December 8, 2005
Invasion of the 'spiders'
by DR. JAY DAVIS
IT STARTS AS A SMALL PIMPLE, usually dismissed as a harmless zit. Within several days it may be several inches across. By now it is red, hard and painful, and the hurt goes deep below the skin. Almost every patient assumes it's a spider bite.
And almost every patient is wrong.
We are in the midst of a nasty epidemic of skin abscesses: infections that were once limited to needle-sticking drug abusers, or immune-compromised diabetics. Now they routinely appear on the formerly-flawless skin of our healthy young people. And while five years ago I could count on seeing such patients about once a week, today they're daily visitors.
The villain is staph Staphylococcus Aureus, a species of bacteria we have battled for eons. Most of the time, we live in wary truce with the billions of staph that colonize our skin: They live on the outside, and we live on the inside. But every now and then the staph turn vicious, and when the skin barrier is breached, all hell breaks loose. It is staph that causes "boils," a condition serious enough to be listed among the Biblical plagues.
In the pre-antibiotic era, staph infections could be as dangerous as cancer and a lot quicker. The teenage son of President Calvin Coolidge developed a blister on his foot playing tennis one day at the White House. The blister broke and developed into a staph infection. A week later he was dead.
Hope and optimism blossomed with the development of penicillin in the 1940s. The new drug could reverse the deadly march of staph. No longer would boils pour their venomous staph into the bloodstream and kill their victim. Instead boils melted away in the path of this new "wonder drug." For several years, it appeared that one of humanity's oldest foes was permanently vanquished.
But the rejoicing was premature. Within a decade of penicillin's widespread use, the wily staph developed immunity to it. At first only a few staph were resistant, but with the constant bombardment by penicillin the susceptible organisms died off, leaving only the resistant ones to reproduce. It was a brilliant demonstration of Darwin's survival of the fittest. Evolution was no longer a mere classroom concept.
The succeeding years saw a deadly arms race. The resistant staph had defeated penicillin by producing an enzyme called "beta-lactamase" a devilish chemical that rips apart the penicillin molecule. To counter this, pharmaceutical researchers created penicillins that were immune to the enzyme. And thus ended Round Two: Doctors had drugs with names like Methacillin and Dicloxacillin, and staph was again on the ropes.
As you might guess, this is not the end of the tale. About 10 years ago, reports again began surfacing about drug-resistant staph. Abbreviated MRSA (for Methicillin-Resistant Staph Aureus), this strain of staph was able to survive even those penicillins specifically created to kill it. This was bad news indeed. Since staph is on everybody's skin, what would happen if all staph morphed into the deadly MRSA?
At first, MRSA was limited to hospitalized patients critically ill folks who had been assaulted with practically every known antibiotic. But soon MRSA was growing on healthy people living in the community. Which brings us back to the beginning of our tale.
Perhaps two-thirds of the abscesses we see now are caused by MRSA. Today we treat with drugs like sulfa and tetracycline ancient antibiotics that only work because no right-thinking physician would have ever prescribed them in the days when staph-specific drugs ruled the prescription pad.
How long will it be until these "old" drugs lose their effectiveness? How long until the only cure for abscesses will be the treatment described by ancient Greeks opening the wound and draining the pus treatment that was tried, and failed, for the ailing son of Calvin Coolidge.
In all likelihood we will be saved again by the drug companies those high-profit, corporate monsters we love to vilify, who, when they're not having their way with our elected officials, manage to create chemical masterpieces that save our skins literally.
In the interim remember this: There is no epidemic of spider bites. We are merely seeing a resurgence of our old enemy staph.
Dr. Jay Davis is a physician at Humboldt State Student Health Services.
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