By: Christopher McDougall, Men's Health
If it weren't so real, so tragic, and such a Critical wake-up call, it could be a sick joke: Ricky Lannetti, 21 years old and tough as a truck tire, was killed by a pimple on his butt.
He'd noticed the little welt last fall, when he was dressing for football practice at Lycoming College in Williamsport, Pennsylvania. It was right under the back strap of his jock and getting a little raw, but he sure as hell wasn't going to ask the trainers to look at a pimple, not while other guys were waiting to have real injuries wrapped and taped.
Besides, apart from that, he felt great. As a senior and a starting wide receiver for Lycoming, Lannetti was having the best season of his life: He set a school record with 16 catches in a game, then the following week broke the record for catches in a season. The next Saturday, he snagged five balls as the Warriors won in overtime to advance in the playoffs. The next Saturday, he was dead.
What was found in Lannetti's blood was a "superbug," an especially aggressive type of bacterial infection called MRSA. Until recently, few family doctors had ever seen methicillin-resistant Staphylococcus aureus, and even fewer people had died of it. But over the past year, it has spread so quickly--and mutated into such frighteningly powerful strains--that even paramedics now know it by its phonetic nickname: "Mersa."
"Two years ago, it was completely unheard of," says Greg Moran, M.D., an infectious-disease specialist at the UCLA school of medicine. His E.R. has seen an "amazing" increase in MRSA cases. "Of the people who come in with skin infections, 64 percent have MRSA," he says. "It's remarkable how fast it's become one of the most common things we see."
Recent estimates by the Centers for Disease Control and Prevention (CDC) place the number of people hospitalized with communiyt-acquired MRSA annually at approximately 130,000. "The majority of the infected seem to be men," says Dr. Moran, "although no one knows why. It's such a new thing, there's not a whole lot of published information out there." So little is known about this sudden surge in MRSA cases that Dr. Moran is leading a nationwide study of skin infections seen in emergency rooms. Until then, he says, "we're learning on the fly."
Just 10 years ago, chronically ill patients in hospital settings accounted for most MRSA infections. Kidney-dialysis patients, burn victims, and HIV-AIDS sufferers were among the high-risk groups, because their immune systems were weak and they took such heavy doses of strong antibiotics that their bodies became veritable petri dishes for the growth of superbugs. And even if they weren't growing their own germs, these patients often had bedsores that allowed bacteria to worm their way in.
But now, MRSA is turning up most among the people who'd least expect to get it: young, healthy men who are often in very good shape. Last year, several members of the Miami Dolphins, including star linebacker Junior Seau and kickoff-return ace Charlie Rogers, were infected with MRSA. Seau and Rogers had to be hospitalized, as did Tampa Bay Buccaneer Kenyatta Walker and the Cleveland Browns' Ben Taylor, who needed an emergency operation to beat the infection.
It's not just pro athletes who've been hit: Five members of a fencing team in Colorado were also stricken, as were two high-school wrestlers in Indiana, 10 college football players in Pennsylvania, and two more in California. Although no quantitative studies have broken down the MRSA outbreak by gender, the CDC has found that the majority of new infections are among young men who share some kind of skin-to-skin contact, such as through sports. Outbreaks have also been reported among military recruits (235 cases were diagnosed at one basic-training site in the South), gay men, police cadets, and prisoners. All those men recovered, but many needed hospitalization and heavy antibiotics.
"You don't even need direct contact to become infected," points out Barry Kreiswirth, Ph.D., the director of the Public Health Research Institute Tuberculosis Center. "Staph has been spread in locker rooms by towel snapping. If he's got turf burn on his leg and you've got the bacteria on the towel, he can become infected."
And the more MRSA spreads, the more aggressive it seems to become. Not long ago, a person infected with staph would show up in a doctor's office with nothing worse than an abscess. But by 1999, MRSA had killed four otherwise healthy children in North Dakota and Minnesota. By December 2003, it was strong enough to kill Ricky Lannetti.
"He called Tuesday and said he was throwing up, but it wasn't that bad," recalls Ricky's mother, Theresa Lannetti, who looks like a grown-up cheerleader with her gentle smile and gymnast-lithe appearance. First thing the next morning, Ricky dragged himself to the school clinic. "Just a stomach bug," the nurse said, and sent Ricky back to his dorm. On Thursday, Theresa called the football trainer to check on her son, which led to a visit to a local doctor for blood work. But Theresa didn't wait for the results: When she heard Ricky was still feverish on Friday, she drove 5 hours through a blizzard to reach him. The Lannettis are as tough as they come--after raising three kids on a secretary's salary, Theresa joined the Philadelphia Police Academy at age 39--so she knew if her son was hurting this badly, it wasn't a touch of the flu.
