Staphylococcus Aureus - Research Paper Example

Staphylococcus aureus A cause of the many skin, tissue, bone and even blood infections in humans, Staphylococcus aureus (S. aureus) was first discovered by Sir Alexander Ogston in 1880 as he identified that it was the same organism that he saw that caused both acute and chronic abscesses that he had dealt with. Sir Ogston named it according to the Greek words staphyle and coccus for its grape and berry-like appearance under the microscope (Adams and Moss 252). It must be noted, however, that it was Robert Koch who first described the presence of staphylococci in the pus. The diseases caused by this organism ranges from simple impetigo and furunculosis to complicated pneumonia, osteomyelitis, septic arthritis, bacteraemia, endocarditis, gastroenteritis, and toxic shock syndrome among others (Bannister, Gillespie, and Jones 97). Being one of the most controversial of the diseases that S. aureus can cause, this paper will tackle about staphylococcal pneumonia, with a special focus on MRSA or the methicillin-resistant staphylococcus aureus, as it has been gathering attention from health care authorities all over the world. It contributes to one of the leading causes of death in countries from all level of economic status as projected by the World Health Organization (“Top 10”). The Association: Discovery of Staphylococcal Pneumonia The S. aureus-caused pneumonia was first recognized as a pulmonary-infection-causing organism during the influenza pandemic of 1918-1919. Laboratory studies of those who had been infected and died during the pandemic were identified to have strains of S. aureus in the body fluids such as the sputum and the blood of those in one of the US Army Camps, the Camp Jackson (Brundage and Shanks 5; Gorbach, Bartlett, and Blacklow 483). However, pneumonia as a separate condition had existed earlier than this. In fact, it was still during the time of Hippocrates that its characteristics had been described. Pneumonia was “one of the oldest diseases to have a specific diagnosis and name” (Murray 1) in the history of medicine. Murray also emphasized that the Greeks had named it pneumonia for being a “condition of the lung.” On the other hand, although it was said that Hippocrates was the first of those who have given specific descriptions of the disease, many believe that it has existed far earlier than the Greek physician. Egyptian mummies who were thought to live in the 1250 to 1000 BC were found to have pneumonia after being subjected to laboratory studies (Klein 299). Canobbio described pneumonia as “an inflammatory process of the respiratory tree and alveolar spaces (air sacs) caused by infection” (629). Like all of the common manifestations of infection, people with pneumonia will appear to be significantly ill, with high temperature and their white blood cell count is higher than normal. Their breathing will be painful too as the inflammation will lead to the rubbing of the pleural surfaces. Hypoxemia and shortness of breath are as well predictable; and other respiratory function will be in jeopardy. These are, of course, still secondary to the inflammation process that is active during the course of the disease (Crowley 370). The Impact: Pneumonia on the World There are many organisms that can cause pneumonia; S. aureus is only one of them. In the overall bacterial pneumonias that appear to have been infecting humans since the time the disease was first discovered, staphylococcal pneumonia only accounts 10% of the affected patients (Goroll and Mulley 422). However, staphylococcal pneumonia is considered relevant as it mainly affects children and newborn infants, those who have weak immune defenses and the individuals who had been infected with viruses (Klein 301). Many consider staphylococcal pneumonia as a “superinfection.” In the influenza pandemic during years 1918-1919, staphylococcal pneumonia attributed to the major causes of death of those who had been infected (Rubin and Strayer 494). To support this assumption, Figure 1 in Appendix A shows the mortality rate of those who have developed pneumonia after having been infected with influenza during the pandemic in question. Figure 2, on the other hand, shows that besides the single but considerably significant spike in the year 2004, the United States still has had occasional instances wherein the line of the epidemic threshold for pneumonia has been reached. Nevertheless, Figure 3 shows the representation made by the World Health Organization to show impact of pneumonia on children aged five years old or less. Pneumonia is one of the leading causes of death for this age group all over the world. According to Stephen, bacterial pneumonias [including staphylococcal pneumonia] affect three million Americans every year. The author added that these numbers peak during the cold and winter season. Moreover, he identified the mortality rate to be 30%, especially when treatment is denied. In another study, Dushoff et al., found out that influenza-pneumonia