Book Review: Superbug, The Fatal Menace of MRSA

Superbug, The Fatal Menace of MRSA, by Mary McKenna. Free Press, N.Y. N.Y. 271 pp., 2010

Review by Wm Olkowski, PhD

What’s MRSA and Why is it Important?

Methicillin Resistant Staphylococcus aureus (MRSA) is a strain of the common bacteria we all carry on our skin and mucus membranes like those in the nose.  Normally this commensal causes no problem but sometimes an infection develops that becomes very serious, cannot be treated with the commonly used antibiotics (AB’s) and can cause a horrible death.

AB resistance occurs when an infection is challenged repeatedly with an antibiotic.  The AB kills off the susceptible bacteria leaving the resistant.  A mutation is believed to be involved in developing resistance.  As a result the species changes to one that cannot be killed by that AB.  It is said to be resistant.  There is now so much resistance to ABs a tragedy looms.  And that’s the theme for this book.

Some History

The first big AB was penicillin.  The AB methicillin was the next choice when people got resistant to penicillin.  It’s a related substance hence the similarity in spelling, but very different in structure from penicillin and that was why it worked for so long.  Penicillin was a wonder drug as it worked on a whole range of bacteria and saved millions of lives.  Its very success caused its downfall, as the more it was used the faster resistance developed. And it was overused, for example, people were given this and other ABs when viruses were the cause and ABs don’t kill viruses.

Methicillin (first used in 1960) worked for a while.  Then SA got resistant to it and these strains could not be controlled and an epidemic would ensue.   Hospital stays got more complicated, longer and some people would die of what first would appear to be minor infections.  Some of these deaths were horrible pus filled infections dissolving skin, muscles and bones.

As more doctors were unable to treat MRSA infections successfully the seriousness of this situation began to be appreciated.  McKenna was a reporter who investigated a hospital epidemic of MRSA and then worked with the Kaiser Family Foundation making observations in ERs as part of a media fellowship program.  In every city she found MRSA everywhere she looked.  The range of infections ran from minor skin infections to gaping pus filled wounds in bones and muscles, and pneumonias that would kill.  She started a blog, called “Superbug” for reporting on such cases and developing epidemics.  This book documents her discoveries and is instructive in many ways.

It’s not just a Hospital Infection

At first MRSA was considered only a hospital acquired infection, but later different strains were found not associated with hospitals.  In the early stages infections were noted in nurseries in hospitals, as new mothers would return after a few weeks with their infected babies, many of which died horrible deaths.  Thus was born MRSA hospital infection epidemics.  Even today MRSA is believed by many to be only a hospital infection.

Although MRSA strains from the community are very different from the hospital strains, the source of these community strains is unknown.  They may be hospital strains that have established somewhere in the community and then mutated to appear different to the immune system and that is a big threat as MRSA, with its large arsenal of toxins is a terrible way of death.

One of the most important lessons from this phenomenon is the need and importance of detection and hand washing.  Note that there is still no national surveillance system for reporting MRSA cases.  The Dutch and other European health systems had such a system in place decades ago and have not experienced the same sort of epidemics we in the US have.  The Dutch also cultured every hospital patient to detect MRSA strains upon entry to the hospital.  In cases where no obvious infection was present but the organism was detected each patient was treated to remove such “colonized patients”.  When every patient in the hospital is decolonized there is no epidemic.

Consequently each hospital afflicted with MRSA cases in our country had to go at detection and control with their own personnel and labs, a rather poor response to the suffering inflicted by this tragedy.  One wonders why people persist in insisting on keeping health care in an industry whose goal is profit.  Stupidities abound when ignorance masquerades as ideology.  Do you notice that those who insist on how bad government is segregate out the military, the largest and most error prone part of government from their view of our political systems defects?

McKenna examines programs run by hospitals to detect and treat patients and their ability to contain these local epidemics.  In one case she describes how a hospital put a nurse with sufficient authority to monitor compliance for hand washing by physicians and staff.  The nurse documented that in too many cases compliance was less than 50%.  Repeatedly the nurse found physicians going from patient to patient without washing their hands.

When compliance rose to 97% or more the epidemic was stopped and no further cases were noted.  Fortunately a simple nose swab and culture detects these strains.  But this costs a hospital not the insurance industry.  Such fragmentation is unbelievable, especially when one knows it’s such a terrible process of treatment and when it fails a horrible death.  So wash hands and make sure your doctor washes his/her hands before he touches you.

Next is a most amazing story of a cure.  Decades ago I read a great book called “Man Adapting” by the famous microbiologist Rene Dubois.  He proposed adding benign strains of SA to newborn babies so these inoculations would adapt and prevent infections by more damaging strains.  At that time such a suggestion was an advanced idea.  Now comes an example of just how such a procedure could work.

