Gyms and Community Acquired Staphylococcus aureus (CA-MRSA)

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meg_

Trad climber
Boston
Nov 8, 2006 - 12:25am PT
I do wonder about the possibilities of contracting this in outdoor environments too. Cracks seem particulary fond of holding onto skin particles, and bacteria can live on rocks too— not just indoor mats. Given every leader has a follower, and both share, (and leave skin and other things on), those cruxy skin abrasive finger locks, well a risk factor does seem to be there. Especially with the traffic I've seen at the Gunks on weekends— how many people climb Bird's Nest on a sunny weekend day at the Gunks? It just takes one unknowing climber (who thinks they have a spider bite) to put some nasty stuff on that rock for all those that follow them.

Not to burst anyone's bubble here, but I do think it's worth while to get the word out about what this is and what to look for. We do a lot of things that can put us at risk for this, and should be on the look out for spider bite looking infections. If you get them- treat them appropriately for your own health, and for other people.

We shouldn't get paranoid about this- it is true that driving in Boston poses a greater health risk than these infections for sure— but it's a situation where getting information out could really help a whole lot.
meg_

Trad climber
Boston
Nov 8, 2006 - 12:43am PT
That is good news.

But to drive that point home in my sometimes thick skull- that includes even those gros off-widthy cracks that eliminate skin from the backs of your hands? I mean, some of the stuff we leave in these cracks seems like heaven for bacteria.

I know you answered this, but I would love to hear your answer one more time to be sure :)
ernst

Trad climber
west coast
Nov 8, 2006 - 01:11am PT
radical and irisharehere have it right. good to be aware, but no reason to be fearful.

ca-mrsa skin infections responds well to bactrim (septra) - the literature shows >90% susceptibility, and i have not personally seen any failures. any abscess needs to be incised and drained -oral and even iv antibiotics will not effectively penetrate a walled off pus pocket.

an interesting note not yet mentioned, for recurrent infection, the nostrils are common sites of colonization, so in addition to either intravenous or oral antibiotics, it is common to prescribe and anitbiotic ointment (bactroban) to use in the nostrils for up to ten days (for that matter, under the fingernails as well).

ancef is not effective against ca-mrsa.
augmentin is not effective against ca-mrsa.
(forgive the jargon - but for those interested, ca-mrsa is not susceptible to beta-lactam antibiotics - this includes all penicillins and cephalosporins).

wash your hands, wear a helmet, and a seatbelt. mom was right. cheers.
TradIsGood

Fun-loving climber
the Gunks end of the country
Nov 8, 2006 - 08:37am PT
...she predicted that CA-MRSA will pose a greater threat to community health than HIV in the next 5 years. That is a pretty profound prediciton,[sic] ...

Check definition of profound. Nothing profound here.

And what the hell do you (or she) mean by "threat to community health"? -that it will be more widespread and kill more people?

I'd predict from personal experience that about 50% of family physicians would misdiagnos [sic] these infections as spider bites- regardless of the fact that there are no biting spiders in New England.

Even if you went to 20 family physicians, your prediction would be based on a hopelessly small population. Statistically unsound. Not to mention that almost anything that hardly ever occurs and presents similarly to something common is more likely to be misdiagnosed than something that commonly occurs.

Years after they discovered deaths from Avian flu in Asia they discovered that infection by the strain was actually quite common in the human population there.
meg_

Trad climber
Boston
Nov 8, 2006 - 09:29am PT
Tradisgood-

My assumption that about half of doctors would misdiagnos this in my area is purely based on my personal experience and hte expereince of another person I know who has CA-MRSA. We were both misdiagnosed through about 6 infections prior to diagnosing ourselves via the internet. My doctor knew close to nothing about CA-MRSA, and was convinced I had spider bites. In reality, there are no biting spiders in New England, and the likely hood of me having recurring spider bites is VERY slim. The likelyhood of my infections being CA-MRSA were much greater, yet no cultures were taken of my infections until after 6 misdiagnosis and over $10,000 in medical expense.

CA-MRSA is now the leading cause of skin and soft tissue infections in emergency rooms across the country— that makes this condition relatively common. Even if it hasn't seen huge numbers in our climbing community, it is still something we should be aware of.

I agree with the notion that we should not be scared of this, but rather informed. I am scared of how people (including my primary care doctor) are not informed of this, and it has had a direct effect on me.