cases cost the United States 41, 400 lives annually from the year 1979 to 2001 (181). The World Health Organization, on the other hand, estimates 150.7 million new cases per year including all levels of severity involving young children only (Rudan, et al. “Global”). Sources about the global prevalence of the condition in all ages are not specified to provide concrete details. Pneumonia and SARS. Pneumonia has been lately associated with severe acute respiratory syndrome or SARS in 2003; and with the latest H1N1 virus outbreak in 2009. Death rates of SARS have reached 15% during the outbreak (Stein and Connolly) whereas H1N1 swine flu’s mortality remains unclear (Fox). However, emphasis must be put on the fact that these pneumonia-like and pneumonia linked conditions may not have a staphylococcal source. Studies are still on going on the issue about the viral or bacterial origin of the condition linked to these outbreaks. Yet, the characteristics of the diseases have convinced most on its viral origin. Nevertheless, case detection, isolation and infection prevention and control, and contact tracing and follow-up surveillance as mandated by the World Health Organization and the Center for Disease Control and Prevention in clinical and community settings were deemed useful as strategies (WHO “Severe” 2; WHO “Infection” 2-12). MRSA: A New Enemy Unlike the common staphylococcal infection which is referred to as “methicillin-sensitive” S. aureus or MSSA (Chang 3), the world is now threatened with a more serious staphylococcal infection called the methicillin-resistant staphylococcus aureus or MRSA. Discovered during the early 1960s, these methicillin-resistant staphylococcal species were found to be resistant to the anti-staphylococcal penicillins which were also just newly introduced and used to fight against infections which are staphylococcal in origin due to their fatal effects (Haile-Mariam 347). “The mechanism of resistance involves in part alteration of penicillin-binding proteins in the periplasm if the bacterium, resulting in a decrease in affinity for those antibiotics” (Saez-Llorens and McCracken 937). Currently, MRSA is considered to be one of the causes of staphylococcal infection cases that are difficult to cure due to its resistance to a wide variety of commonly-used and first-line antibiotics (“MRSA”). This prevents the provision immediate medical intervention for those who are affected. To get to know why many regard it as the most dangerous than any other S. aureus infection, the paper would focus on the epidemiology of MRSA, the pathologies it causes in the different parts of the body especially pneumonia, and the treatments available and other measures to counter its effects. The Epidemiology of MRSA. Epidemiology is the branch of medicine that focuses on identifying “the causes, distribution, and control of diseases in populations” (“Epidemiology”). The bacteria S. aureus is considered to be a prevalent bacteria as it resides in more than a fourth of the general population (Kluytmans and Diederen 257). The bacteria particularly inhabit the nares of these people, specifically those who have IDDM (insulin-dependent diabetes mellitus) or those who are dialysis-dependent renal failure patients. Evidently, it affects the weak and the people with low resistance. MRSA, on the other hand, does not spend much time in the nares unless there are hospital outbreaks. In fact, it was found that only 10% of the carriers of the bacteria contain them in the nares (Hill and Casewell 150). This pattern, however, is more likely present among hospital staff members than patients. The bacteria typically colonize the patients’ rectum, pharynx, wounds, and chronic dermatitis (Crossley and Thurn 188). Nevertheless, MRSA bacteria and infections have been found to be widespread in hospitals and other healthcare facilities and in the people who are or have been admitted to them than those who are only in the community (Mathema, Mediavilla, Chen, and Kreiswirth 32). Zahar and Timsit also specifically pointed out that there are particular clinical areas in these facilities that have become more susceptible to MRSA infections (226). The longer the patients stay in the intensive care units or burn units among others increase the likelihood to acquire the infection or become colonized with MRSA as well (Crossley and Thurn 188). All the same, some geographical locations have shown higher and increasing susceptibility rates like the United States, and the countries of the southern part of Europe as compared to others (Zahar and Timsit 226). The cases in the community or those that are community-acquired, too, have drawn more specific attention as they “have resulted in serious medical complications with poor clinical outcomes” (Mathema, Mediavilla, Chen, and Kreiswirth 32). Authors Mathema et al. even also noted that although MRSA infections are usually nosocomial in origin, community-acquired MRSA or CA-MRSA infections are increasing in number that have even resulted to