Staph germ causes quick, deadly pneumonia

[Snowy Owl]

Staph germ causes quick, deadly pneumonia
Drug-resistant infection can kill in 72 hours, researchers say

http://www.msnbc.msn.com/id/16691062/

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WASHINGTON - A nasty staph germ circulating in the community and some hospitals produces a poison that can kill pneumonia patients within 72 hours, researchers said Thursday.

Staphylococcus aureus bacteria ? Staph for short ? can pass one another the gene for the toxin and are apparently swapping it more often, the researchers report in Friday?s issue of the journal Science.

The toxin, called Panton Valentine leukocidin or PVL, can itself cause pneumonia and can kill healthy tissue.

Luckily, people infected with the bacteria quickly develop a high fever and astute doctors can identify it, said Gabriela Bowden of the Texas A&M Health Science Center in Houston, who led the study.

?This is a scary situation. We are trying to put the word out and to educate people about it,? Bowden said in a telephone interview.

S. aureus is the most common cause of hospital-acquired infections, and can cause inflammation of the heart, toxic-shock syndrome and meningitis.

A new strain resists the antibiotic methicillin, but it can be treated with other antibiotics like doxycycline and vancomycin.

Methicillin-resistant Staph broke out in a British hospital in December and killed two patients with a new type of pneumonia called necrotizing pneumonia. This infection destroys lung tissue and also kills some of the immune system cells sent to battle it.

?The pneumonia itself is very severe,? Bowden said. ?There is massive inflammation and there is fluid in the lungs and there is damage to the tissue. It can progress very quickly and in 72 hours the patient can be in a severe condition, or it can even be lethal in 72 hours.?

The bacteria, which commonly live on the skin anyway and cause pimples, boils and other minor infections, can cause a serious wound if the toxin-producing strains get into a cut.

Wash your hands
Old-fashioned hygiene is the best line of defense, Bowden said.
?This is a community-associated strain, which means that in schools, the kids can carry it. Anybody can be colonized with it,? she said.

?I tell my kids if you scrape your knee, go to the bathroom immediately and wash it with soap.? Hospitals must impose strict hygiene to control it.

Any skin infection that appears to become serious quickly requires immediate attention, Bowden said. The strain is common in Houston, where she works, and researchers in Europe are also concerned about its spread.

Bowden?s team tested the PVL-producing Staph on mice and found that two days after infection, their lungs were filled with immune cells and lung tissue was starting to bleed and die.

A stretch of DNA known as a cassette carries the code for the PVL toxin. Such a little segment is easily passed from one strain of bacteria to another, said Bowden, and viruses called bacteriophages can also carry them.

Understanding how this happens could provide a way to develop new drugs or vaccines and shed light on how bacteria acquire new and dangerous qualities.

Because bacteria swap genetic material so easily, the risk that this toxin could spread is real, Bowden said.

Penicillin once cured Staph infection but the bacteria quickly developed resistance. The U.S. Centers for Disease Control and Prevention says that in 1972, only 2 percent of Staphylococcus aureus bacteria infections were drug-resistant, but by 2004, 63 percent were.

Some companies are working on staph vaccines but none is on the market.

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</TD></TR><TR vAlign=top><TD class=boxBI_3088867>? Deadly staph infection warning
Jan. 18: A deadly staph germ has the medical community issuing a health warning. NYU Medical Center?s Dr. Marc Siegel talks to MSNBC-TV?s Alex Witt about the warning.
MSNBC
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[Jonesie]

Re: Staph germ causes quick, deadly pneumonia

JUST A REMINDER:

http://www.upmc-cbn.org/report_archive/2006/09_September_2006/cbnreport_090106.html

CBN Report: Antibiotics to Treat Pneumonia: An Overlooked Essential Element of Pandemic Preparedness


By Eric Toner, M.D., September 1, 2006


In a review article in the May issue of Lancet Infectious Disease[1], John Brundage, M.D. examines the relationship between influenza and bacterial suprainfections in past pandemics. He points out that the evidence available from the pandemics of 1918, 1957 and 1968 suggests that the majority of fatal cases of pneumonia in all three pandemics were associated with positive bacterial cultures, most commonly with pneumococcus, S. aureus, S. pyogenes, and H. influenzae. While there were cases that appeared to be purely viral pneumonia, based on clinical features and negative bacterial cultures, these cases were a minority.