As for the views I was relaying from the seminar, I was bringing this to light to show that there are other well informed, qualified sources that do see CA-MRSA as a significant issue. There are many reasons that are hard to get into through this forum as to why she saw this a real threat- this had a lot to do with the rapid rate that bacteria evolves and mutates. In the 6 years since it's been in the community, there have been instances where USA300 has developed resistance in certain individuals to all antibiotics. There are aspects of this disease in particular, including it's very virulent properties, that make it of concern. I don't want to be misleading with giving information, and do agree it is best to be informed rather than scared. My intent would be to inform here.

I would just hope that now to all who reads this forum, they will now insist to have a culture done if they get a spider bite. Even though this is in general CDC guidelines, it's still not practiced by many family doctors.

TradIsGood

Fun-loving climber
the Gunks end of the country
Nov 8, 2006 - 10:03am PT
Trachelas tranquillus, Dysdera crocata.

Both live in New England.

Both reported to bite.

http://www.ento.psu.edu/extension/factsheets/Spider/spiders.htm

Dartmouth Hitchcock Medical center listed New England phone number for bites.

Finally, it would seem strange that a physician would rule out spider bites even if there were no local species unless he also ruled out travel. And the brown recluse apparently sometimes arrives with food.
jnut

climber
Nov 8, 2006 - 10:19am PT
However, the brown recluse is the only one that will cause necrosis, which is what CA-MRSA does. Wouldn't the appearance of the bite be the first thing a doc would consider when diagnosing?
meg_

Trad climber
Boston
Nov 8, 2006 - 11:03am PT
Tradisgood-

This may be a bit longwinded, but worth including. This is an email to me from an entemologist in Pittsburgh concerned with the recent increases in spider bites in New England.

Start copied message:
I am NOT AT ALL an expert on spiders, their behavior, their bites, or on the fauna of New England. However, the species implicated so often as the cause of necrotic "spider bites" that in fact are not, are species in the genus Loxosceles, in particular L. reclusa, the brown recluse. Unfortunately we know of virtually no records of this spider in New England despite many records of its bites. In Pittsburgh we are regularly contacted by medical doctors asking about the bites by this species, but in fact have NEVER found a recluse spider when examining evidence...and in fact we have no Pennsylvania/Pittsburgh recluse spiders in our collection at all! You can see why some of us have been wondering if the reported lesions are indeed spider bites, and because they may in fact be something worse and more serious, there is need to clarify the diagnoses.

So here are some guesses at answering your questions....

1. All spiders bite, at least potentially, and all spiders have toxic glands producing venom in the bites....the ones implicated for health reasons are the recluse spiders and the black widows. The widows are not that common, and the brown recluse is unknown from much of New England.

2. Widows hang out in tangle webs under rocks, boards, and in other relatively enclosed spaces...the recluse is a surface runner, much like a small wolf spider, and in the plains states often enter homes, running about on the carpets and floor. Both species bite only when confined or pressed against the body by accident...they don't just cruise up and bite things.

3. I believe serial or clustered bites from any spider would be rare, usually a single accidental bite forced by the person "crushing" the spider or otherwise confining or constraining it in some way.

4. Bites are usually where constraint happens, on legs or arms placed against the ground, or under clothing where spider got trapped and when constricted against clothing, induced to bite. They can be on the trunk if the bite was caused by rolling over, often while sleeping, on the hapless spider. I have never seen or heard of one on the face.

5. Basically necrosis from bacteria are wet ulcers....spider bites like the recluse are relatively dry (a probe is not easily passed into the center of even a large necrotic region). Damage increases slowly, the necrotic area increasing in size over days, not hours. Obviously the very real concern here is that aggressive bacterial infections might not be appropriately treated if misdiagnosed as spider bites, and the danger is not from the spiders but from the rather rapid and frightening symptoms of a bacterial attack.

In the last year or so there are many sources of information on this confusion, the diagnosis of bacterial attacks as spider bites, and these may be found on the web. Of course, the web is also full of urban legends about deadly spiders, so you have proceed with caution. My concern is that someone with knowledge should carefully review the IMAGES in diagnostic texts, physician's guides, and other media for assisting in diagnosis of spider bites, as I suspect you will find that some or several of these "spider bite" images that doctors are using for comparison to clinical observations are in fact NOT spider bites.

Google Loxosceles brown recluse diagnosis bites images ........or any combination of those...you will find a rich literature on the web on this matter....two for example are below....go carefully amidst the web data....trust only stories that are published in valid journals...have fun.

http://www.arachnology.org/Arachnology/Pages/Reclusa.html

http://www.medscape.com/viewarticle/518429_References

and many many more....