epidemics in some areas of the world (32). MRSA Infections. MRSA infections are like the methicillin-sensitive S. aureaus infections only tougher. It infects the skin and soft tissues, with special cases found in the diabetic foot of those who are insulin-dependent diabetics. MRSA bacteremia and MRSA pneumonia are also found to be prevalent; severe and even fatal effects have been noted (Weigelt). Skin infections caused by MRSA resemble a spider bite; and thus, they are called “false spider bites.” The Washington State Department of Health released a number of signs that characterizes MRSA skin infections. According to them, MRSA infections would look like “a large, red, painful bump under the skin, a cut or sore that is swollen, hot, and oozing with pus or blood,” and have “blisters filled with fluid.” MRSA infection in the diabetic foot is given increasing consideration as it is a fact that confinement to healthcare facilities of the diabetic patients are commonly caused by their diabetic foot. As soon as these diabetic feet are colonized with the difficult-to-treat MRSA, risk of amputation will surge and death may be even more apparent (Manzella). MRSA bacteremia or invasion of the MRSA bacteria into the bloodstream has been found to be one of the leading causes of morbidity and mortality of those who have been infected with the bacteria. In a letter to the editor, Blot highlighted that those who were infected with the methicillin-resistant bacteria suffer more than those with methicillin-sensitive ones. The wide-range antibiotic resistance itself was identified to cause the trend (Blot). MRSA Pneumonia. The cause of half of the nosocomial staphylococcal cases of pneumonia in the hospitals of the United States, MRSA is said to be the prevailing cause of pneumonia in patients who are in the state of comatose, or those who are mechanically-ventilate or have head trauma, diabetes, and renal failure, and in those who have stayed in the hospital for more than five days (American Thoracic Society, qtd. in Fong and Kolia 119-120). The Panton-Valentine Leukocidin (PVL) gene that is existent in the MRSA strain kills the neutrophils that results to lung tissue necrosis -- one that is uncommon in MSSA-infected pneumonia (Al-Tubaikh 115). Signs and symptoms include sepsis, high-grade fever, hemoptysis, and pleural effusion. Besides, the necrosis “can result in the formation of pulmonary cavity infiltration” (Al-Tubaikh 116). Death is also frequent; in fact, the mortality rate is believed to be around 31% to 46% (Fong and Kolia 120). Because of the inherent trait of the organism, MRSA – especially the community-acquired MRSA – is considered deadlier than any S. aureus infection. In an interview with Reuters, some researchers see the harm of the infection as the pneumonia caused by MRSA is associated “with rapid progression to septic shock… and an urgent need for mechanical ventilation” (Kahn). Treatment and Control Measures versus MRSA. The treatment against MRSA “depends on the site of the infection and the in vitro susceptibility pattern of the infecting strain,” Kluytmans and Diederen noted (256). The authors emphasized that removal of the bacteria-inhibited devices from the vicinity of the infected patient and even drainage of the pus from the infected site [especially when it is superficial] are regarded as better ways to counter the effects of MRSA than use of drug therapy unless the cause are located deep in the body. Anyhow, drug therapy such as vancomycin, glycopeptide, and others including linezolid, quinupristin-dalfopristin, and daptomycin are currently in use as resistance is not observed; the effectiveness, though, are not as efficient as to those that are used against MSSA (Kluytmans and Diederen 256-257). Control of the spread of the MRSA is focused into two views: the hospital and in the community. Hospital infection control measures are suggested separately in Figure 4 found in Appendix A. Community control procedures simply consist of frequent hand washing; and direct contact with open lesions, wounds, infected devices and other body fluids such as urine, pus and others can be prevented by the use of disposable gloves and apron (Wilson 112). Patient isolation is not needed if preceding methods of controls are practiced. Conclusion Although staphylococcal pneumonia only accounts more or less tenth of the cases of bacterial pneumonia in totality, knowing the organism that causes any infection is indeed relevant as each causative agent or organism has their unique trait which characterizes the severity of the effects of its infection. There may not be an effective antibiotic agent that existed in the influenza pandemic in 1918 to treat all the cases that presented the organism; but it would have nonetheless lessened the death of more than 25 million people worldwide if the cause had been known (Angelo). Millions, even billions, have been spent for researches finding answer to scientifically-significant questions and the search for treatment and prevention