The first time I saw the Flesh eating Staph, it was one of our teachers.

She was a diabetic, and had developed a foot infection, a small foot ulcer with some redness. Luckily, this was Indian Health Service, so we could hospitalize her for treatment, not an HMO that would have required her to drive 40 miles each way daily to the hospital for IV antibiotics in a busy emergency room.

So we admitted her from our Diabetic Clinic that morning; but at 3 pm the nursing staff called the doctor on call. Her small cellulitis (small wound with red streaks starting to go up the leg) had changed into massive redness and swelling up to her knee. We immediately got the helicopter and transferred her to the University 300 miles awy while giving every antibiotic we could think of to try to stop this aggressive infection.

At the University, she almost died, but several weeks later she came back to us with only a few toes off, but a huge skin defect of her leg that had to be skin grafted over and over again, and finally healed by using a product made from infant’s foreskins called apligraft (which is another story).

And all of this from a simple blister on her foot.

Flesh eating bacteria AKA Necrotizing fasciitis, can be caused by several bacterium, including strep, staph, and clostridium (gas gangrene). Technically, the germs don’t eat the flesh, but produce a poisonous toxin that makes the tiny blood vessels clot off, the flesh dies, and then the skin/muscle etc. die and start peeling off. The patient often dies of shock from the overwhelming infection and toxins causing the blood pressure to drop (toxic shock).

Organisms spread from the subcutaneous tissue along the superficial and deep fascial planes, presumably facilitated by bacterial enzymes and toxins. This deep infection causes vascular occlusion, ischemia, and tissue necrosis. Superficial nerves are damaged, producing the characteristic localized anesthesia. Septicemia ensues with systemic toxicity.

Now, most cases of Necrotizing Fasciitis are sensitive to antibiotics, but as I noted, some cases are caused by the Staph germ (Stapholococcus Aureus) and alas this germ has a nasty habit of getting resistant to antibiotics.

Staph Aureus is best know for causing boils. Usually it enters the skin via a small crack or abraision, and then causes pimples or boils. It can also cause more serious infections, such as pneumonia and bone infections (osteomyelitis) and infect the heart valves (Bacterial endocarditis).

Lately doctors have become very worried about this germ spreading from patient to patient in our hospitals, and there has been an emphasis on prevention: isolating the patient, handwashing, decontamination of bedding and dressings, using gloves, and checking personnel who work in the area to make sure they aren’t carrying the germ from patient to patient.

The tendency to spread via skin to skin transmission is important since it means a doctor or nurse could easily spread it into wounds if they don’t use strict handwashing or gloves.

One problem: Staph also tends to hide in the front of the nose, so carriers often have to apply Bactroban ointment locally to get the germs there. But otherwise for the majority of these infections, simple hygiene is the way to stop it from spreading.

It also means that people who simply carry it on their skin can spread it to each other. The germs may sit on the intact skin, not bothering anyone, until the skin gets scratches or rubbed, or can spread from a person who doesn’t know they have it to another person’s open skin wound.

It doesn’t take a large wound to let the germ get into the body, just a scratch. And so a few weeks ago there were reports of staph spreading among high school wrestlers from skin to skin contact.

Concern over MRSA spiked in October when more than two dozen cases were reported in Montgomery County Public Schools. At the time, many of those cases involved high school athletes, and a Virginia high school football player died in the fall after contracting the bacteria.

And the treatment? Simple but rigorous implementation of hygiene:

Preventing the transmission of MRSA is no different for wrestlers than for anyone else. Athletes are encouraged to shower as soon as possible after matches and practices, and wash equipment — including clothing, headgear and any knee or elbow padding — in hot water. Cuts and abrasions should be covered immediately; personal items such as razors, towels and soap are not to be shared.

School facilities, including locker rooms, practice rooms and the mats, are regularly scoured with bleach solution, a procedure the county established in response to the reported MRSA cases last fall.

But wrestling is not the only common skin to skin contact for human beings. So now the latest worry is it’s spread in the gay community, not because of any kinky activity but merely via skin to skin contact. And the public health prevention efforts are the same:

“Taking a shower after sexual contact may minimize contamination. Ordinary soap will do. It dilutes the concentration of bacteria. You don’t need antibacterial soap.”

So let’s hear it for handwashing, soap and showers.

Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at Hey Doc Xanga Blog.

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