And remember...Megan, I'm not an expert on any of this...but you would think that here in Pittsburgh, where the incidence of recluse bites would seem to be rising steadily....that someday us old buggers would actually see on in the lab!!! They are very easy to identify accurately....only six eyes.....and so they are not likely to be overlooked or confused with other similar spiders.

Good luck and sorry we aren't authorities on this topic!!! But it is one that concerns me....! The bacteria are serious business, and any delay in appropriate treatment because the physician thinks the cause is a little spider, is time we just can't waste!

End message.
meg_

Trad climber
Boston
Nov 8, 2006 - 01:08pm PT
Thanks so much for responding in this way— it gives me a strong feeling of comfort to hear your responses and reactions.
meg_

Trad climber
Boston
Nov 8, 2006 - 01:18pm PT
FYI: Allergies should be carefully monitered with this. I for one took many antibiotics over this past summer that I had never been exposed to. I had a severe reaction to Levquin, which was given to me through an IV in the emergency room. My mother and I watched as it caused my veins to bulge, and a bright red rash spread up my arm and neck. Mom ran around like a chicken trying to get help, but by the time somone responded the entire dose had gone into my arm. They gave me benedryl in response, and my blood pressure hit an all time low (given it is already very low due to my high activity levels).

Another nasty side effect was that the allergy prohibited me from absorbing IV fluids over the next four days. With NO food intake, I gained 16+ lbs in four days- that's pure IV fluid retention. No one could quite explain my feelings of being "bloated" until an xray (for gastritis) showed huge amounts of water retention.

Food for thought to you med professionals--

allergies are no fun.


Bruce Morris

Social climber
Belmont, California
Nov 8, 2006 - 03:25pm PT
After reading this chain, I developed an iching rash around my neck and began to blame my climbing gym. Then, I realized I had just bought a new merino wool bicycle jersey and it was hot outdoors while I was riding. Now, it's cooled off and the rash has gone away. IOWs: Don't visit the dermatologist or call for a surgeon too soon. A lot of rashes are caused by sweat.
jnut

climber
Nov 8, 2006 - 04:00pm PT
Yeah no kidding, this is the last thing a climbing gym owner wants to read, right?!
Amazing those little bugs can cause such turmoil.
A lot of athletic teams are proactive about keeping rid of thes problems, but in a gym what do you do about the fact that the shared equipment (sweaty climbing holds) cannot in reality be disinfected every day? And every few weeks is not even good enough when dozens of different fingers with thin worn out skin are thrutching and sliding all over them every day, one after the other. I guess the only action they can take is to help the educational side of it all...


fear

Ice climber
hartford, ct
Nov 8, 2006 - 04:38pm PT
>>Oh- Staph can live on climbing holds for up to 4 days

Or 12 days with a little blood and booger....
meg_

Trad climber
Boston
Nov 8, 2006 - 10:55pm PT
I'm also interested in hearing more about how people think climbing gyms should approach this. Do you feel they should take some responsibility in educating people about it? Should we wait until more people become infected, and then address the issue? Do you think it is the community's responsibility to educate ourselves? What are your thoughts?

How would you want your local gym to respond to this?
meg_

Trad climber
Boston
Nov 9, 2006 - 08:55am PT
LEB-

CA-MRSA is different from HA-MRSA, which is what you were exposed to with your patients. Yes, the immune system plays a role, (of course), but this is effecting people who have no compromised immune systems. You too could easily get this is you were exposed to it, regardless of how healthy your immune system is.

Another way education plays an important role in this, (in addition to things we have already discussed in this forum), is that I could have never had this experience if I had been aware of what CA-MRSA is. In fact, I could have prevented myself from ever getting infected (possibly- that's another story). My Ca-MRSA was in fact contracted from another climber who didn't know what they had. If they knew, we could have treated it the right way and I never would have gotten it.

BUT, if I visited your local gym, was climbing there, and then this happened to me, would you want to know about it? With all of my life habits, it is likely the climber I contracted this from picked this up at the gym, although this cannot be proven. Would you want to know about this if someone contracted this at your local gym that you climb at? This brings up some interesting ethical questions.

FYI: There is a decolonization process that i went through for this, and since doing so have tested negative on all tests and have had no recurring infections. There are ways of treating this, although no methods are 100% effective. I am currently not considered a threat of spreading this, and may never get an infection ever again, (meaning this bacteria could not live on me anymore).


Irisharehere

Trad climber
Gunks
Nov 9, 2006 - 10:50am PT
Given how recently CA-MRSA has emerged, I don't know of any large-scale epidemiological studies on its prevalence among the community at large. It may be that it's more common than we think, but it passes unnoticed as our immune system takes care of it.