When she arrived at Ricky's dorm, she was shocked. Ricky was deathly pale, and so weak his roommate had to carry him downstairs. He had a raging thirst and kept gulping Gatorade, even though he hadn't urinated in days.
By the time they got to Williamsport Hospital, Ricky was vomiting blood. Every specialist in the hospital crowded into his room, but they were all mystified: They were looking at a muscular young man with zero medical history whose body was acting like that of an ailing geriatric. The doctors tried one antibiotic, then another, and another, until Ricky had five in his system, but he was still burning with fever and passing blood through his catheter. The hospital called for a medevac chopper to fly him to an infectious-disease unit in Philadelphia, but just that fast, it was too late: Within hours, Ricky's vital functions were shutting down. His kidneys went, then his liver, and when surgeons tried to keep his heart beating with a catheter, they lost him.
"I couldn't believe this was happening," says Theresa. She'd just seen Ricky slamming his 5'9", 170-pound body all over the field a few days before, and now he was lying dead on a gurney and no one could explain how it had happened. A few days later, however, the coroner discovered two things: Ricky had MRSA in his blood and a tiny red welt on his buttocks. "He told me the infection must have spread from that little pimple," Theresa says.
"We're seeing more people who've been infected with abscesses on their buttocks, and the truth is, we don't know why," says Kreiswirth. It might be because a larger, fleshier area is more vulnerable to soft-tissue sores, or because the buttocks tend to be more damp with sweat and less exposed to air, but that's just speculation. "Until we understand more about how this staph operates," says Kreiswirth, "we won't know why it seems to favor certain parts of the body . . . or why one person will get a boil, and another will die."
Until MRSA came along, the game plan of Staphylococcus aureus was pretty simple: If four guys play two-on-two hoops, statistically one of them will be a staph carrier, since more than 30 percent of all humans have the bacteria in their noses at any time. You could be a carrier your entire life, though, and never know it: For staph to become a problem, you'd have to be carrying a strain that's strong enough to cause infection and have it come in contact with a break in someone's skin. Ironically, that skin could be your own--a carrier can infect himself, by wiping his nose and then touching an open cut.
"What's new is that some of the strains carry a toxin that destroys white blood cells," says Frank Lowy, M.D., a professor of medicine at Columbia University school of medicine who is studying staph colonization. "If you get staph under your skin, a white blood cell eats the bug, and that's the end of it. But this bug easily kills the white blood cell, which attracts more white blood cells. Eventually, a pus pocket builds up, allowing the bacteria to survive."
Like most of its contagious cousins, MRSA also has three great loves: humidity, skin cuts, and a weakened immune system. The opportunity for infection increases dramatically when these factors come together, perfect-storm-style, as they do in a gym. Locker rooms are damp and steamy, that game of two-on-two can lead to cut lips and scraped knees, and an exhausting workout temporarily lowers the body's resistance. Add to that workout gear that may not have been washed in days and you have the bacterial version of the Playboy grotto.
"If you're active and do anything that would traumatize the skin, you're potentially at risk," says David Gilbert, M.D., a past president of the Infectious Diseases Society of America (IDSA). "I've had professionals, lawyers, doctors, who have all gotten boils from this strain." Fortunately, none died, but they all required stronger antibiotics than Dr. Gilbert is comfortable giving--not because of what they'll do to the patients but because of what they're doing to the bacteria. That's the catch-22: Powerful antibiotics are needed to kill MRSA, but using them will eventually create an even more lethal version of the bug.
"It's natural selection at work," says Dr. Lowy. "There will always be mutant bacteria the antibiotic can't kill, and these may develop into a more virulent strain." And unfortunately, as antibiotics have become more prevalent--not just in doctors' offices but also in our food supply--we've sped up this evolution. For example, methicillin is the big-gun antibiotic that came after penicillin, but its current effectiveness is summarized in MRSA's name: methicillin-resistant.
