Mujeres! Cuidado com os tampões... Stalking a 'Superbug' <http://www.startribune.com/1244/story/1584744-a1584748-t3.html>
Photo by Jeff Wheeler <../mail?view=cm&tf=0&[EMAIL PROTECTED]> , Star Tribune Pat Schlievert transfered staph bacteria to a fresh petri dish in his University of Minnesota lab Monday afternoon. As MRSA outwits science's best weapons, a U of M microbiologist is at the forefront of finding ways to conquer the deadly bacteria. *By Josephine Marcotty <../mail?view=cm&tf=0&[EMAIL PROTECTED]>,*Star Tribune Last update: December 01, 2007 – 8:17 PM <http://oas.startribune.com/RealMedia/ads/click_lx.ads/www.startribune.com/health_wellness/1952775737/sponsor01/StarTribune/default/empty.gif/63393337366566393437353239363430> Related Content <http://www.startribune.com/1244/story/1584744-a1584749-t3.html> One of the scars from the staph infection that Renee Roehrick survived in 2004. *Jeff Wheeler <../mail?view=cm&tf=0&[EMAIL PROTECTED]> ,* Star Tribune - Elusive Staph <http://www.startribune.com/1244/story/1584763.html> More from Health + Wellness <http://www.startribune.com/1244> - Elusive Staph <http://www.startribune.com/1244/story/1584763.html> - Stalking a 'Superbug'<http://www.startribune.com/1244/story/1584744.html> - Yoga: Help in healing<http://www.startribune.com/1244/story/1582983.html> *R*enee Roehrick didn't know she had a new disease. In fact, she didn't know anything because the infection that started after a botched pedicure had crashed her blood pressure, turned her skin purple and put her on a respirator, unconscious at St. John's Hospital in Maplewood. Miles away in a cluttered University of Minnesota lab, microbiologist Pat Schlievert smeared a petri dish with a drop of her blood and watched the growing bacteria turn the bottom of the dish gold. Just as he and her doctor suspected: Staphylococcus aureus, commonly known as staph, had morphed again to fool doctors. Again, it was proving a lethal transformation. And again, Schlievert was in hot pursuit. In the war between killer bugs and humanity, Schlievert is one of the generals. As slender and energized as a live wire, he knows more about staph than just about anyone. That's why each day he fields phone calls and e-mails from doctors around the country seeking his help in figuring out if and how staph is making their patients sick. Last month Schlievert's 30-year war on staph hit the headlines. A Centers for Disease Control and Prevention study put the public on notice that a staph variety known as methicillin-resistant Staphylococcus aureus, or MRSA, belongs in the realm of superbugs to be feared. *T*he CDC study, which included about 100 cases in Minnesota, showed the increasingly antibiotic-resistant bacteria were running rampant in hospitals and nursing homes, and are increasing among otherwise healthy people. Researchers estimated that nationwide it contributed to the deaths of 19,000 people in 2005. Schlievert says that number is vastly underestimated, a testament to how the organism outwits even scientists. Nor is he optimistic about staying one step ahead of it. He has come to regard his bacterial nemesis as a remarkably ingenious life form, evolving to resist humanity's best weapons. "It keeps making new things," Schlievert said. "And it will continue in this never-ending battle in how to outdo us." *An initial breakthrough* So far, Schlievert has proved a potent adversary. He figured out how staph cleverly deploys toxins to hijack the body's immune system, and he has seen how it swoops in behind flu virus to roost in weakened lungs. Mike Osterholm, now director of the Center for Disease Research and Policy at the university, once gave Schlievert the ultimate compliment. Pat, he said, you think like a microbe. At the time they were trying to solve one of the biggest modern-day health mysteries -- toxic shock syndrome. In the early 1980s, toxic shock was a mysterious, rare but terrifying disease. For reasons no one could explain, some menstruating women would develop high fevers, rashes and a dangerous drop in blood pressure. Thousands of cases were reported, including dozens of deaths. Many of the early cases were identified in Minnesota, where Osterholm was the state epidemiologist and Schlievert was a young assistant professor at the university. The two things the women had in common when they got sick were their periods and staph bacteria in their vaginas -- but not in their blood or elsewhere inside their bodies. The CDC was quick to blame a new type of super-absorbent tampon called Rely. Its maker, Procter & Gamble, pulled it from the market. Both Osterholm and Schlievert thought there was more to it than the tampon. Between 1981 and 1983, Schlievert was one of the key researchers who proved it. Half of the population carries staph in or on their bodies, usually inside their noses. Though the bug can cause nasty boils and other skin infections, it generally wasn't considered dangerous to healthy people -- unless it had the right conditions. Schlievert showed those conditions existed inside the vagina of a menstruating woman with lots of oxygen provided by a tampon, even more so with super-absorbent tampons. Under those circumstances -- and only in some people who were susceptible -- the bacteria produced a toxin so powerful that a microscopic amount could kill. Even though the bacteria never entered the body, the toxin could penetrate the lining of the vagina and put some women in shock. Continued: Stalking a 'Superbug' [image: previous page]<http://www.startribune.com/1244/story/1584744.html> <http://www.startribune.com/1244/story/1584744.html> Related Content <http://www.startribune.com/1244/story/1584744-a1584748-t3.html> Pat Schlievert transfered staph bacteria to a fresh petri dish in his University of Minnesota lab Monday afternoon. *Jeff Wheeler <../mail?view=cm&tf=0&[EMAIL PROTECTED]> ,* Star Tribune <http://www.startribune.com/1244/story/1584744-a1584749-t3.html> One of the scars from the staph infection that Renee Roehrick survived in 2004. *Jeff Wheeler <../mail?view=cm&tf=0&[EMAIL PROTECTED]> ,* Star Tribune - Elusive Staph <http://www.startribune.com/1244/story/1584763.html> More from Health + Wellness <http://www.startribune.com/1244> - Elusive Staph <http://www.startribune.com/1244/story/1584763.html> - Stalking a 'Superbug'<http://www.startribune.com/1244/story/1584744.html> - Yoga: Help in healing<http://www.startribune.com/1244/story/1582983.html> "It was a new concept," said Dr. Frank Cerra, the university's senior vice president for health sciences. "That you would have bugs growing in a tampon that would release a toxin -- a toxic shock in the absence of an infection. It was controversial." But really, Schlievert said, all he had to do was think like a microbe. "If I was doing this, how would I do it? I would be the most common microbes and make people think I'm not doing anything. That's what I would do." *The long, shifting battle* That was nearly 30 years ago. Now Schlievert, 58, is one of the world's experts on toxins that some strains of staph produce and how they overwhelm the body's immune system. He still works in a cluttered lab, stuffed toy replicas of microbes dangling from the ceiling. "This one is adenovirus -- it causes the common cold," he said, reaching up to touch a fuzzy pink blob. He dashes around like a professional chef in a giant kitchen, slipping a petri dish from the bottom of a pile and deftly lighting a Bunsen burner. Schlievert runs six days a week and commutes by bike three days a week, year-round, from his home in Edina to the university campus. One of his favorite TV show, "House," about a doctor who solves medical mysteries, because he often does the same thing himself. One particularly memorable case came from a medical examiner who asked him to determine whether an infant covered with blisters -- one of the telltale symptoms of toxic shock -- had been killed by staph or a scalding at the hands of the baby's parents. That time it wasn't the microbe. Schlievert has even been called in on bedeviling bacterial cases for animal patients. He confirmed that two zoo dolphins, Misty and Stormy, died of toxic shock from blowhole infections. Word has gotten out that he makes the toxins in his lab for use in research. Once in a while he gets an e-mail from Iran, Syria or Iraq asking if he is willing to send along some of the toxins, which the federal government considers potential bioterrorist weapons. Those he forwards to the FBI. Schlievert estimates that 75 percent of adults are missing the protective antibodies to at least one of the four primary toxins created by different strains of the bacteria. Even more confounding to doctors attempting to diagnose their patients is that the bacteria and its toxins can have vastly different effects from patient to patient. "In some people the same strain might produce a boil and someone else could be critically ill," said Ruth Lynfield, state epidemiologist. It's not always clear what role the toxins play when staph does get into the blood, she said, where it can wreak havoc with heart valves, lungs and other organs. Staph-related pneumonia is one of the most common reasons people die from complications of flu. In fact, Schlievert says he believes that staph is the culprit in many more deaths than it gets credit for. He thinks that it will continue to outsmart doctors and researchers unless the federal government funds more research into how it resists antibiotics, and how it hijacks the immune system. And he's working on some new weapons himself. The university has patented a product he has devised with other researchers that he hopes can be used to block the toxins that the bacteria produce. In the meantime, staph's ability to adapt and change to produce new diseases provides Schlievert with an endlessly fascinating quest. Roehrick, 59, who lives in Wyoming, Minn., was a case in point. *A pedicure, then a coma* Now that she's nearly healthy again, Roehrick can joke about how she almost died from a pedicure. There is no proof of how she got the infection, but a week before she landed in the hospital in 2004, a pedicurist accidentally drew blood while scraping the bottom of her foot. She doesn't remember much about the hospital because she was in coma. But her infectious disease doctor, Dr. Gary Kravitz, who has worked closely with Schlievert on severe staph cases, said Roehrick was among a handful of patients who proved the microbe had caused another kind of deadly disease. She came into the hospital with severe muscle pain and went into shock. But she also developed a purple rash across her body -- usually associated with a different kind of bacterial infection altogether. Kravitz and Schlievert had already found staph was the culprit in a few other similar cases, so they knew what to look for in hers. "It was a signal that we were dealing with a different manifestation of staph," Kravitz said. "The toxins related to staph were changing and becoming more severe." The bug invaded her leg muscle. To get rid of it, surgeons removed a large swath of tissue in her thigh. In a wheelchair for months, she suffered nerve damage and still needs lifts in her shoes to walk. "But I'm alive, so none of that matters," she said. Of the five patients that Schlievert and Kravitz described in a paper published to warn doctors of the new disease, three died. A fourth had both legs amputated. Those kinds of severe toxic shock cases are very rare. Dr. Aaron DeVries is an epidemiologist with the Minnesota Department of Health, one of the few health agencies that tracks toxic shock. He said that each year in the Twin Cities area there are fewer than two such cases per 100,000 people. But Schlievert thinks there are more. The ones reported are only those that fit the CDC's definition of toxic shock, which Schlievert says is too narrow. He has seen hundreds of cases of severely ill people who tested positive for staph and its toxins. The bacteria's fluid properties don't always fit the CDC's precise definition. "We think we are smarter than microbes," Schlievert said. "But we have a few organisms that are like junkyard dogs. Like staph, they figure out how to become resistant very, very fast. It's only a matter of time." Josephine Marcotty • 612-673-7394 Josephine Marcotty • [EMAIL PROTECTED]<../mail?view=cm&tf=0&[EMAIL PROTECTED]> Co <http://www.startribune.com/1244/story/1584744-p2.html> [image: Next page] <http://www.startribune.com/1244/story/1584744-p2.html> -- ÿØÿà Oswald'Ørf
