MRSA PVL

The bacteria took hold in many hospitals resulting in a significant number of deaths mainly to elderly patients - the elderly due their weakness caused by other medical problems.

The bacteria also entered new wounds caused by surgery and if the infection was not recognised very quickly could destroy the flesh in short time.  The problem was treating it due to it's immunity to the frontline antibiotic Methicillin.

MRSA is reported quite often now but this is generally not because of infection breakouts but of quicker recognition and recording by health care trusts.  Isolating the patients quickly and closing down wards for deep cleansing has helped enormously to bring this bacteria under control.

Anyone who has visited hospital or clinics in the last five years will have noticed the alocohol hand rub dispensers at main entrances and access doors to wards.  This has become the norm' nowadays to stop infections from leaving hospital and visitors bringing new ones in.

Bacteria mutation over time is inevitable, so when we visit the doctor for an illness and prescribed anitbiotics we must finish the course to kill off all traces.  But many of us haven't or don't as soon as we feel well again and there maybe just a few survivors of the bacteria, who after being in contact with the antibody create their own immune system against it.

The New Breed

But health experts are now confronted with a new version with more deadly intentions - MRSA PVL (Panton-Valentine-leukocidin).  Some health experts say if urgent steps are not taken soon this mutation could cause a pandemic, sounds extreme but possible.  Many bacteria create PVL, a dangerous toxin that destroys our white blood cells but they are not so difficult to treat as MRSA.  Now that MRSA-PVL is becoming a community infection the health experts want the government to be aware of this fact and put in place provisions in case of a total breakout.

Many people naturally carry Staphylococcus bacteria in their throats and their skin and they can cause a mild infection in a healthy patient. There are a wide range of different types of Staphylococcus, and some are more of a threat than others.   Some of these are methicillin sensitive Staphylococcus aureus (MSSA), but this can be treated with the frontline antibiotic methicillin.

More of a problem is methicillin resistant Staphylococcus aureus (MRSA), which, as the name suggests, is immune to the effects of the antibiotic. Estimates show that the PVL toxin is produced by less than 2% of Staphylococcus aureus strains. But the problem is the serious risk to health when produced by the MRSA strain, because  there is no easy way to treat a bug which can pump out a potentially deadly toxin.  The majority of  MRSA infections target elderly people in hospitals who have weakened immune systems, but PVL MRSA strains also affect young, healthy people and very quickly too.

Why is PVL infection so dangerous?

PVL infections tend to attack the skin and cause painful boils and abscesses. At first patients may not take much notice at the time and many GP's were unable to recognise the true identity of the problem.  Most cases can be treated with antibiotics. But in some cases, PVL infections spreads to the lungs and causes fatal pneumonia. It can also cause blood poisoning.

PVL is dangerous because it attacks and kills the body's white blood cells that we have to normally fight infections.  However some of the strains genetic make-up will give them a slight advantage when it comes to fighting off the antibiotic attack. Weaker strain versions will die when they encounter antibiotics, while those who have become naturally resistant may prove harder to kill.

This means that next time you encounter a Staphylococcus bacteria, it is most likely to be a resistant one which has survived an earlier antibiotic treatment.

In 2006 in the Midlands, Unitied Kingdom a number of cases were significant when a nurse and a patient died from MRSA PVL which aslo affected six other people.  At the time doctors did not realise that a new version of MRSA had arrived and  that for the first time had been transmitted in hospital and caused deaths.  There had been some previous cases but with no fatalities from the strain in question.

PVL-producing strains of MRSA have been seen in the UK previously, however the small numbers of cases reported have usually been in the community rather than within hospital.

These strains generally affect previously healthy young children and young adults  contrasting with the so called 'hospital-associated MRSA' strains which do not produce PVL and are more commonly associated with causing wound infections and blood-poisoning in more elderly hospitalised patients.

In April this year a boy of 10 years had picked up an infection after a fall at a playground. Within two days he had suffered septic shock and major organ failure. Despite treatment with huge volumes of antibiotics, the boy was not expected to survive.

