Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date.
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San Francisco Examiner - January 29, 2003
Noel Wilson, Of The Examiner Staff
"Any lab work that gets done, they'll look and see if it is there" and report it to city officials, said Department of Public Health spokeswoman Eileen Shields. Although Shields said there have been no cases reported here, people in The City's gay community say they have friends who have it.
In Los Angeles, there have been four outbreaks since summer, all linked through molecular fingerprinting, said Dr. Elizabeth Bancroft, a medical epidemiologist with the Los Angeles County Health Department. It began in the summer with a group of newborns at a hospital and later showed up in a group of gay men, a high school athletic team and an unidentified "large institution."
Since The Los Angeles Times first reported the outbreak Monday, more doctors are coming forward with cases, Bancroft said.
Although drug-resistant staph, or staphylococcus aureus, is not new, this outbreak appears to be unique, hitting young, healthy people with very little healthcare exposure. Normally, drug-resistant staph is contracted in a hospital, through surgical incisions or bedsores.
"This is particularly aggressive," Bancroft said, refusing to say how many people were affected or whether any were immune-suppressed.
"A lot of doctors and patients have been diagnosing them as spider bites," she said.
Initially an infection would appear as a boil that is red, hot, tender and swollen before filling with pus and becoming pointy, according to Dr. Mark Conant, a San Francisco dermatologist who was a pioneer in AIDS care.
A doctor should drain the lesion, he said, and request specific lab work: a culture and an antibiotic sensitivity test, and request that the lab keep the sample.
Conant said patients should insist on lab work and that "if managed care won't pay for it, they should raise hell."
Most importantly, patients should be sure to complete any drug regimen they are prescribed, he said.
"What we are seeing here is nothing more than people not taking their drugs," Conant said. "It's already happening with AIDS drugs. We're seeing the emergence of resistant HIV, and we're going to see the same thing with HIV drugs 10 years from now."
Staph, which resides in the nose, transfers easily to the skin and to other people.
Investigators say doctors, likely the first to spot a boil that won't heal, should be sure to prescribe drugs that work against drug-resistant staph instead of the usual methicillin or penicillin drugs.
E-mail: nwilson@examiner.com
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