of pneumonia. Yet, it continually appears at the topmost in the lists of leading causes of death all over the world not only in the past but also today. Researches and studies are beneficial. Lucky for countries like the United States for having enough funds to spend on these; but for the developing and third-world countries of Asia and Africa, the time, effort and money spent on research would be much more useful if they spend it on the treatments and other strategies in fighting against pneumonia. Communicable diseases caused by organisms like S. aureus and its more serious counterpart (the MRSA) have long affected us. Improvements to resist the infections’ negative effects are now apparent as technology boosted. Despite this, many unnecessary deaths every minute result from the lack of treatment, prevention and things that would have been helpful to intervene with its. It is obvious, when it comes to health and the practice of medicine, the current efforts seem not enough. Works Cited Adams, Martin R., and Maurice O. Moss. Food Microbiology. Cambridge, UK: The Royal Society of Chemistry, 2008. Print. Angelo, Robert Wesley. “The Influenza Pandemic of 1918.” Philosophy, Biography, Family History. Roangelo.net. Jan. 4, 2009. Web. 15 June 2010. . Bannister, Barbara, Stephen Gillespie, and Jane Jones. Infection: Microbiology and Management. 3rd ed. Malden, MA: Blackwell Publishing, 2006. Print. Blot, Stijn. “Staphylococcus aureus Infections.” The New England Journal of Medicine 339.27 (31 Dec. 1998): 2025-2027. Print. Brundage, John F., and G. Dennis Shanks. “Deaths from Bacterial Pneumonia during 1918- 1919 Influenza Pandemic.” Emerging Infectious Diseases August 2008: n. pag. Print. 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Web. 15 June 2010. . --. “Infection Prevention and Control During Health Care for Confirmed, Probable, or Suspected Cases of Pandemic (H1N1) 2009 Virus infection and Influenza-like Ilnessess.” World Health Organization. World Health Organization, 16 Dec. 2009. Web. 15 June 2010. . Zahar, J. R., and J. F. Timsit. How to Control MRSA Spread in the Intensive Care Unit. Infectious Diseases in Critical Care. 2nd Ed. Ed. Jordi Rello, Marin Kollef, Emili Diaz, and Alejandro Rodriguez. Berlin, Heidelberg, Germany: Springer-Verlag, 2007. Print. Appendix A Figure 1. Influenza-pneumonia-related mortality in percentage during the influenza pandemic 1918-1919 (Brundage & Shanks). Figure 2. Figure 2. US influenza-pneumonia-related mortality rate in 2002-2006 (IFPMA). Figure 3. Distribution of deaths from and other causes in children aged less than 5 years (Rudan, et al. “Epidemiology”). Healthcare Facilities Control Measures Against MRSA Isolation Colonized or infected patients should be nursed in a single room, where available Gloves and aprons should be used for contact with the patient and discarded after use. They should also be changed between procedures Hands should be washed after contact with patients or their environment Alcohol hand-rub should be available by the bedside and the entrance to the room to enable rapid hand decontamination Cohorting A group of several affected patients can be isolated together in a designated part of the ward. This can help to reduce workload for staff and improve adherence to the control measures Cleansing Isolation rooms should be kept clean during use, especially the horizontal surfaces where dust may settle and bacteria accumulate Rooms should be cleaned with detergent and water after isolation has been discontinued to remove microorganisms remaining in the environment Readmission Previously colonized or infected patients should be rescreened on readmission to hospital as the resistant strain may persist in small numbers Notes can be labeled and computer-held records flagged to indicate patients who have had MRSA Transfer of patients with MRSA Avoid moving patients to other wards or departments Home care personnel and residential care facilities should be informed of patients with MRSA prior to discharge but this should not affect their transfer Screening of other Patients Other patients may need to be sampled for MRSA carriage by taking swabs from the nose, perineum or groin, skin lesions and invasive device insertion sites. This can enable early identification, isolation and treatment of MRSA carriers and help to limit spread The extent of screening will depend on the type of clinical area and the number of patients affected High-risk units, e.g. ICUs, may screen all patients on admission Screening of Staff Contacts This is usually necessary only in high-risk areas, such as the ICU, or where the organism continues to spread despite the control measures and a staff carrier may be contributing to transmission Swab nose and skin lesions of staff in contact affected patients Staff members who are colonized with MRSA should be treated with mupirocin. In high-risk wards, exclusion from work for 48 hours may be necessary Figure 4. Hospital Infection Control Measures against MRSA (Wilson 111). Read More