An important post by Maryn Mckenna at Superbug, excerpt :
" The latest postings to the website of the CDC journal Emerging Infectious Diseases include a sad and very troubling letter from physicians in Lyon and Paris, reporting the death from necrotizing pneumonia of a previously healthy 14-year-old girl. That would be sad under any conditions, but here's what makes the death so troubling: It appears to have been caused by MRSA — but not by the community strain, USA300, that has been implicated in a number of deaths from necrotizing pneumonia.
Instead, her death appears to have been caused by infection with MRSA ST398 — the livestock-associated strain that was first noted in pigs raised with antibiotics, and the pig-farm workers caring for them, in the Netherlands 6 years ago, and that has since spread across the European Union, Canada and into the United States.
This may be the first death associated with ST398, though I can't say that for sure as I am away from my big computer and working without my database. I'll update later today and confirm or knock that down.
The physicians say that the girl came in with flu-like symptoms and abdominal pain, was put on IV antibiotics (cefotaxime and amikacin), underwent an exploratory laparotomy that showed nothing, and shortly afterward developed acute respiratory distress and was put on a vent. A chest X-ray was shadowy on both sides. She went rapidly downhill and died 6 days later.
On analysis, the staph strain infecting her was ST398; there was no indication where she had picked it up. The strain had an unusual characteristic: It possessed the ability to make the cell-destroying toxin Panton-Valentine leukocidin, PVL for short, a genetic trick that until now has been a property only of community MRSA strains such as USA300. Though its role is disputed, PVL has been linked to community MRSA's ability to start infections on intact skin, and to the cellular damage that destroys children's lungs in cases of pneumonia caused by USA300. Until now, ST398 has been PVL-negative."
This is a regrettable event, but it should be noted that this ST398 was not MRSA, but MSSA, and was susceptible to all antibiotics tested except macrolides. Furthermore, the t571 subtype isolated is relatively uncommon in pigs in Europe, but was found to be common among two communities originating from the Dominican Republic (in Manhattan, NY and in the Dominican Republic). It is therefore established that ST398 strains are not limited to pigs, nor to livestock and the source of this infection is not yet known
ReplyDeleteMr. Davies, I appreciate and value your insightful thoughts on this. Thank you!
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