Superbugs- children hit by playground superbug PVL-MRSA
Within two days he had suffered septic shock and total organ failure. Despite treatment with huge volumes of antibiotics, he was not expected to survive.
Daniel had been struck by Panton-Valentine leukocidin (PVL), a toxin that combines with MRSA, the methicillin-resistant staphylococcus aureus bacterium that causes thousands of infections in hospitals.
The PVL-MRSA infection can get into the skeleton, where it is particularly hard to treat with drugs. Instead, doctors have to remove infected bone.
Daniel was in a coma for a month and has had to undergo five operations to scrape out the infected bone in his leg and hip. He is now largely confined to a wheelchair. “One day he was playing happily, and the next day he couldn’t see, speak or move,” said Roberts, 33. “The doctors didn’t know what to say to me, they didn’t know what was happening.
“They tried drug after drug and nothing seemed to work. It was a terrifying experience that you would not wish on anyone. We still don’t know how much the bones will grow back or how well he will recover.”
David Hunt, a children’s orthopaedic surgeon at St Mary’s hospital, Paddington, said the infection had eaten away the bone in Daniel’s hip and leg.
“The most worrying element of Daniel’s story is that although he complained that his leg began to hurt after the fall, there was no sign of broken skin, bruising or other damage to allow the bacteria into his bloodstream,” said Hunt. “It is very alarming. We don’t know enough about these organisms. They are appearing in new forms and what happened here is going to happen more frequently.”
The phenomenon of PVL combining with MRSA was first identified in the United States several years ago. The Sunday Times established that reports of cases in Britain have occurred from the south coast to Birmingham.
They include a six-year-old girl left brain-damaged after she fell off her scooter and contracted the infection in her shin bone, from where it spread throughout her body; a boy of nine crippled after a graze playing football; a girl of 12 who fell while dancing; and a 13-year-old who banged his leg on the side of his bed, suffering similar near-fatal infections.
One 11-year-old in a boarding school did not appear to have had an accident that could have led to the bacteria taking hold.
Specialists in the condition accuse the labour government of ignoring warnings about the seriousness of PVL-MRSA, failing to mount adequate infection surveillance and blocking the use of a costly treatment to tackle it.
Professor Richard Wise, a leading microbiologist, says he warned a labour government health minister three years ago of the threat. Wise said the minister told civil servants: “This needs to be sorted, get it sorted.”
Yet the special advisory committee on antimicrobial resistance, which Wise chaired, was later disbanded, and a commitment to provide £250,000 to study the bug was not honoured. “It does seem strange to set up specialist advisory committees and then take no notice of the advice they give,” said Wise last week.
A deputation of three experts from the Intensive Care Society and specialist infectious diseases societies met officials to try to persuade them to change guidelines on the treatment of PVL. At present the use of intravenous immunoglobulin, a blood product that costs £2,500 a treatment, is not approved by the NHS. Doctors say it can save lives.
“We are bracing ourselves for much more of this,” said Nick Clarke, professor of paediatric orthopaedic surgery at Southampton University, whose team treated the case of the boarding school child and another nine-year-old victim.
“MRSA has not only mutated to get round antibiotics but it has also picked up this PVL toxin, which even seems to change once it has infected someone. There are grave fears about this in the paediatric orthopaedic community worldwide.”
A number of other cases, particularly of young adults, have involved PVL pneumonia, a “necrotising” infection that can eat away a fatal level of lung tissue within 48 hours.
One victim was Kirstie Bristow, 23, of Torpoint, Cornwall, who contracted it while pregnant two years ago. Luckily an Australian locum doctor recognised the symptoms and arranged emergency treatment. She was unconscious for three weeks and given only a 50% chance of survival. “I am so lucky to be alive,” she said recently. “It’s important people know what to look for and act quickly.”
Marina Morgan, a consultant microbiologist in Exeter, Devon, said the Health Protection Agency (HPA), had no idea of the real level of risk: “I have had eight cases of PVL pneumonia in Exeter alone and three of them have been fatal,” she said. “It is worrying and it will get worse.”
The latest HPA figures show the number of recorded PVL infections DOUBLED from 224 in 2005 to 496 in 2006. A Department of Health spokesman said research on the prevalence of PVL was now being planned.
According to other figures to be reported on Panorama on BBC1 tonight, 10 times as many elderly patients die from the superbug clostridium difficile in Britain as in any other country in the world. The health department denies the comparison.