Random Nature #30

Neurotoxic Waste:  The genus Clostridium is famous for a bacterium whose extremely toxic waste product causes botulism, an often fatal paralytic condition.  The bacteria can be found in soil and marine sediments, and can go dormant when times are bad.  Being anaerobic, it thrives in the absence of oxygen. 

If the bacteria's spores get into a closed wound, a baby's intestine, or something like a can of soup or vacuum-packed food which hasn't been sterilized properly, it can grow...and create toxins.  Babies are more vulnerable to the bacteria, so it is recommended that they not be fed honey before their first birthday.  About 13 percent of tested honey samples contain low levels of the spore, which the average person's immune system easily fends off.

Four of the seven types of botulism toxin can cause illness or death.  There are about 110 cases of botulism poisoning in the U.S. each year, a number which is slowly rising due to black tar heroin use.  Boiling for 10 minutes destroys the toxin.  Highly acidic foods, some preservatives (like nitrates and nitrites), and cold temperatures inhibit the bacteria's growth.

Nowadays, many people think positive thoughts about being injected with very tiny amounts of botox, which paralyzes nerves and thus can smooth wrinkles.  It was originally developed to calm nerves for medical reasons.  A friend of mine was one of those in the original tests.  The muscles around one of her eyes spasmodically caused her to wink all the time--like a flinch or a tick.  It drove her nuts and made it distracting for people talking with her.  Botox quieted those nerves.

A Different Waste Product:  A bacterial relative of the botox producer is increasingly causing human health problems.  Clostridium difficile likes to grow in the stool of our large intestines.  Some strains are benign, while others produce waste products that cause us to eject our own waste products much too loosely and quickly.  Some cases are much worse than others, and unusually, Lomotil and Immodium are counterproductive treatments...they slow the intestines, thus increasing retention of the toxin.   

C. difficile is often opportunistic, attacking after other intestinal flora have become victims of friendly antibiotic fire while people are being treated for unrelated infections.  Recently, a superbug version has shown up, primarily thus far in Canadian hospitals.  The superbug is especially vicious to the sick and elderly, causing intestinal scarring, dehydration, and sometimes death.  It has killed over 600 people in Montreal hospitals alone since 2003.  In spore form, it's much harder to disinfect than live bacteria, and the spores can remain viable for 70 days.   

Fortunately despite its antibiotic trigger, C. difficile can be treated with flagyl and vancomycin...the "antibiotic of last resort."

MRSA:  There are various staph bacteria that live on our skin benignly and/or that cause minor infections like zits.  If staph gets into the wrong places, it can cause serious infections, toxic shock syndrome, and other sometimes life-threatening conditions.  And then there's Methicillin-resistant Staphylococcus aureus (MRSA), a formerly ordinary bacteria that's gained resistances to nearly everything, making it a "superbug."

The MRSA superbug can cause pneumonia as well as bone and skin infections, all of which can be fatal.  This superbug, like most superbugs, is found in hospitals, but it is increasingly being found in settings of close human contact, like child care centers, prisons, and sports teams (like maybe a football player who gets an infected rug burn). 

The toughest of the MRSA bacteria are resistant to all but vancomycin.  This 40-year-old antibiotic is the one doctors try to keep in reserve, only breaking it out when nothing else works.  Increasingly, doctors are having to turn to vancomycin, which is giving superbugs the chance to gain resistance to it as well.  For awhile, methicillin was the antibiotic of last resort for MSRA (and others).  Pfizer developed zyvox specifically to treat MSRA; but after just four years, resistant MSRA are showing up. 

Partially or fully vancomycin-resistant MSRA have turned up in eight nations as of June '04.  Evolution can sometimes be frighteningly quick.

Necrotizing Fasciitis:  If MSRA sounds like a flesh-eating bacteria, note that it's one of several that can cause the condition.  Most infamous is probably a distant cousin of MRSA, Streptococcus pyrogenes--which is also called Group A Streptococcus (GAS).  10-15 percent of school-age children carry one or more of the 80+ varieties of the GAS bacteria in their throats without symptoms.  However, especially if the more virulent forms of the bacteria can get a foothold, there are several possible results. 

GAS can cause strep throat, rheumatic fever, scarlet fever (the rash that sometimes goes with strep throat), and impetigo (a skin rash also caused by Staph. aureus of MSRA fame).  These are non-invasive GAS diseases (as they tend to stay on the surfaces of the skin and throat), despite the fact that rheumatic fever progresses to other connective tissues like the heart, brain, and joints.  Before antibiotics, it was a leading cause of death in children. 

Necrotizing fasciitis (NF) is one of several invasive GAS diseases (including versions of pneumonia, toxic shock syndrome, and septic infections), as it goes after things like blood, muscles, the lungs, etc.  It usually gains access to flesh via open sores and surgical procedures.  The GAS that causes NF is unusual in that it produces toxins and enzymes which damage soft tissues.  It has also developed ways to fool and/or survive white blood cells.   

Unfortunately, early symptoms of NF often feel flu-like and/or look like typical post-operative swelling, delaying proper treatment of the condition.  The tissue attacked by NF becomes gangrenous.  With a particularly aggressive flesh-eating bacteria like GAS, the necrosis can sometimes spread (often painfully) at over an inch of flesh an hour.  It usually takes massive doses of antibiotics and surgery (debridement--removing the bad flesh from the good) to arrest its progress.   

GAS is rapidly becoming resistant to erythromycin, part of its journey to becoming a superbug.

Comments

[Linda Stevens]

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[waptek]

I have had staph that swelled and then burst my feet open like water baloons, "painfull" dosn't cover it. The procedures for treatment are supposed to include; incision, drainage, & irrigation but the "emergancy room" said there liability policies forbade it?.
I was told at OHSU that i should file a malpractice suit against the emergancy room for there refusal.
I am prminantly at risk of loosing my legs..