Combating CA-MRSA in Physical Education, Sports, and Dance: This Potentially Deadly Bacterial Infection Demands Attention
Andrews, Amanda K., Candice, Howard-Shaughnessy, Adams, Jon E., JOPERD--The Journal of Physical Education, Recreation & Dance
For years, methicillin-resistant Staphylococcus aureus (MRSA), commonly known as "staph," had been believed to be a problem limited to hospitals. However, a new strain of antibiotic-resistant Staphylococcus termed "community-associated" or "community-acquired" MRSA (CA-MRSA) is infecting the sport community at alarming rates (Centers for Disease Control and Prevention [CDC], 2003). Infections have been noted at all levels of sport--including high school, college, and even professional sports--as well as at local health facilities. Left untreated, this infection can spread and cause life-altering damage, the loss of a limb, and in extreme cases, death.
What Is CA-MRSA?
Community-associated MRSA is a bacterial infection that will initially present itself as a small bump. It is often mistaken for a "bug bite" or an ingrown hair. This bump will rapidly grow in size and will eventually expand into an abscess that will be extremely red and may have pustule drainage (figure 1). Some abscesses look like enlarged pimples or clusters of pimple "heads" called carbuncles or, in laymen's terms, a "boil" (Gorwitz et al., 2006).
In 2005, the CDC (2005) noted,
... outbreaks of MRSA in community settings [i.e., CA-MRSA] have been associated with strains that have some unique microbiologic and genetic properties compared with the traditional hospital-based MRSA strains, suggesting some biologic properties (e.g., virulence factors) may allow the community strains to spread more easily....
A recent study (Labandeira-Rey, 2007) confirmed this speculation, identifying Panton-Valentine Leukocidin (PVL) toxin, secreted by CA-MRSA, as "a major virulence factor both in pneumonia and in deep-seated skin infections" (Bowden & Vandenesch, 2007, [paragraph] 3).
Potential for Death
This infection can result in death, in some cases, if not treated. Substantial attention to CA-MRSA began only in the late 1990s, with the deaths of four children in Minnesota and North Dakota (CDC, 1999). Subsequently, Texas Children's Hospital reported 14 cases of severe community-associated S. aureus infections in adolescents (12 were CA-MRSA), resulting in three deaths, between August 2002 and January 2004 (Gonzalez et al., 2005). One of the youths who died had acquired the infection from a football injury. Another football player, at Lycoming College in Pennsylvania, died of CA-MRSA in 2003 (Mihoces, 2006).
The potential lethality of the disease seems to have increased recently with the emergence of PVL toxin in most strains of CA-MRSA, in contrast to a previous rate of only five percent (Science Media Centre, 2007), and with this toxin's role in the often-fatal necrotizing pneumonia (Labandeira-Rey, 2007). Recent research has also found an association between CA-MRSA-caused pneumonia and influenza, which seems to act as a trigger (CDC, 2007). The CDC received reports of 15 such cases, including four deaths, during the 2003-04 influenza season. Another 10 cases, including six deaths, occurred in Louisiana and Georgia from December 2006 to January 2007.
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Where Is CA-MRSA?
The most recent group to report CA-MRSA is the athletic population. Athletes who participate in sports that involve close skin-to-skin contact, such as wresting, are more likely to have outbreaks of CA-MRSA infections. To take a less obvious example, an outbreak of CA-MRSA among members on a fencing team could be caused by sharing the sensor wire worn under the clothing. In sports such as football, turf burns and "strawberries" are easy entry points for many bacteria. The spread of CA-MRSA is often hastened by poor hygiene, sharing towels, direct skin-to-skin contact, and the close quarters of a locker room. Crowded environments with poor hygiene, such as prisons, have also reported instances of CA-MRSA. In professional baseball, Sammy Sosa, a player for the Baltimore Orioles, missed 16 games during the 2005 season due to a CA-MRSA infection in his foot. …