Flu complication question......Jill?...Sue?

A friend of mine suffering from the flu beome suddenly and critically ill from what sounds like a very nasty complication. He described the “super-bug” as a toxin producing strain of pneumococcal staph, resistant to all drugs except varomycin.

Now all this information came from my friend, and I can’t promise that he wasn’t exagerating his condition, although I do know for sure that he was very very sick. He claims that 4 other people were admitted to the hospital he was in for the same condition, and he was the only survivor. I have no info about the general health of the other 4 patients, but aside from being a heavy smoker, my friend is in good health with no chronic problems. He’s in his early forties.

Most of the information I can find regarding pneumococcal flu complications seems to indicate that generally they are only life threatening for the elderly or chronically ill. The bug my friend described is supposedly life-threatening for anyone if it isn’t treated quickly, which is consistent with what I’ve heard about other toxin-producing bacterial infections.

So what’s the straight dope on this? Is my friend unlucky enough to have caught something extremely rare? Or, despite the news reports I’ve heard, are flu complications killing off healthy young adults? How common is this?

Dropped that name into the search box & got this:

By Terence Monmaney
Los Angeles Times

In a disturbing sign of the growing danger of drug-resistant microbes, a new federal survey has found that 25 percent of the people sampled had pneumococcal infections resistant to penicillin, which was once nearly infallible in killing the bugs.

That figure is 1,000 times greater than estimates made only a decade ago, indicating that antibiotic-resistant pneumococcus germs have spread quickly and are now more common than researchers believed. Moreover, among one group of children under age 6, more than 40 percent had infections resistant to penicillin.

The bacteria cause pneumonia, meningitis and other diseases. Doctors worry about antibiotic resistance because it renders drugs useless or weakened, requiring much higher doses.

The study of 431 people in Atlanta, by researchers at Emory University and the U.S. Centers for Disease Control and Prevention, is the most thorough analysis yet of the prevalence of drug-resistant pneumococcus in a U.S. city. “We were quite shocked,” said Dr. Martin S. Cetron, a CDC epidemiologist involved in the study. He added, “This gives us the first handle on the extent of the problem, at least in Atlanta.”

A little clarification is needed here. Influenza is caused by a virus. While the virus alone can cause enough destruction to lung tissue to be fatal in rare cases, most deaths due to influenza are caused by secondary bacterial infections.

Staphylococcus aureus (SA) is the cause of most of these. Mostly, SA lives harmlessly in our nose, on our skin, etc without invading into tissue. When influenza causes marked inflammation of the lining of our nose & throats, and throughout the lungs, SA can get into the tissue and set up deep infections. Some strains of SA release toxins that can be fatal (Toxic Shock Syndrome). Others just do so much damage to the lung tissue that huge cavities develop. If enough lung tissue is destroyed this way, effective gas exchange is no longer possible. The bacteria can also get into the bloodstream & cause abscesses to arise anywhere else in the body. One area particualrly susceptible to these infections is the lining of the heart, particularly over the valves that regulate flow. In severe cases, heart valves can go from healthy to completely eaten away in 24-48 hours.

One of the worst of the “superbugs” in the news these days in SA which has developed resistance to penicillin-like antibiotics. The standard one mentioned for is Methicillin, so the bug is referred to as Methicillin-resistant Staph, or MRSA. Until very recently, Vancomycin is the only antibiotic with bacteriocidal (lethel) activity against MRSA. Another antibiotic, Rifampin, has bacteriostatic activity (slows growth in hopes of giving enough time for the immune system to have a chance), but it is not generally effective by itself.

Side-note: Sadly, 4 cases of deaths due to Vancomycin-resistant Staph or VRSA have now been reported in the US. Hopefully, SA strains resistant to it will not develop before different antibiotics are developed, but it took 15 years or so, IIRC, before the first cases of Penicillin-resistant Staph developed.

Pneumococcal pneumonia is caused by a different bacteria, Pneumococcus pneumoniae, formerly known as Streptococcus pneumoniae. It is the most common cause of ALL pneumonias, but a lesser cause of influenza-related secondary bacterial infections.

I think your friend probably had “just” a Staph-pneumonia, although it is possible he had both. There is no pneumococcal staph, however.

I see no reason to believe he was exaggerating. Staph pneumonia killed Jim Henson in his forties several years ago, and was responsible foe millions of deaths in the flu pandemic of 1918.

