Julie was proud and excited about her new tattoo; it was cool! Jason, her boyfri
ID: 141199 • Letter: J
Question
Julie was proud and excited about her new tattoo; it was cool! Jason, her boyfriend, had bought it as a gift for her 18th birthday, and she loved the way it covered her arm. A week later something else covered her arm … and his leg. Julie and Jason had fallen victim to an emerging disease—community-associated, methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. Julie’s arm was covered with red, swollen, painful, pus-containing lesions, and she had a fever. Jason thought he had a spider bite on Wednesday, but by Thursday morning a bright red line extended from his ankle to his groin. He could barely walk, and then his condition worsened. By the weekend, he was hospitalized, and his fever hit 107°F107°F during his 10 days there. MRSA had entered his blood (bacteremia) and infected his bones (osteomyelitis). Jason’s pain was so severe that he wondered only when he might die to be free of the agony. Click for more options Click for more options For years, health care workers have battled healthcare-associated MRSA (HA-MRSA), which commonly afflicts patients in hospitals. Now, researchers are concerned that victims who have never been in a hospital are succumbing; MRSA has escaped hospitals and travels communities worldwide, including among athletes, students in middle schools, and customers of unsafe tattooists. The bacterium can be spread between individuals who share fomites—towels, razors, clothing, or sheets. Physicians drained Julie’s lesions and prescribed oral antimicrobials, including trimethoprim-sulfamethoxazole, doxycycline, and clindamycin. Jason received intravenous vancomycin. Both eventually recovered, but her tattoo is now a reminder of a terrible experience and not a happy birthday. (For more about staphylococcal infections, see Chapter 19.) 1. How were Julie and then Jason likely infected? 2. Why is CA-MRSA considered an “emerging disease,” given that MRSA has been around for years? 3. Why doesn’t the map show more countries in Africa and South America with cases of CA-MRSA?
Explanation / Answer
1)Julie and Jason were likely infected because of tattoo .
Staphylococcus aureus is known to be a common infectious agent particularly of wound infections. MRSA is a staph aureus with a special resistance to antibiotics that are usually effective (e.g. oxacillin or cephalosporin). Therapeutic measures are therefore considerably limited in case of an MRSA infection. Regularly sensible staph aureus strains (MSSA) occur rather often in the population as colonizers of the skin and mucous membranes; MRSA, on the other hand, only very rarely so.
In case of colonization, wounds can get contaminated and infected by a so-called smear infection. It is particularly possible to pass on staph aureus via contaminated instruments. If the tattooer also carries staph aureus, they can pass it on to their customers directly or indirectly as well by improper work practices.
2)The incidence of disease caused by MRSA bacteria is increasing worldwide. Thirty years ago, MRSA accounted for 2 percent of staph infections. By 2003, 64 percent of staph infections were caused by MRSA. According to a report by the Centers for Disease Control and Prevention (CDC) in the United States in 2005, more 94,000 people developed life-threatening infections caused by MRSA; nearly 19,000 people died during hospital stays related to these MRSA infections. The majority of MRSA cases, 85 percent, were associated with healthcare facilities, while approximately 14 percent occurred in individuals with no known exposure to healthcare.
The staph bacterium continues to evolve and is beginning to show resistance to additional antibiotics. In 2002 the first staph strains were found that are resistant to vancomycin, an antibiotic that is one of the few available treatments used as a last resort against MRSA. Although vancomycin-resistant staph strains are currently still quite rare, it is feared that these strains will become more widespread over time and further reduce the limited number of antibiotics that are effective against MRSA.
The rising problem of resistance of staph bacteria to methicillin and other antibiotics is part of a larger issue that greatly concerns healthcare professionals. The emergence of antimicrobial-resistant organisms is making it more difficult to treat a variety of infectious diseases. Besides MRSA, the treatment of other diseases complicated by drug resistance include HIV, tuberculosis, influenza, and malaria.
3)The prevalence of MRSA is much lower in most African countries and South America.The significant change in antibiotic susceptibility compared to what has previously been reported in our hospital is most likely a consequence of the transition to an automated platform rather than a trend towards lower resistance rates.in South Africa, the prevalence of MRSA decreased from 36% in 2006 to 24% during 2007–2011, probably due to the implementation of effective infection control policies.
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