Two Sick Boys and a Deadly Medical Mystery

“Is that your son?” The nurse barked the words out before the parents of the 14-month-old boy could open their mouths. “Is that your son breathing like that?”

It was, and he was barely alive. “Come with me,” the triage nurse at Rady Children’s Hospital San Diego said as she grabbed the boy and carried him into the ER.

The year was 2005 — the last day of the year, in fact — and little Bryce Smith, whose skin had the sickly color of a faded bruise, was very ill. By the next morning, he was hooked up to a dozen IV bags and near death.

He had become one of the first people in the United States to come down with a case of pneumonia related to a staph infection known as MRSA. And the doctors at Children’s Hospital were among the first in the world to need to figure out what to do about it — and him.

Medical journalist Maryn McKenna tells the story of Bryce Smith and Carlos Don IV, a Ramona boy who developed the same disease, in the new book “Superbug: The Fatal Menace of MRSA.”

The disease once only struck hospital patients with weakened immune systems. It has spread to the general population, and is now thought to kill 19,000 people in the U.S. each year. (The CDC has more details about MRSA.)

I interviewed McKenna this week about what happened to the boys — and a sick baby elephant at the Wild Animal Park — and the ongoing threat of MRSA (methicillin-resistant Staphyloccocus aureus).

(Disclosure: I know McKenna through two journalism associations. She thanks me in the book’s acknowledgements.)

How did MRSA become a threat in the first place?

It was a hospital infection in the U.K. in 1961, landed in the U.S. in Boston in 1968 and worked its way across the country until there was a massive hospital outbreak in Seattle in 1980.

In the late 1990s, the bug changed slightly, became resistant to slightly different drugs, and acquired the ability to make people sick who are otherwise healthy. It didn’t need debilitated victims.

MRSA has also picked up some additional stuff in its genetic makeup, a virulent set of cellular toxins that do an enormous amount of tissue damage.

Nobody thought this bug would do this, and took medicine and public health a while to catch up. And while they were catching up, people were dying.

What stood out about Bryce Smith and a 12-year-old Ramona boy named Carlos Don IV who became ill in 2007 and also went to Children’s Hospital?

They were among the first victims, the canaries in the coal mine. (When Bryce appeared at the hospital) there had been fewer than 20 cases across the country since 2003.

By chance, two Children’s Hospital physicians, Dr. John Bradley and Dr. Bradley Peterson, had already seen a case of a two-week-old baby with flesh-eating bacteria connected to MRSA. So they already knew what the disease could do, right?

They were already attuned to the possibility that MRSA could behave in ways that were lethal and unusual. If Bryce had gone to another hospital, he might not have gotten the right treatment in time.

How did the boys get sick in the first place?

We don’t know how either kid got the infection. That’s one of the hardest things: MRSA is a variety of staph, which lives in and on us all during our lives.

Probably a third of the population walks around with staph living on their skin and inside their nostrils. The last estimate was that 1.5 percent of the population walks around with MRSA on them at any time.

It doesn’t necessarily make us sick. The reason why it does is still mysterious.

Carlos, the child from Ramona, passed away. Bryce survived his scare after spending almost two months in the hospital. How is he doing now, more than four years later?

He looks great, a very cute kid. He doesn’t look like he was in danger of death.

But he had some long-term damage: he’d forgotten how to walk, how to swallow. He got hooked on morphine as a painkiller and had to go on methadone, and he lost the hearing in one ear.

In another case you write about, a newborn elephant at the Wild Animal Park became mysteriously sick.

Her mother had a postpartum infection that was interfering with her milk production. The folks at the Wild Animal Park were really attached to these animals, so they decided to try to take the baby away and hand-rear her themselves. That hadn’t been done much there or much in the world.

They worked really hard at it, trying to get her to understand that she was still an elephant and not a human. Then she started getting sicker, and they thought she was a risk to them. Then they realized to their horror and guilt that it was MRSA: they had given MRSA to an animal in whom that bug had never been recorded before.

She died of a number of things, but the MRSA didn’t help.

This goes down in the medical history books as a footnote to the ongoing story of MRSA: They discovered that it could not only live in another species, but in a species nobody would ever have thought of. It makes sense that dogs and cats might get it from us, but that an elephant could get it from us — it’s so at the end of the curve, that in a small scale way it’s shocking and shows how inventive and adaptive this bug is and what a foe it is.

What have we learned from these cases?

The lessons is how unpredictable and dynamic bacteria are. We should not underestimate them.

We didn’t have to think about that very much in the glory days of the antibiotic miracle, after penicillin came out and companies were developing antibiotics right and left. But due to the spread of bacteria-resistant infections, we’re running out of antibiotics.

We have few treatment options, so we need to be much more thoughtful. We have to be clever.

– RANDY DOTINGA

 

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