elbow but mistakenly believed it was just an insect bite.

Looking back, Williams now realizes how close he came to losing a limb, or worse.

''That was one of toughest times of my life,'' he said. ''Another day or so and that would have been it for me.''

Threats as serious as Williams' are not all that uncommon among athletes. That wasn't the case years ago when staph was just as prevalent but not as lethal.

Dr. Blaise Congeni, director of Pediatric Infectious Diseases at Akron Children's Hospital, agrees that the increase in the number of cases has been significant.

''We see a lot of athletes. There undoubtedly is a substantial increase in athletes - and non-athletes,'' Congeni said recently.

''What I can tell you, which is probably substantially more important in my mind, is a substantial number of humans carry staph on their skin or nose. Over 50 percent of the strains are of the MRSA variety. So we know that is increasing. Prior to 2003, it was zero. The strain we are talking about may have arrived on the scene about 2000. Before that, nobody was carrying MRSA of the community acquired variety,'' Congeni said.

Cutrona echoed that.

''We've always had staph around, it's just that this particular strain, this USA300, is loaded with a packet of enzymes called PVL (Panton-Valentine leukocidin), and it destroys tissue, it destroys white blood cells,'' Cutrona said. ''The outbreaks in the area have been notably seen, for example, in high school sport activity areas.''

The reason cases have been seen at area schools is mainly due to poor hygiene and not washing clothes, Cutrona said. When athletes perform in the same jerseys and undershirts on a daily basis, the bacteria is more likely to be picked up because of the damp and unclean conditions areas where staph forms. If an athlete then suffers a cut or abrasion, doesn't shower after practice and ignores signs of an infection, the bacteria can enter the bloodstream.

''You even see it in professional sports teams the Cleveland Browns had an episode of it,'' Cutrona said. ''It has to do with personal hygiene and locker-room hygiene. You'll get outbreaks because, if you think about it, a lot of guys who are athletes or jocks, they don't always follow the most hygenic lifestyle.''

Congeni agreed that hygiene and good skin care are the keys to avoiding staph.

''No. 1, we recommend that you try to keep the skin as intact as possible,'' Congeni said. ''As smooth as silk.''