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Reasonable Rascal
11-13-02, 18:21
http://abclocal.go.com/ktrk/news/111202_local_infection.html

Infection outbreak strikes dozens of students at local school

By Mark GarayABC13 Eyewitness News

(11/12/02) - There's something spreading among the students in Pasadena's independent school district. Since the beginning of the school year, there have been about 50 cases of MRSA, a staph infection that is resistant to certain antibiotics and can be tough to treat.

This bacterial infection was actually discovered about two weeks into the school year. Officials believe the infection may have started with some of the team sports, like the football team.

Pam Exner has two children who have contracted a bacterial staph infection known as MRSA. She says they got it at Sam Rayburn High School where they both attend class.

Exner asserted, "Everybody at school's got it, all the football players and the dance team."

Pam says her son, who's on the football team, has had to make 20 trips to the doctor so far, and has missed about 13 days of school because of the boils that attack his skin. The symptoms first appeared two months ago.

Exner isn't happy with the way the school district is responding. "I haven't heard anything that they've done over there yet. I mean, half of the parents are really ticked off about it. I talked with three parents already, they're really mad about it."

We told Pasadena ISD Spokesman Kirk Lewis about the parents' complaints that the district hasn't done anything to correct the situation. "We've done everything we know to do," he responded.

Pasadena ISD says 29 students at Rayburn have been affected, and 50 district-wide. Officials say they took safety measures right after the initial outbreak.

Lewis told Eyewitness News, "We initially went through and cleaned all the gyms with an extra disinfectant just to try and make sure that the surfaces were clean. And then, as we began talking with the health department and the physicians, that's not the way this is contracted."

Lewis says county officials report MRSA is spread through human contact, and that could be why the football team got hit so hard. But he says the school district is doing all it can, and the kids should, too.

"Everybody bathes and takes care of themselves, but in times like this I think we just need to do a little bit more," Lewis advised.

The Harris County Health Department is sending out a questionnaire to all the parents around the school district and county-wide to try to get an idea how widespread this problem is.

Methicillin resistant staphylococcus aureus, or MRSA for short, is a type of staph infection. Most of you know it as a very common infection. Ninety percent of the time it's a simple skin infection that's easily treated. But sometimes it can be serious.

"Ninety percent of the time MRSA is a local skin and soft tissue infection, treated generally with oral antibiotics and occasionally may require drainage and an abscess," explained Dr. Sheldon Kaplan of the Baylor College of Medicine.

Probably nothing to worry about unless you see these symptoms:

- Redness that spreads or begins to streak
- Swelling
- Enlarging infection that isn't responding to simple cream antibiotics
- Fever

If your child has these symptoms, Dr. Kaplan says go to your doctor. He says it's called methicilline resistant because it's resistant to this type of antibiotic, but other antibiotics are treating the staph infection appropriately.

Last Updated: Nov 13, 2002

Reasonable Rascal
11-15-02, 07:54
The story has caught the attention of the ProMED list, which added the following comments and observations in addition to the story reproduced above:
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[Clusters of infection spread by direct contact among members of a competitive sports or recreational group are well recognized (1) and have been caused by _Herpes simplex_, _Trichophyton species_ (cutaneous fungal infection), Group A streptococcus, the molluscum contagiosum and hepatitis B viruses as well as _Staphyloccoccus aureus_. Both methicillin-sensitive and -resistant staphylococci have been represented. In fact, a cluster of community acquired MRSA (CA-MRSA) occurred in a high school wrestling team in Vermont, USA in 1993-94 (2).

Regarding CA-MRSA itself, most of the initial isolates that seemed to have been acquired without health care center contact could, in fact, be linked back to a hospital (3). It is, however, now clear that true CA-MRSA is occurring more frequently. Outbreaks in the USA have been teported in a number of states including Illinois, Texas, Minnesota, and New Mexico.

Two abstracts highlighting aspects of CA-MRSA were presented at last December's Antimicrobial Agents and Chemotherapy meeting in Chicago, Illinois (4, 5). It seems clear that significant differences exist between CA-MRSA and its nosocomial (hospital-acquired) cousin. Antimicrobial sensitivity-wise, the community acquired strains are usually resistant only to the beta-lactam group of agents and retain sensitivity to a number of other agents that the hospital strains do not. These include clindamycin,
trimethoprim-sulfamethaxozole, and the quinolones. Although not directly stated in the news piece, it is implied that this CA-MRSA cluster was "multi-susceptible". It appears that the CA-MRSA strains have acquired a transposon only coding for the _mecA_ gene which confers resistance to the beta-lactams only altering the penicillin binding protein PBP 2A.

In addition, Fey's group reported that CA-MRSA strains may produce superantigens such as SEB and SEC (staphylococcal toxins B and C) that appear to be important in the pathogenesis of toxic shock syndrome (4). Hospital acquired MRSA strains generally do not produce these antigens.

1. Goodman RA, Thacker SB, Solomon SL, et al. Infectious diseases in competitive sports. JAMA 1994; 271: 862-7.
2. Lindenmayer JM, Schoenfeld S, O'Grady R, Carney JK. Methicillin-resistant _Staphylococcus aureus_ in a high school wrestling team and the surrounding community. Arch Intern Med 1998; 158: 895-9.
3. Suntharam N, Hacek D, Peterson LR. Low prevalence of community-acquired methicillin-resistant Staphylococcus aureus in adults at the university hospital in the central United States. J Clin Microbiol 2001; 39: 1669-71.
4. Fey PD, et al. Comparison of community-acquired and hospital-acquired MRSA. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Dec 2001, Abstract LB-5.
5. Charlebois ED, et al. Alarming prevalence two predominant genotypes of methicillin-resistant _Staphylococcus aureus_ (MRSA) in community-acquired soft-tissue infections. Presented at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Dec 2001, Abstract C2-306.
- Mod.LL]