Dear Readers:

Last time, I promised to look at an emerging condition: MRSA, or methicillin-resistant staphylococcus aureus. This is based on several communications, including this one from a massage therapist in the Northeast:

Hi Ruth - I'm searching the internet for help and I'm hoping that maybe you can point me in the right direction. I have been a massage therapist for 10 years and have suffered re-occurring boils since June. This past episode has been the worst and diagnosed as MRSA. I have been off work for 2 weeks now and not sure when I will return. However, when I do, I need to find a way to protect myself.

Any advice would be greatly appreciated.

Anyone who works in a hospital setting probably is already familiar with methicillin-resistant staphylococcus aureus, or MRSA, but this pathogen is now being found in community settings. Since we work so closely with people, it's in our best interest to be well-educated about this bug.

What Is MRSA?

Staphylococcus Aureus (named staphyle, Greek for grapes, and aureus for its yellow color under a microscope) is a group of bacteria known for colonizing human skin and nasal passages. Staph has two mechanisms to cause damage to humans: active tissue invasion through the building of abscesses, and the release of corrosive toxins that can kill cells. MRSA is an antibiotic-resistant form of staph that usually colonizes the skin, respiratory tract, or urinary tract. It's estimated that about 1 percent of the population carries MRSA.

We all know that bacteria can be transmitted from one person to another, but they also can be transmitted from one area to another within the same person. In other words, if a child wipes his nose and then scratches his scabbed knee, it's possible his knee injury could develop a staphylococcus infection. Further, once such an infection is established, it's possible for the staph bacteria to travel through the bloodstream to set up infections elsewhere. Pneumonia, bone and joint infections, heart valve damage and varieties of toxic shock syndrome are all possible complications of superficial staph infections. These are particular risks for people who already are immune-compromised.

MRSA has been a relatively common nocosomial (hospital-based) infection since the 1950s, but in the past several years it has been identified in nursing homes, outpatient treatment centers, prisons, athletic facilities, and others; these outbreaks are called community-acquired infections. MRSA is considered an emerging disease because it's easily communicated from one person to another, and its incidence is rising quickly. It has been identified in about 12 percent of all cultured boils outside of hospital settings.

Signs and Symptoms: Community-acquired MRSA infections usually are picked up through skin-to-skin contact, cuts and abrasions or contaminated surfaces. They often look like a boil or spider bite: a single pustule that is large, red and might be mildly to extremely painful. Fever and fatigue might accompany the lesion, which gets progressively worse. It does not respond to topical or oral applications of methicillin, penicillin, oxacillin or amoxicillin.

Treatment Options: Treatment for MRSA requires long doses of antibiotics that are not in the penicillin family. Infections can recur if antibiotic treatment is not completed. MRSA currently is sensitive to vancomysin, but vancomysin-resistant bacteria have already been observed in some settings, and the crossover from MRSA to vancomysin-resistant staph is a distinct possibility. In addition to antibiotic prescriptions, MRSA infections might be lanced and drained. Pain usually is managed with NSAIDs.

The continuing evolution of this and other pathogens makes prevention of infection vitally important for any person who comes in close contact with other people. Preventive measures include washing and carefully covering all open sores, avoiding picking at or touching open sores, not sharing any personal items like towels or razors, and disinfecting all surfaces touched by many people.

Massage?

The recommended protocols to prevent the spread of MRSA are the same as those to prevent the spread of any contagious condition: observe standard precautions by covering any skin lesions, and cleaning all surfaces and fabrics that clients contact.

Any client with an undiagnosed skin lesion, especially if it's inflamed, painful and showing signs of infection (i.e., pus), should consult his or her primary care physician before getting massage. Certainly, if a boil-like lesion is accompanied by fever and malaise, the massage needs to be rescheduled and the client should be counseled to see a doctor. MRSA is a contagious and potentially dangerous bacterial infection that must be cleared before any modality that moves lymph or blood increases the risk of spreading infection.

Massage therapists who develop boils themselves and worry about whether they've been exposed to MRSA would be well-advised to consult their doctors, too. As long as the therapist is treating his or her diagnosed infection appropriately (this means taking the correct antibiotics exactly as prescribed), and as long as any lesions are carefully covered and not in an area that comes in contact with clients, giving massage is safe.

One resource available to people with concerns about contagious diseases is your local hospital. If you call and ask for the infection control department, they will connect you with a person whose job is to answer exactly these kinds of questions. Whenever I have done this I have left messages and received a call back within a day. This is a wonderful community resource and I encourage everyone to use it!

For Next Time

I've been on a communicable disease track for a while. In the past several issues, I have written about avian flu, whooping cough, and now MRSA. I am content to stay here: I could do a piece on meningitis, or mononucleosis ("kissing disease"). Or, we could pick up a new thread with a common, stubborn chronic skin condition: psoriasis. It's up to you - let me know, what's on your table?

Many thanks and many blessings.

Resources

1. Community-Associated MRSA Information for the Public. Centers for Disease Control and Prevention. www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.
   
2. Los Angeles County Department of Health Services Guidelines for Reducing the Spread of Staph / CAMRSA in Non-Health Care Settings. County of Los Angeles De-partment of Health Services. http://lapublichealth.org/acd/MRSA.htm.
   
3. MRSA Infections: Physicians Expect to See More Cases in Athletes. The Physician and Sportsmedicine, Vol 32, No. 10, October 2004. www.physsportsmed.com/issues/2004/1004/news1004.htm.