While much has been made of the fulminant cases of presumed viral pneumonia in 1918, Dr. Brundage?s research indicates that the majority of pneumonia cases, even in 1918, were either secondary bacterial pneumonias following an influenza infection or mixed viral and bacterial pneumonias. In the pre-antibiotic era, these cases of bacterial pneumonia carried a very high mortality rate; however, with appropriate antibiotic therapy, many such patients may be saved.

Today, much of pandemic preparedness is focused on H5N1. Of the 240 human cases so far, almost all have had pneumonia, and there have been no reported cases of known bacterial suprainfection. However, in the clinical setting many, if not most, of the patients have been treated empirically with antibiotics since it is difficult to rule out the possibility of bacterial involvement. This same clinical dilemma will be faced by clinicians during the next pandemic. Therefore, it seems likely that most influenza patients sick enough to seek medical care, particularly if they require hospitalization, will be administered antibiotics.


The HHS Pandemic Influenza Plan assumes that 45 million Americans will seek medical care for influenza in a severe pandemic, and that 10 million of these will require inpatient care [2]. Assuming that most of these people receive a course of antibiotics, there will be a large surge in demand for antibiotics over and above what is needed for other indications. For comparison, there are typically 4 million cases of community acquired pneumonia in the U.S. each year and about 1 million hospital admissions for pneumonia [3]. Thus, there is a potential 10-fold surge in demand for antibiotics to cover pneumonia in a relatively compressed timeframe.

For a variety of reasons, U.S. hospitals have experienced frequent shortages of common antibiotics in recent years [4]. And due to the adoption of just-in-time supply chains, many hospitals maintain a stock of only a few days? worth of antibiotics (this is particularly true of parenteral forms typically be used for inpatients). Thus, it is likely that shortages of common antibiotics will occur during an influenza pandemic.


While much preparedness effort has focused on the availability of antivirals and vaccines, there has been little discussion of the need to assure a ready surge supply of antibiotics. For outpatient management, the Strategic National Stockpile of 40 million 60-day courses of antibiotics for anthrax prophylaxis is a resource that could be tapped if needed[5]. The ciprofloxacin and doxycycline that make up most of the stockpile are reasonable choices for the outpatient treatment of most adults with community acquired pneumonia. However, this writer has been unable to substantiate the existence of either stockpiles of parenteral antibiotics or surge manufacturing capacity adequate to deliver the volume of parenteral antibiotics that will be needed to treat the numbers of patients likely to be hospitalized during a severe influenza pandemic.


Dr. Brundage?s research suggests that the extraordinary mortality associated with 1918 pandemic could be significantly reduced by the administration of antibiotics if a similar outbreak were to occur today. This assumes that the antibiotics are available. Pandemic planners at all levels--institutional, local, state and federal--should work to ensure that there will be sufficient amounts of the appropriate antibiotics available when the next pandemic occurs.


--------------------------------------------------------------------------------

References

[1] Brundage JF. Interactions between influenza and bacterial respiratory pathogens: implications for pandemic preparedness. Lancet Infect Dis 2006;6:303-12

[2] HHS pandemic planning assumptions. Available at http://www.pandemicflu.gov/plan/pandplan.html, accessed on August 30, 2006

[3] Reuters Health- Pneumonia, June, 2001. Available at http://www.reutershealth.com/wellconnected/doc64.html, accessed August 30, 2006

[4] FDA Drug Shortage list. Available at http://www.fda.gov/cder/drug/shortages/, accessed August 30, 2006

[5] Testimony of Gerald W. Parker, DVM, Ph.D., MS Principal Deputy to the Assistant Secretary, Office of Public Health Emergency Preparedness, U.S. Department of Health and Human Services, Before the Committee on Government Reform, Subcommittee on National Security, Emerging Threats, and International Relations, United States House of Representatives, May 9, 2006. Available at http://www.hhs.gov/asl/testify/t060509a.html, accessed August 30, 2006