The lad did survive but only after a month in a coma and serious damage to bone tissue.  The infection had got into his skeleton where it is difficult to treat.  Damage to his hip and leg bones have occurred and he largely confined to a wheelchair.

Other cases were a six-year-old girl left brain-damaged after she fell off her toy and contracted the infection in her shin bone, from where it spread throughout her body. A nine year old crippled after a graze whilst playing football.  A girl of 12 who fell while at dancing, a 13-year-old who banged his leg on the side of his bed both suffering similar near-fatal infections of the bacteria.

A boarding school pupil who did not appear to have had an accident was rushed to hospital after becoming infected.  When doctors realised the identity of the infection the HPA (Health Protection Agency) were calle din and screened the whole school, pupils, staff and recent contacts.  The HPA had taken the possibilty of an outbreak seriously.

Some years ago the United States had discovered the fact that the bacteria known there as PVL-MRSA had combined with PVL.  This was widely reported globally.

In the United States a new strain has been sweeping America.  Breakouts have occurred within military barracks, gyms and educational facilities - places where people are in close contact with each other.   This highly virulent strain of the superbug has spread across America and it is feared it could take hold here.  The form, known as US300, PVL-MRSA, produces a toxin that destroys white blood cells and would normally cause boils and other skin complaints.  But if it gets into an open wound it can cause serious complications which are lethal in 75 per cent of cases.

There were just 159 cases of PVL-MRSA in 2006 in England and Wales but this rose to 516 in 2007.  Government scientists say the rise is mostly due to better reporting of cases and increased testing which was encouraged by experts

The HPA state that many other countries have encountered serious problems with PVL-related disease, but it is important to note that infections caused by PVL- Staphylococcus aureus (including PVL-MRSA) remain uncommon in the UK.  However, we must remain vigilant and continue to encourage awareness of this type of infection.  In 2006 the chief medical officer  for the UK wrote to all medical staff and health workers warning them to be alert for this type of infection and doctors were advised to follow up patients with symptoms.

The HPA also saidthat most cases of PVL-Staphylococcus aureus are contracted in the community and affect previously healthy children and young adults.  Most forms of the infection found in the UK can be successfully treated with everyday antibiotics.

New Strain Crosses the Channel

A call for urgent tests in Summer 2007 on the UK's farm animals after the emergence of a new strain of MRSA which has spread rapidly among farmers in Europe.  The new drug-resistant bug known as ST398 is thought to have originated in pigs fed with antibiotics to protect them against farm-borne diseases and boost their growth.  The new strain was first detected two years ago in the Netherlands.

The emergence of the new strain backs up fears voiced by some experts that the heavy use of antibiotics in farm animals could lead to a drug-resistant bug capable of infecting humans.   This strain of staphylococcus aureus again is resistant to commonly used antibiotics and has caused skin infections and rare heart and bone infections in people in the Netherlands, Denmark, Belgium and Germany.  However it appears to only have effected humans with regular close contact with animals.

But scientists are concerned that it may be only a matter of time before the bacteria makes the final mutation to be able to cross between human and animal.  Drug companies who make antibiotics have been asked to go back over previous versions and look for the possibilty of a modification to the antibody with a view to confuse all ready resistant strains and therfore extend the useful life of a antibiotic medicine further.

Possible Origin of MRSA

The "superbug" that has killed thousands of hospital patients worldwide originated in Guildford, say American scientists. A New York research team has traced the first two people known to have caught the MRSA bug, which is resistant to standard antibiotics, to a hospital in the Surrey town. They were an eczema patient and a nurse whose names are not known. The infection they developed in 1960 has gone on to cause a global epidemic.

Millions of hospital patients have been infected by the Guildford strain of the bug, which can be passed on by the slightest touch. Any wound is a target for MRSA. It can create terrible infections that are increasingly difficult to treat.  In the worst cases, it can exacerbate the flesh-eating condition, necrotising fasciitis, a severe infection of the soft tissues below the skin which causes dreadful deformities and is often fatal.

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