We still might be holding staph infections in check if pharmaceutical companies hadn't shifted their R&D focus; instead of constantly trying to concoct updated antibiotics, says Dr. Gilbert, they turned more of their attention toward erectile dysfunction, hypertension, and heart disease. The IDSA reports that, as of 2002, "Bristol-Myers Squibb Company, Abbott Laboratories, Eli Lilly and Company, and Wyeth all halted or substantially reduced their anti-infective discovery efforts." Over the past 30 years, in fact, only three new classes of antibiotics have been developed, and resistance to one emerged before the FDA had approved it.
Nevertheless, it's hard to fault the drug companies, Dr. Gilbert says. "Why spend a billion dollars on a drug that a patient will take for only 2 weeks, when you can spend the same money on a product he'll take for the rest of his life?" On top of that, antibiotics can quickly become obsolete. Pfizer could take 10 years to get an anti- biotic developed and approved, only to see it become defunct in 2. It's doubtful the penis will ever become resistant to Viagra.
Right now, the "drug of last resort" in MRSA cases is Vancomycin. Already, there have been three cases of Vancomycin-resistant MRSA. "That's very troubling," says Dr. Lowy. "The genetic information for this resistance can be transferred from one strain to another. And if that happens, we're facing a potential crisis over the next 5 years." There are other antibiotics, but they're not always available and can't beat all infections, warns Dr. Lowy. "Vancomycin is our workhorse, but it doesn't have the legs for a long race."
On a sweltering July afternoon 7 months after Ricky Lannetti's death, one of his buddies from high school, 20-year-old Derek Talley, was preparing to take a postworkout soak in a kiddie pool behind his Philadelphia home when he saw a sore spot on his right thumb. "Must've gotten stung by something," Talley figured. He ignored it. But over the next few days, his entire hand began to swell. He went to the hospital, where they gave him Benadryl and sent him home.
That night, his hand ached so badly, he couldn't sleep. He returned to the E.R., and this time he was admitted and put on antibiotics. The next morning, his infection was even worse. The doctors then made a long Z incision in Talley's hand to drain the abscess, and put him on stronger antibiotics. "That should take care of it," he was told.
It didn't. By his second morning in the hospital, the infection had spread further. His doctors were getting worried, so they ordered a more extensive round of blood work. When they received the results, they sat down to brief Talley. "Have you ever heard of MRSA?" they asked. He nearly fell off the bed. "Yeah," he responded. "It killed my buddy."
He was immediately started on Vancomycin, every 12 hours around the clock, two IV bags a day. Because the infection was in his hand, the doctors told him, it was especially dangerous, since it had nowhere to travel but straight up toward his heart. Talley remembered something Ricky's mother had told him: "If Ricky could have made it through that first day in the hospital, he would have been okay."
So when Talley woke the next morning, he felt he was already winning. He checked his hand; for the first time in a week, it was back to normal size. For him, the Vancomycin worked. He would still need extensive physical therapy; a month after his touch-and-go week in the hospital, he had recovered only 75 percent of his hand function.
Surprisingly, the greatest source of hope in the fight against MRSA may come from the most common defense: soap and water. By making sure to wash their hands thoroughly and by keeping all cuts well disinfected and bandaged, most people can avoid spreading or contracting MRSA. "It's not going away," Dr. Lowy says, "but we have a chance of slowing it until new antibiotics, or even a vaccine, are created."
The NFL has begun sponsoring hygiene workshops for players and is encouraging trainers to disinfect hot tubs and showers regularly, according to Steve Antonopolus, ATC, head of the NFL's Trainers' Association. "There's a potential for MRSA to be everywhere in the locker room," he says. "Around trash cans, in cleats--everywhere."
Meanwhile, the IDSA has been lobbying Congress to treat MRSA like a terrorist threat. It proposes a "10 Most Wanted" list of bacterial infections, so that any drug company that goes after one would be rewarded with a "bounty" of tax breaks and extended patents. One Florida company, Nabi Biopharmaceuticals, is already in phase three of clinical trials of a staph vaccine, which would immunize recipients. A request for FDA approval is expected by the end of 2005.
"At this point, we project it for use only among high-risk candidates, like kidney patients," says Nabi spokesman Mark Soufleris. "But potentially, it could be used for millions of people." Best of all, Soufleris points out, it could take a tremendously long time before MRSA develops resistance to the vaccine. "Antibiotics attack the bacteria at one point of entry, but our vaccine creates antibodies that attack at multiple points."
Dr. Gilbert likes what he's heard about the Nabi vaccine. "Won't that be great, to get a shot and never worry about staph again?" he says. Till then, he urges, do what your mom always told you: "Change your clothes, wash your hands, and no roughhousing."
