Deadly new superbug hits Wales (Can cause Cellulitis)

Deadly new superbug hits Wales (Can cause Cellulitis)
Jan 10 2007
Madeleine Brindley, Western Mail

A PATIENT has been admitted to a Welsh hospital suffering from the new, potentially lethal superbug PVL-positive MRSA.

This is the same bug that killed a nurse and a patient in the West Midlands last year, and is thought to be one of the first cases of its kind in Wales.

The patient is being treated at Prince Charles Hospital in Merthyr Tydfil. It is understood that the patient, who has not been named, acquired the bug in the community - there is no evidence currently that it was caught in a healthcare setting.

The PVL toxin destroys white blood cells. PVL-positive MRSA commonly causes skin infections, such as cellulitis (inflammation of layers under the skin) and pus-producing conditions like abscesses, boils and carbuncles.

On very rare occasions it can lead to more severe infections, such as septic arthritis, blood poisoning or necrotising pneumonia - a severe, life-threatening form of pneumonia.

A joint statement from Paul Hollard, interim chief executive of North Glamorgan NHS Trust, and the National Public Health Service for Wales, last night said, "A patient with community-acquired Panton-Valentine Leukocidin (PVL)-positive MRSA has been admitted to Prince Charles Hospital, Merthyr Tydfil.

"The trust has liaised with the Health Protection Agency and the National Public Health Service for Wales and the appropriate infection control procedures have been put in place.
"The patient is comfortable and receiving appropriate treatment."

PVL is a toxin that is carried by about 2% of Staphylococcus aureus bacteria, including the antibiotic-resistant strains MRSA (methicillin-resistant Staphylococcus aureus) and MSSA (methicillin-sensitive Staphylococcus aureus).

But unlike MRSA and MSSA, with which the public have become familiar as the number of cases in hospitals has risen over the years, PVL-producing strains can affect previously healthy young children and young adults. People tend to become infected in the community.

This is in stark contrast to so-called hospital-associated MRSA and MSSA strains, which do not produce PVL, and affect more elderly and debilitated patients.

Dr Eleri Davies, director of the Welsh Healthcare Associated Infection Programme for the National Public Health Service for Wales, said, "The rate of transmission is the same for PVL-producing strains as it is for other Staphylococcus aureus infections - some infections will be caused by our own bacteria getting into a breach in the skin, such as a graze or a picked spot, or through transmission between close family members."

Until recently most cases of PVL-related infections were caused by PVL-positive strains of MSSA, which was common in hospitals in the 1950s and 1960s.

But experts have recently become aware of a small number of cases, like the one at Prince Charles Hospital, of PVL-positive MRSA infections.

It is thought that these new strains have evolved from PVL-positive MSSA.

The Health Protection Agency is aware of seven deaths in England and Wales associated with PVL-positive MRSA in the last two years, including the two deaths at the University Hospital of North Staffordshire last year.

The West Midlands cases were unique in that they were the first cases of PVL-positive MRSA that had been transmitted in a hospital or healthcare setting in the UK. Nine other people, including another patient, were infected in the same outbreak.

In most of the other deaths attributed to PVL-positive MRSA, the infections were caught in the community.

Last month six babies in a hospital neonatal unit in Norfolk tested positive for a strain of PVL-positive MSSA. One of the babies, who was born very premature and was extremely sick, died after contracting the infection.

The HPA website states, "While PVL-producing MRSA can cause more serious infection, we have no evidence to suggest it is more dangerous than some other types of MRSA.

"Indeed, some previous and more recent data suggests that the PVL gene may not be the main virulence factor even in PVL strains.

"PVL-positive MRSA has not been shown to spread more rapidly than any of the usual hospital-associated MRSA organisms.

"There is no indication that current PVL-positive MRSA strains are more transmissible than other MRSA strains."

Persons with recurrent skin infections - spreading inflammation [cellulitis], boils and abscesses - should seek medical advice.

"Standard treatment and infection control measures are highly effective."

PVL-positive MRSA can be treated with antibiotics, even though it is resistant to methicillin. But the HPA said it was important that the infection is diagnosed early.

As with MRSA, good hygiene is important to stop the infection spreading to other patients and hospital staff.

"The HPA said thorough hand-washing and drying, and the use of alcoholic hand rubs are the most important measures in reducing cross-infection in both the community and the hospital.
Its website also states, "The infection control measures used to prevent the spread of PVL-positive MRSA are the same as for any type of MRSA infection.

"Standard infection control measures are effective and the most important first line of defence."

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