Dealing with a stronger germ

Hospitals noticed it first. Then cases started appearing in nursing homes, in jails and among athletes who shared locker rooms.

Now the infection is becoming more and more common in other settings.

It is a dangerous form of staphylococcus that resists treatment with common antibiotics. And it can kill. In August the germ took the life of 4-year-old Ethan Patrick Williams of rural Perry County.

Williams died Aug. 25 at Cardinal Glennon Children's Hospital in St. Louis. Doctors fought to save the boy's life, but the infection had spread to his lungs, and powerful antibiotics did not work.

Ethan's mother, Emily Altom, 25, and stepfather, Michael Altom, 25, are charged with voluntary manslaughter and three counts of felony child endangerment. The manslaughter charge is based on allegations they did not seek medical care promptly for their son.

The child endangerment charges stem from the unsanitary conditions described by law enforcement and state child welfare workers in the trailer occupied by the Altoms, Ethan and his two brothers.

Sanitation can play a big role in developing staph infections, experts say. Poor sanitation allows staph, whether resistant to antibiotics or not, to spread.

"The issue of cleanliness always crops up," said University of Missouri infectious disease specialist Dr. Gordon Christensen. "It would seem natural that a person who is not clean or does not live in a clean setting is more likely to pick that up. But proving it is very difficult. People who are clean come down with this problem, too."

Bacteria all around

Staph germs are all around. A small boil on the skin is probably a staph infection. So is the tiny inflammation around a hair follicle. Or a bad pimple.

"Staph is a bacteria that is very common," said Nicole Coffin, a spokeswoman for the federal Centers for Disease Control and Prevention in Atlanta. "A third of us have it in our nose."

When staph gets into the bloodstream, it begins to cause big problems. It can lodge in soft tissue around muscles, causing a flesh-eating infection. Or it can spread to the heart, causing endocarditis or a destruction of the heart valves. In severe cases, it spreads to the lungs, creating abscesses that are almost impossible to treat and causing a severe case of pneumonia.

The germ spreads by close personal contact.

"These cases get passed on from person to person," Christensen said. "People can carry this without any apparent illness. Why that occurs, we don't know."

Infections are opportunistic, and bacteria gain entry through breaks in the skin. The breaks occur either by accident, such as a child falling off a bicycle, or on purpose, such as through the tiny abrasions caused by shaving.

The first sign is redness around the wound, Coffin said. "If your child falls down and gets a scrape and you notice an infection, go to the doctor."

Infections can be easily prevented, Coffin said. Whenever a child gets a scrape, it is essential to wash the wound. "Soap and water is adequate," she said. "Soap is releasing the germs and the water is washing them away."

Staph infections are so common, in fact, that health agencies such as the Missouri Department of Health don't even count them statistically. But the resistant type, called methicillin-resistant Staphylococcus aureus, or MRSA, in medical journals, is starting to scare enough people that steps are being taken to monitor the disease.

The disease gets its name because it is resistant to antibiotics that are related to penicillin. The antibiotic properties of the fungus that produces penicillin were first noticed in 1928 when the fungus infected -- and killed -- a laboratory culture of staph germs.

'A common organism'

The Missouri Legislature last year mandated the collection of data on resistant staph infections in hospitals. The agency is just beginning to do so, said Eddie Hedrick, the emerging infections coordinator for the Missouri Department of Health.

"One of the reasons we don't keep statistics on staph is that it is a common organism," Hedrick said. "There is not a lot we as public health officials can do about it."

Medical journal articles and media reports about MRSA in community settings are becoming more common. The St. Louis County Jail had treated 59 staph infections -- many caused by MRSA -- as of late September, the St. Louis Post-Dispatch reported. That compares to 23 cases in all of 2004.

In Grayson County, Texas, an outbreak among school athletes led to media reports and a major effort to sanitize showers in locker rooms and educate students on the way the germ spreads.

Deaths among children are the subject of numerous medical journal reports. The journal case studies describe children who, much like Ethan Williams, developed pneumonia, toxic shock and high fevers.

The New England Journal of Medicine reported in September on three cases of pediatric death in Chicago between 2000 and 2004. Morbidity and Mortality Weekly reported on the deaths of four children from North Dakota and Minnesota in 1999.

And the Journal of the American Medical Association in 1998 described an increase in infections from MRSA in children treated at the University of Chicago.

"We have learned that this is a bacteria that we believe is now pretty widespread," Coffin said.

The increasing incidence of MRSA and other resistant bacterial strains led the CDC in 1995 to launch a campaign to educate the public about appropriate use of antibiotics. The campaign includes efforts at medical schools so new doctors understand the need for judicious use of antibiotics. The public portion of the campaign is designed to inform the public that some diseases, such as the cold and flu, cannot be controlled with antibiotics.

The strains of MRSA found outside hospital settings can, in most cases, be treated with newer antibiotics. "Early treatment, if you have an infection, makes a huge difference," Christensen said.

Medical journal reports and media reports make it clear that the resistant strain can crop up anywhere. Precautions are the best defense, Christensen said.

"The organism that is spreading or present in the community is very aggressive," Christensen said. "It is a true pathogen. It has the ability to attack healthy individuals. I have seen young men and young women who develop overwhelming staphococcal pneumonia."

rkeller@semissourian.com

335-6611, extension 126