Teen's skin infection turns out to be MRSA
Facial acne she could handle, but a big pimple on her arm - that was a little weird. The high school student showed the bump to her mother, who having read enough about unusual, potentially serious skin infections, promptly took the girl into the local emergency department for a professional opinion.
The lesion had come to a head and the treating physician was able to lance the area and obtain a wound culture swab for lab evaluation. These days, physicians often suspect that unusually placed skin lesions are likely to be caused by a resistant bug, most often MRSA, the bacterium formerly known as methicillin resistant Staphylococcus aureus.
The teen was put on the oral antibiotic clindamycin while her culture results were pending. This drug ended up being a good treatment choice, as by the time my partner checked the wound in the office a few days later, the skin was already healing nicely. At the same time, the lab was able to report that while the culprit was indeed MRSA, clindamycin was one of the few antibiotics effective against this particular strain.
Infectious disease experts at the Centers for Disease Control and Prevention divide MRSA into two categories: the infections found in health care settings, and CA-MRSA or community-associated or acquired infection. While both pathways can theoretically lead to serious infections of the lungs, blood or bone, CA-MRSA infections in otherwise healthy kids and adults tend to be limited to skin involvement, and usually respond well to incision and drainage of the lesion. Antibiotics may not even be needed if the infection is drained early on by a health care provider.
The CDC notes that MRSA can be spread in the school setting when young athletes share contaminated personal hygiene items such as towels and razors, or when an infected lesion comes into direct skin contact with a competitor's skin during close contact sports. Infections are more likely to occur when skin has already suffered a minor injury such as a small cut or abrasion, creating an entryway through what had previously been an intact, protective skin barrier. Other skin surfaces at risk include patches of skin with many hair follicles, such as the beard, armpit and groin.
As with prevention of all types of communicable diseases, from MRSA to influenza to the common cold, common sense prevails. Hand washing with soap and water, or with alcohol-based hand sanitizers, remains the cornerstone of infection control. The CDC also reminds young athletes to shower right after physical activity, to launder and fully dry contaminated linens, and to always use their own towels, razors and other personal hygiene items. Sharing is not caring in this case (and while we're on the subject, don't let me catch you drinking out of your teammate's water bottle!).
Students with clean cuts and abrasions can help prevent infection of these areas by covering their minor wounds until they are dry and healed. If an individual develops a pustular or weeping skin lesion, MRSA or not, it is OK to be around others if the area of infected skin is well-covered. School and sports participation should be avoided if the wound is draining and can't be kept "sealed-off" with a clean, dry bandage.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.