Gyms and Community Acquired Staphylococcus aureus (CA-MRSA)

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Messages 21 - 40 of total 66 in this topic << First  |  < Previous  |  Show All  |  Next >  |  Last >>
quietpartner

Trad climber
Moantannah
Nov 7, 2006 - 08:53pm PT
Awright, awright, I'm never climbing the crags again unless the sun has been blasting it with ultraviolet radiation for days, and no climber has touched it in weeks. ;^)
LEB

climber
Glen Gardner
Nov 7, 2006 - 08:59pm PT
quiet,

You really do not have to worry much about this problem when climbing outdoors. This is an issue for persons who climb in gyms, wrestle in gyms or even weight lift in gyms. It is also a problem for folks like firemen, soldiers and other persons who live in close contact with others as they share communal facilities. If you are strictly an outdoor climber, this need not be a concern for you. You have plenty of other things to worry about: falling, equipment failure, allergic reactions to bees/wasps, hypothermia, altitude sickness, etc.
meg_

Trad climber
Boston
Nov 7, 2006 - 09:25pm 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.
LEB

climber
Glen Gardner
Nov 7, 2006 - 09:33pm PT
meg,

While I can appreciate your rationale, outdoor rock is simply not a good millieu for S aureus. There are pathogens which "hang out" outdoors, to be sure, but the scenario you describe is simply not one of them. Each pathogen has environments in which it thrives.

Now if you start talking about sharing sleeping bags, plastic backpacking mats, climbing harnesses, - this sort of thing, etc. then we can talk about spreading staph. Absent sharing gear on outdoor ventures, the liklihood of anyone getting MRSA from a rock is not very probable.
meg_

Trad climber
Boston
Nov 7, 2006 - 09:43pm 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 :)
LEB

climber
Glen Gardner
Nov 7, 2006 - 10:00pm PT
Meg,

You need sweat, you need heat (body temp) and you need adequate moisture for staph to thrive. Pieces of skin alone is not going to do it. Isolated particles of skin on rocks would not likely be sufficient for staph to survive.

Now when we talk about mats in indoor gyms, we have plenty of sweat, we have nice warm temperatures and a substrate (the plastic and the foam) which they (the bacteria) like. Same thing when fireman share bunks, faucets, plastic chairs, etc. Fireman wear heavy jackets and then they go into places which are very hot causing the men to sweat profusely. They can't easily throw their jackets in the washer on a regular basis. After fighting the fire, they then go back to the (warm) firehouse and touch (or sit on) everything.

Rock, by contrast, is coolish or else it is very hot from baking in the sun. Sweat does not soak into rock and any sweat which falls on a rock is miniscule in comparison the the size of the rock. Accordingly little pieces of skin which find their way onto the rock do not find a very hospitable enviroment in which the staph on them can grow.

P.S. again when using indoor equipment, showering with good antibacterial soap is crucial. No one should be sweating his or her brains out at the gym, throwing on his or her clothes without showering and then going home to crash on one's bed and sleep all night. By the time one gets around to showering in the am before going to work, the damage is already done.
ernst

Trad climber
west coast
Nov 7, 2006 - 10:11pm 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.
LEB

climber
Glen Gardner
Nov 7, 2006 - 10:22pm PT
ernst,

I like mupirocin (Bactroban) for topical application and nasal colonization. I also find that staph (more than other organisms) tends to form very loculated abscesses. Even the small, pimple-like ones seem to loculate. I find that when you do an I and D on any staph abcess, you really have to be en-guard to make sure all those membranes get broken up.
TradIsGood

Fun-loving climber
the Gunks end of the country
Nov 8, 2006 - 05:37am 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 - 06:29am 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.

LEB

climber
Glen Gardner
Nov 8, 2006 - 06:50am PT
Meg's position is well taken and well-spoken. Now Meg there is something I want to tell you. Your very best friend in the whole world (in this arena) is your own immune system. Do everything you possibly can to keep it strong and healthy. It will serve you well.

BTW, I, too, would be very annoyed if I spent huge amounts of money and did not receive proper treatment for something. You are correct in saying that MRSA is not always foremost on the prescriber's brain when we look at skin infections in healthy, young persons. Perhaps, we providers need to keep a higher index of suspicion. I certainly will now that you and others have posted all this stuff about your experiences.
TradIsGood

Fun-loving climber
the Gunks end of the country
Nov 8, 2006 - 07:03am 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 - 07:19am 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 - 08:03am 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.
LEB

climber
Glen Gardner
Nov 8, 2006 - 09:41am PT
radical, these is good news about Bactrim because it is alot cheaper (actually it is dirt cheap) and has a lower side-effect profile than vanco. Also it is PO. One major problem with Bactrim, however, is that it is a sulfa drug. That will knock out a good percentage of the people given how common sulfa-allergies are.

Thanks very much for posting all the good info on MSRA. I for one learned from it and I will now have a higher index of suspicion when I see patients with suspicious lesions. Your efforts were most appreciated in this regard. Go, nurses!
meg_

Trad climber
Boston
Nov 8, 2006 - 10:08am 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 - 10:18am 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 - 12:25pm 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 - 01:00pm 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 - 01:38pm PT
>>Oh- Staph can live on climbing holds for up to 4 days

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