Frankly, without data that suggests its a widespread problem, I don't think its necessary to take anything more than the usual precautionary measures - i.e. avoid other peoples bodily fluids, be aware of the possibility of transmission in situations of close living conditions, and use plenty of soap andhot water!

Crying wolf too many times when it turns out to be a puppy will just lead to people switching off (who listens to the evacuation proceedures on the plane any more?)

Irish

P.S. - All of the above is not meant to belittle the painand suffering that Staph aureus infections can cause. They can be life-threatening. But for the healthy general population, it doesn't seem that it requires any special vigilance at the moment
meg_

Trad climber
Boston
Nov 9, 2006 - 11:42am PT
In 6 years, CA MRSA has surpassed other strains of bacteria and is now the leading cause of soft tissue infections in emergency rooms across the country. Whether you like it or not, this is a problem that currently effects everyone.

Here's an excert from this cite, http://www.dermatologytimes.com/dermatologytimes/article/articleDetail.jsp?id=375405&pageID=1

National report — Community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) has become a ubiquitous presence across the United States.

It was the most common identifiable cause of skin and soft tissue infections in a study conducted at 11 university-affiliated emergency rooms during August 2004. The study was conducted by the EMERGEncy ID NET Study Group, and the results appeared in the Aug. 17 issue of New England Journal of Medicine.

"The main message for physicians is to recognize just how common this has become," study leader Gregory J. Moran, M.D., tells Dermatology Times. "In most places in the U.S., this is the most common cause of skin infections."

The cities ranged in size from Albuquerque to New York. Kansas City had the highest proportion of MRSA infections (74 percent) and New York the lowest (15 percent). Dr. Moran says anecdotal reports suggest that the lower-incidence cities have caught up over the two years since the samples for this study were gathered.

End copied excerpt.
I'm not crying wolf here- nor do I want to people to be scared, but do think this is something we should all know about and take very seriously. Education is important with this one. Considering this has effected so many people in 6 years since its emergence in the community, it's reasonable to assume that this will effect you too if you come into contact with it. This doesn't mean it will kill you, but you will have to deal with infections caused by it. My story is one of a more severe reaction to the misdiagnoses of infections- it is not likely that the infections will cause most people as much harm as they did to myself.

Irish-
quoted from you, "But for the healthy general population, it doesn't seem that it requires any special vigilance at the moment."

I encourage you to read a bit more about this condition. It effects competely healthy people when they come into contact with it. I have always lead a very healthy lifestyle and have a very strong immune system. My labwork, according to doc's, is stellar. As a said before, I am a picture of health and take good care of it. I suspect if you learned more about CA-MRSA, your point of view would change.
can't say

Social climber
Pasadena CA
Nov 9, 2006 - 02:07pm PT
I guess I should chime in here and reiterate the "heads up" regarding innocent looking spider bites. I was unfortunate enough to have to deal with a staph infection last year and I have to say it scared the beejeezus outta me. I had never had something like that and the speed at which it grew blew my mind. This stuff is everywhere these days and it appears to be spreading into the general population.

A recent study of one hospital's single month treatment for bacterial skin infections found over half of them to be CA-MRSA.

Dirtbaggin just ain't what it used to be. Now you can die from not taking a shower I guess. But then again I'm not a dirtbag anymore.

A friend of mine had a long time friend of his die from the flesh eatting bacteria. He was surfing at a river-mouth in N. California and cut his leg with his board's fin. It was cold water, it had stopped bleeding under his wetsuit and he soon forgot about it. The next day it became infected and he kept it under observation. The next day it was way worse. He went to the hospital to have it checked out. They admitted him and had to amputate the leg. This didn't stop the spread of the infection and the next day he died.

Don't ignore gobbies or innocent looking spider bites.
meg_

Trad climber
Boston
Nov 10, 2006 - 01:49pm PT
Noone has expressed opinions about how they would like their gym facilities to respond to this one- say in an instance where there were breakouts at your gym. Would you want your gym to help educate other people who use this facility, or would you consider it the responsibilty of those infected to educate other gym users? Right now, this disease is unreportable, so there is no obligation for those who have this to publically report that they have been infected.

How would you want this type of situation to be approached at the gym facility you use? These are interesting ethical questions I am curious about. My stance on this is not yet decided, and I consider my opinion somewhat skewed due to personal experience. I would love to know opinions on this.
Ed Hartouni

Trad climber
Livermore, CA
Nov 12, 2006 - 04:29pm PT
From the late Stephen J. Gould... The Age of Bacteria...

the crown of creation?
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