One of the hospitals tracking the source of the infective strain of MRSA traced it to a nursery where no baby had been found to be infected by a deadly MRSA strain then rampant in the hospital.  Then after swabbing all the hundreds of staff one nurse in the nursery was found with a benign strain, labeled as 502a.  Two investigators working to find useful treatments tried an experiment on a small family who had repeated MRSA infections and a few years of misery of unsuccessful but intermittent repeated infections.  Apparently their MRSA strain would hide and then reinfect.  So the two investigators set up an AB course to knock back the infection, treating with an AB mix for 12 days.  After that they inoculated the family with 502a and the colonization was successful, as no reinfections occurred.  But this experiment was never repeated as the two investigators separated and joined other institutions.

This story affirms an approach which Dubois suggested decades ago, but has never been adequately followed up.

So beware of hospital infections.  Before admission look into their infection control systems and check on compliance for hand washing.  It would help if hospitals were required to publish their infection rates and compliance with sanitation practices, but that seems just too much for a system running on profit.

Wishing MRSA on those who oppose a public healthcare system or even a public option would provide some incentive, albeit too late for prevention.  But the decision makers in our congress don’t have to worry as they have a publically supported health care system which they denied the rest of us, even as an option.

“When will we ever learn?”

 

Book Review: Riddled with Life by Marlene Zuk

Harcourt.  327 pp., 2007

Subtitle:  Friendly Worms, Ladybug Sex, and the parasites that make us who we are.

Review by Wm Olkowski, PhD

This is a most amazing book, for a combination of reasons.  It is well written, with synoptic summaries of many complex areas pertaining to our health and well being, e.g., evolution, immunology, sexual selection, nutrition, sexually transmitted diseases, disease dynamics, ethnology, and parasite treatment selection, among others.

Did you know that parasites all over the world change the behavior of their hosts so as to aid their own survival and transmission?  Seems logical, right? When one knows that most people in the world are or have been infected with the protozoan parasite, causal agent of Toxoplasmosis (Toxoplasma canis is a parasite of the family cat), the pause for thought about that fact could be significant.  Infections are acquired by breathing cat feces, most likely in changing cat litter.

Infection rates from toxoplasma surveys run from 20-80% of populations assayed.  If such large portions of people have been exposed to this protozoan and if parasites affect the behavior of their hosts we have a cryptic disease-causing organism right in our homes and it could be most severe as it requires an intermediate host, the cat flea.

Cats get the infection from mice and rats that get it from eating fecal matter.  The local sandboxes at playgrounds are good sources too.  T. canis can cause miscarriages, and probably damages the developing fetus.  Now there’s a pleasant thought.  What if these and other organisms are really good at hiding in our bodies causing troubles we cannot detect, nor treat?

Zuk speculates that such hidden parasites are worthy unappreciated threats and could be causes of other modern diseases.  After all, the discovery of how a bacterium, Helicobacter pylori, was the causal agent of stomach ulcers reversed the common belief that stomach ulcers were produced by stress.  Two Australian physicians got a noble prize for this discovery.  A month long course of antibiotic treatment eliminates the symptoms and the infection.   Could these sorts of infections/infestations explain so much stupid and erratic behavior hosts exhibit, including contributing to car accidents and criminal activity, like violent altercations?  Zuk suggests this may be the case, with other extrapolations from animals and even human studies showing higher car accident rates with people infected with Toxoplasmosis.

Alone, the presentation of new scientific findings about our closest “real relatives” on the tree of life is worth attention from all parasitologists, biologists, public health personnel, microbiologists and physicians, just to keep up with new findings.

But Zuk’s thesis is that since these sometimes killers can and have helped our species over the past thousands of years and generations, they may be helpful again now in understanding how we got to be who we are, and how we arrived at our genetic and phenotypical selves and what we could do about it.

Childhood Fevers – Better to Leave Them Untreated

Her discussion about fevers is exemplary for new information, and its consequences for health care and treatment selections.  For example, childhood fever is the most common reason parents bring children to hospital ERs, all for nothing, it turns out.  Also, such visits are the most common cause for visits to the ER overall.  Think of the economic cost and the pain and suffering one experiences in the ER, waiting, and waiting, for help in the midst of a crowd of really sick people.  Then, add in the costs of buying the aspirin, acetaminophen, ibuprofen, to treat such fevers, to say nothing about the side effects these drugs can have.

New information says that treating a childhood fever is useless.  This comes from a paper in the Bulletin of the World Health Organization that surveyed the use of fever reducing drugs and their efficacy in a number of countries.  This conclusion was based on large populations in double-blind placebo controlled studies.  They found that these drugs made no difference in outcome, neither in duration nor comfort level of the children.  Febrile seizures are also another example of misinformation.

Pathogenicity Is A Gradient

Our life as humans is riddled with many other organisms, particularly potential and actual pathogens like helminths, protozoa, bacteria, prions, insects, rickettsia, and viruses.   But more importantly what these species have done to our species needs further examination.  A pathogen in the strict sense is any organism that can cause disease.  Zuk presents a view of pathogens as being our partners in evolution, and through this appreciation she thinks we can learn a great deal about how to get along with them.

