by Eike Blohm, MD
MRSA — Methicillin-Resistant Staphylococcus Aureus — is a bacterium that has become immune to Penicillin-like and Cephalosporin-class antibiotics. The pathogen is found where people live together in close quarters such as hospitals, nursing homes, and overcrowded U.S. prisons.
How It Spreads: Transmission from one prisoner to another occurs by direct skin contact (such as a fist-bump) or indirectly (perhaps by using somebody else’s blanket).
Colonization vs. Infection: You may be colonized with MRSA and not know it. During colonization, the bacterium lives on the body surface — often in the nostrils — but doesn’t cause disease. However, a colonized person can still transmit MRSA to someone else. Infection occurs when the pathogen gets into the body, most commonly through small nicks in the skin.
Prison-Specific Risk Factors: Prisoners with recent antibiotic use have a heightened risk of MRSA infection, since these drugs can kill the “good” bacteria in your body and allow MRSA to grow unchecked. Intravenous drug use is also a risk factor. So is a recent trip to a hospital. Sharing personal items that come in contact with your skin — towels, clothes, soap — also increases your risk of infection. Finally, beware handwashing laundry, since the water temperature in your cell probably won’t be high enough to kill MRSA.
Illnesses Caused By MRSA: Skin and soft-tissue infections predominate in MRSA cases, appearing 95% of the time. These include: folliculitis, or infection of hair follicles; abscesses (“boils”); or cellulitis (a red, warm, tender area of skin). However, MRSA can infect virtually any organ it manages to reach and can even cause sepsis.
MRSA Often Misdiagnosed as “Spider Bites”: Most suspected spider bites are not from a spider at all but are MRSA infections. Only the Brown Recluse Spider can bite a person painlessly and thus unseen; but it tends to live in the dark recesses of basements and wood piles in the southern U.S., not in the brightly fluorescent steel-and-concrete world of prisons. Brown Recluse bites have a blue center where the skin is dying surrounded by a pale circle and a red halo (red, white, and blue). MRSA infections are only red and often produce pus.
What Else Could It Be? There are many skin infections that aren’t MRSA, often caused by different staph or strep bacteria. Some people get chronic red discoloration of their legs from venostasis — slow blood flow in the veins — which can look a lot like cellulitis. Unlike MRSA cellulitis, venostasic skin changes (1) don’t spread quickly, (2) they aren’t warmer than the surrounding skin, and (3) they don’t turn pale when a finger pushes on it.
MRSA Diagnosis and Treatment: Abscesses smaller than two inches (five centimeters) are often drained or treated with hot compresses. Antibiotics are usually not needed unless the person has a weakened immune system (perhaps from diabetes or HIV). Larger abscesses (over two inches) are more likely the result of MRSA and will benefit from drainage and antibiotics. Antibiotics can be given empirically (i.e., without testing for MRSA), or after MRSA is confirmed with a wound culture. Cellulitis routinely gets antibiotic therapy, but only TMP-SMX (“Bactrim”) and clindamycin can kill MRSA. A person with systemic symptoms such as fever may need IV antibiotics (vancomycin or linezolid) and might even need to be hospitalized.
Disclaimer: This column aims to educate prisoners about a common health condition, but it does not constitute medical advice and is no substitute for evaluation by a trained medical professional.
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