TEEN HEALTH:

MRSA: Fight Scary Bug With Common Sense

by Dr. Ann L. Engelland

(October 29, 2007) Last week one of my more anxious parents brought her daughter to me with a skin rash. Mom sat in the waiting room while I examined the daughter and determined that the “rash” was a series of bug bites. The warm fall weather means there are still mosquitoes ready to spawn as soon as it rains. I always feel a bit guilty charging money for bug bites and called the mother in to talk, wondering why she had taken her child out of school for bug bites. As she entered the room, she burst out with: ”How do you know this isn’t ‘murrsa’?”

Anxious parents tend to be up to date on the latest scares and so I asked her what she was referring to. I hadn’t heard or read the news yet that day. So my patient’s mom told me about the football player in Connecticut who was reported to have died of an overwhelming Staph infection. And she wanted to know how I knew this wasn’t MRSA or Methicillin Resistant Staphylococcus Aureus.

Over the past ten days, I have followed the reporting in the media about MRSA and brought myself up to speed on what we in the community and I as a physician need to know. Fortunately, what we need to know is no different than what we needed to know two weeks ago. There is nothing new. But after flurries of emails concerned about “staff” infections in our schools, and after carefully listening to and reading what is out there, I know that we need to understand MRSA so that we don’t overreact to this problem.

Although tragic stories continue to grab headlines, the basic facts remain the same. Rather than re-educate about MRSA, here I offer a few basic facts to remember and some sources to refer to for simple advice for families, athletes, and staff.

Basic MRSA information:

Carriage or colonization: approximately a third of people “carry” staphylococcus aureus on their bodies (especially nostrils) and live harmoniously with these organisms (and millions of others) all the time. So, when you hear that as much as a third of a football team tested positive for Staph, understand that what is being measured is the “carriage” rate.

Infection: Infection is different from colonization. Infection implies that the bacteria are multiplying and stimulating an immune response in the host. Infections usually occur in previously compromised skin—bug bites, pimples, broken skin from scrapes, cuts, or eczema. Part of the immune response is the development of pain, redness, swelling, and pus or drainage from the site. BUT, not all pus-filled spots require aggressive treatment. Most of them will resolve with good wound care and management (see below). Only if a sore appears to be rapidly spreading or not responding does it require medical attention.

MRSA: Methicillin is a penicillin-related antibiotic, long ago the first line of defense against infections such as Staph. Due to wily bacterial abilities to mutate, they have become resistant to the antibiotics that we have poured into our systems over the last fifty years. For the past decade medicine has been aware that the overuse of antibiotics has increased bacterial resistance. BUT, this does not mean that if a person is colonized with MRSA or even has an infection with MRSA, that it is untreatable. In fact most MRSA infections are treatable with oral antibiotics that are commonly available at reasonable cost in their generic form.

Can You Catch MRSA?

MRSA is contagious by skin-to-skin contact. It may also be transmitted by direct skin contact with materials that have been in contact with the bacteria or body secretions that are carrying or infected with the bacteria. To be graphic: If I carry MRSA in my nostrils, blow my nose, forget to wash my hands, shake hands with you, and you scratch open your mosquito bite, you may deposit MRSA in the open bite. Whether this becomes a local infection at all or spreads into other tissues (skin, muscle, bone, blood---all of which are rarely infected) depends on a number of factors, not all of which are understood.

So, this means that MRSA is not spread through the air, toilet seats, swimming pools, desks, utensils, someone coughing in the same room with you, or even sitting next to you with an MRSA-containing wound. On the other hand, towels, bandages, shin guards, razors, helmets, and soap bars (hence the recommendation for liquid soap in schools) can transmit bacteria (and some viruses, fungus and good old dirt).

But it should be noted that the expensive, extensive, efforts to “completely clean” a school including windows, floors, desks, etc. are not only of limited value in limiting MRSA, but they may be polluting the environment and doing more harm than good. Breathing chlorine bleach isn’t good for anyone. It’s a price to pay for irrational “peace of mind” and pandering to panic in the public.

How Can You Prevent MURSA?

First we need to remember what exactly we are preventing. We are trying to prevent the spread of MRSA from one person to another.

And we are trying to prevent MRSA in a person shifting from a completely innocuous and asymptomatic “carrier state” to a bothersome localized infection (nasty, pus-filled pimple) and from there to a potentially life-threatening systemic infection (blood, bone, lungs, etc).

Basically, this means:

• Keep hands clean by washing with soap or hand sanitizer
• Wash any cut and apply a clean bandage until healed
• Avoid contacts with another person’s wounds
• Avoid sharing personal items

In addition athletes,

• Do not share towels, washcloths or other hygiene items
• Shower with soap before using the whirlpool, steam room, or sauna.
• Shower after every practice or game
• Wash your hands after using weights and other multi-user equipment
• Shower and wash your clothes regularly  

Gone should be the days of throwing the sweaty shinguards, helmets and pads back in the athletic bag where the MRSA are happy to multiply in their warm, dark, dank environment. Gross? It’s simply nature without soap.

Reconsider That Hair Removal

I would add one further and very important piece of advice. The current trend among adolescents and young adults toward shaving body hair, including extensive pubic hair removal by razor or waxing (See my previous article: No Hair: What's Going On Down There?), is an invitation to MRSA acquisition and spread. Each one of those tiny razor cuts is an entry point for bacteria. Among sexually active people, this intimate skin-to-skin contact is an invitation to spread of infection - whether MRSA, herpes, HPV, HIV, or hepatitis. People who make the choice to remove hair should be vigilant about skin health and conscientious about getting medical attention at the first sign of infection (pus, irritation, redness, pain, spreading, and swelling).

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She is also the Mamaroneck School District physician. She can be reached at 698-5544. Her website is: annengellandmd.com Have a teen health question? Use the form below to send it to Dr. Engelland. Please note: Dr Engelland cannot respond privately to individual queries online. Comments are welcome and anonymous questions may be answered in future columns. Serious medical problems should be referred to your own physician.

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