Maybe.  At least in a grand view not just focus on eliminating them.  As she demonstrates over and over we are still learning a great deal about most of these species.  {There aren’t any I would tolerate deliberately tolerate, however, maybe I would make an exception for good strains of probiotics, including Escherica coli, toxic strains of which invade at birth and can track along for a lifetime causing problems).

Zuk’s goal in presenting a great set of findings about poorly studied species of great medical importance.  I use that term in the sense that my grandmother stressed to me: “When you lose your health, you lose everything.” And these organisms can destroy bodies and lifetimes.

The ignorance about these organisms is widespread, their biology and control is poorly understood and difficult to diagnose by medical professionals, and mostly overlooked by everybody else.

Inventory the Parasites of the World

This is an example one of the ideas Zuk sprinkles here and there through out the book.  This one is dear to me as I started evaluating this idea back in graduate school.  I found out that this process was already on going.  Now we have the tree of life web project (http://tolweb.org/tree/)instigated by E.O. Wilson.  The objective is to document all the life forms on the planet, making it a sort of wikiLife project.  This maybe just the time for this sort of thing because it relies on volunteers, mostly.

Book Review: Cure Unknown, Inside the Lyme Epidemic, by Pamela Weintraub

St. Martin’s Press, N.Y. 408 pp., 2008

Review by Wm Olkowski, PhD

This book combines the personal story of the Weintraub family, many others and renegade doctors fighting for the infected patients vs. the medical establishment who were blinded by ignorance.  And it may still be the case as a check on the CDC and the NIH website will show.  Weintraub and her husband are journalists who moved into a Lyme disease enclave in Chapaqua New York to escape the city environment.  Their story of infection and the search for treatment and the story of thousands of others denied diagnosis and consequently treatment led her on a many year quest to find answers to this most unusual infectious disease complexes.  The blinded ignorance is described over and over again and refers to first a steady myopia by academic researchers and government officials, most notably the CDC, who is supposed to be protecting us from such maladies, but in essence repeatedly dropped the ball.  This is a most disturbing book undermines confidence in CDC, after all what else are they dropping from hubris.  But the story is complex.

We now know that Lyme disease with its many diverse symptoms can be caused by at least 3 and up to six pathogens all transmitted by ticks, including the first found, a spirochete called Borrelia burgdorferi.  And there may be more pathogens.  Another spirochete, Treponemia pallidum, the causal agent of syphilis, was virtually knocked out by early antibiotics, particularly penicillin.  If only the earlier experiences with syphilis were examined more closely by investigators, things might have been different.  And then there is the European experience with different strains, which does not seem to be part of this CDC nor US considerations.

And then there are the clinicians who learned that the infections could not be treated successfully with a few weeks of antibiotics as the medical establishment said.  These “renegades” were threatened with loss of license, brought before examination cabals and gave up treating patients from these threats.  This adds another layer of stupidity but tells much about the current health care system in the US, dominated by private insurance companies trying to maximize profits to the disregard for patient experiences.  Repeatedly patients who knew something was wrong became highly frustrated by the inability to get real help from their medial professionals.   Patients who get long term antibiotic treatments, some of which improve the lives of patients even when they do not cure, are consigned to a life long disease and high expense.  For example, when denied a positive (usually blood test) diagnosis and subsequently treatment can spend up to $100,000 if they can find a doctor who is willing to go against the establishment.  No wonder the insurance companies wanted to believe that chronic lime did not exist.

The movie “Under the Skin” covers this ground but like most such exposés leaves out much of the science leaving the viewer with a sad feeling of another tragedy among so many others.  Weintraub covers some recent science, including the great work mostly by veterinarians working with mice and other animals who show that the Borrelia spirochete can form cysts which are resistant to antibiotics and can hide in various tissues, particularly collagen based where they cannot be killed.   This cyst stage, and the odd shapes it forms, was missed by early researchers who stubbornly resisted searching and acknowledging patient experiences, in order to find the long-term cause and treatments.  Even today I don’t know the status of this situation as Weintraub’s book is now four years old already, and possibly fast changing discoveries may provide some hope.  This of course, assumes that the medical establishment gets off its high horse and looks further to account for actual patient experiences rather than assume they know everything.

One of the heroes of this story is a doctor who successfully fought the ignorant medical establishment and retained his license, Joe Burrascano.  He has a website from which one can download his continually revised book on treatment.  The book is sizeable and now in its 16th revision as he updates it as he learns more.  His website should be explored as it contains many other resources for Lyme patients, especially the free documents: http://www.lymediseaseresource.com/Free_Ebooks.html.  Burrascano’s website is far superior to either the CDC or NIH websites covering the same disease.  Sometimes people never learn.  No wonder some hate Burrascano.

The arrogance of many doctors and researchers is certainly a barrier, but that can have a human face.  Insurance companies are just phone calls and premiums via phone and paper.  And still our representatives look to private sources for medical help.  Gads! My sympathies go out to those infected.