Flu and USA300: The Perfect Storm

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For all the media hype, there’s not much an ordinary reader can do, at this point, about bird flu. Unfortunately, the hype--and growing fatigue--with the subject has obscured important news of a more immediate but less-publicized flu threat.

RICKY LANNETTI in classic running form. Photo by Dick Hostrander.

Two winters ago, emergency-room doctors across the country reported a spate of deaths involving rapidly worsening pneumonia in flu-weakened but previously healthy young adults. One of those victims was Ricky Lannetti, the star wide receiver for Lycoming College, in Williamsport, PA, when he died on December 6th, 2003.

“Like sand running through our fingers,” is how the doctors at Williamsport Community Hospital described Ricky’s rapid decline from flu-like symptoms to massive organ failure and death over the course of 12 hours.

Autopsy showed that Ricky died from an overwhelming infection of methicillin-resistant staph aureus, or MRSA, this on the heels of the flu that had been downing students on his campus since they returned from Thanksgiving break.

The CDC’s analysis of the staph that killed Ricky showed it to be the same nasty strain--USA300--that had been making headlines for causing so-called “flesh eating” skin infections among college and pro athletes the previous year.

That same flu season, hospitals in Baltimore saw four eerily similar deaths. Infectious-disease specialist John Francis, of Baltimore’s John Hopkins University, led the team of investigators who made the link between USA300 and influenza.

Doctors have long known, of course, that flu predisposes the frail and immune-compromised to bacterial lung infections, which is why this patient group is at the top of the list for vaccination each season.

Now USA300 staph provides ample reason for the rest of us to get vaccinated. Its genetic tricks include an array of toxins, including one that garrotes the white blood cells that the immune system deploys to attack microbial invaders.

“When this strain of staph ends up in the same body as the influenza virus,” says Francis, “the result is the perfect storm, a one-two punch to the immune system.”

Bear in mind, about a third of us silently harbor one strain of staph or another inside our nostrils without ever realizing it. It's not something doctors try to eradicate because, well, it just pops right back. Or worse, you get rid of a one strain only to pick up a worse one.

Some researchers have suggested that the only way to prevent colonization with a potential killer such as USA300 might be to inoculate people with a relatively harmless strain of staph. (Choose who gets your parking places, as it were.) Something very similar was done in the 1950s and '60s to stop an epidemic of highly virulent staph that was infecting and killing newborns in hospital nurseries around the world. Indeed, there's growing evidence that USA300 may be that same pandemic killer reincarnated in methicillin-resistant form. (more on that later)

Meanwhile, USA300s is rapidly spreading. It is now THE dominant strain in a number of communities across North America, and has begun surfacing in other countries as well. But surveys of its presence—typically done by testing patients coming into hospitals--remain sparse.

So how to protect yourself? Experts in infection control offer a few modest tips such as don't share towels and equipment at the gym. More importantly, though, it's not to late to get a flu shot to protect yourself of the worst-case scenario of potentially deadly co-infection--advice especially important for team athletes and college students, whose close quarters and shared athletic equipment encourage USA300's spread.

Here’s the medical journal report from the Baltimore investigators who connected the influenza-USA300 dots. And here’s a link to the Ricky Lannetti memorial website recently launched by his father. It likewise includes more information on MRSA.

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I suppose you are aware that this problem is not unique to adolescents or young adults? That is, it's happening in young children also:

From "Troubling Trends Converge" (Sept 22, 2005) Univ of Chicago Medical Ctr

" . . . three cases of rapidly progressive and ultimately fatal Staphylococcus aureus infections in small children. Although all three children were previously healthy, the infection caused severe sepsis, rapid clinical deterioration and bleeding into the adrenal glands, a complication, known as Waterhouse-Friderichsen syndrome, that is usually associated with fulminant bacterial meningitis. Two of the three bacterial strains were resistant to standard antibiotics. In all three cases, the disease progressed so rapidly that neither standard nor alternative antibiotics had an effect."

"In the 25 February 1998 issue of JAMA, however, a team led by Daum published the first study showing that Staphylococcus aureus infections that were already resistant to many types of antibiotics were being seen in children outside of the hospital environment. Many physicians initially had doubts, but since then cases of community-acquired methicillin-resistant Staphyllococcus aureus infections (now known as CA-MRSA)have been detected in most major U.S. cities and several rural settings, and subsequently in Europe, Asia and South America."

A very good point by PF Jennings. Community-acquired MRSA, in general, and USA300, in particular, both came to light in 1998 with the referenced deaths of three Midwestern children. Rates may be higher now among young adults owing to the elevated risk for picking up USA300 among team athletes and, perhaps, college students and others living and showering in shared quarters. Prison inmates are also at high risk.

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