The elderly & persons with chronic lung or immune system limitations are more susceptible to secondary infections when infected with influenza. It is not common for a healthy person in their 40’s to get Staph pneumonia (unpaid political announcement: SMOKING makes it much less uncommon), but your friend is right about the fact that once the Staph pneumonia develops, it can be fatal in the healthiest of individuals.

On the one hand, your friend is unlucky to have gotten this secondary infection. OTOH, by now, you should realize your friend was also lucky to have lived to tell about it. Healthy people under 60-70 are not dropping like flies (like they did in 1918) from this flu outbreak. But hospitals are packed, and very sick people are being moved out of ICUs early in some places to make room for even sicker people.


Sue from El Paso

Experience is what you get when you didn’t get what you wanted.

Sorry - I got interrupted & this came out very unclear:

Hopefully, SA strains resistant to Vancomycin will not develop resistance to the just-released new antibiotics before even newer antibiotics can be developed.

But the pace with which resistance is emerging is clearly picking up, and new drug development will be hard-pressed to keep up.

Hope that’s clearer…


Sue from El Paso

Experience is what you get when you didn’t get what you wanted.

Personal anecdote. At the age of 26 I came down with a nasty flu which developed into a pneumonia so strong it probably could have killed me (I was taken to the emergency room with blue lips and a 104 degree fever). My health had otherwise been pretty good, though I was about a pack-a-day smoker, and has been mostly fine ever since.

In other words it’s not to be sneezed at, whatever your age and general health.

You do know there are pneumonia vaccinations, too, which last quite a long time?

This is a real reach, but has there been any research on ways to treat healthy people with some other drug which would select against penicillin (or other antibiotic) resistance. This could be as a follow-up treatment in people who’ve recently taken antibiotics. The goal would be to minimize the prevalence of resistant strains in society. The genes which make them antibiotic resistant probably don’t help much outside of the presence of the antibiotic. (or do they?)

What about introducing antibiotic susceptible strains of benign bugs like SA to people coming off treatment?

It is too clear, and so it is hard to see.

This is not really my area of expertise… it’s more my area of interest. MajorMD did an excellent job of answering the question. At least with recent flu outbreaks, most deaths are caused by secondary infections, not by the flu itself. That’s not to say there haven’t been killer influenzas - See the thread on the 1918 flu. One strange aspect of the 1918 flu was that it appeared in two waves - the first was a typical flu epidemic - fairly mild illness that generally resolved. The second wave was the killer. We have a lot better surveillance and early warnings of possibly outbreaks nowadays, but there’s no guarantee it can’t happen again.
Jill

I never heard of the Pneumonia vaccines. Tell more.

Sue and Jill- Is there any means of “beefing up” one’s immune system to keep this type of infection from happening in the first place?

[[Sue and Jill- Is there any means of “beefing up” one’s immune system to
keep this type of infection from happening in the first place?]]

If you’re talking about influenza, yep, it’s called “immunization.” As for the pneumonia vaccines, they only protect against specific pneumonias, not all of them (same with the flu vaccine).
Jill

Markxxx, its pretty simple. Just visit the Doc, ask for a pneumonia vaccine, get it & you’re all set. I think its for 10 years.

Here’s hopefully unrelated flu question. I just lived through the flu, and it is a bad one. I was shaking for almost two days and wanted very much to die.

My question: I developed a fever blister in the days leading up to full flu symptoms. After I started feeling sick, the one turned to two, then my gums became very tender, then I got sores on my tounge, then inside my mouth. I couldn’t eat solid food for 10 days, until yesterday, and my mouth is still all messed up. Question one: What the hell happened? I went to the ER and the doc gave me Famvir and ran a viral culture. Not herpes, at least not the STD related one, not positive for anything really. My fp skirted the issue and I forgot to ask directly beecause she took blood (scaring me) and I couldn’t talk well at that point because of the sores. When I left her office I said, “I think I’ll ask on the SDMB.”

Sorry, by the way, I’ve never had fever blisters, neither has my girlfriend. She didn’t get sick this time.

Here’s the package insert for the Pneumovax:
http://whale.to/Vaccines/pneumococcal.html

This vaccine is intended to induce antibody production against the most common strains of Pneucoccus pneumoniae. It is not effective against any other kind of bacterial pneumonia, such as Staphylococcus aureus that is the mojar secondary bacterial infection complicating flu.

Pnuemococcal pneumonia, however, is the leading cause of primary bacterial pneumonias, a frequent cause of admissions to hospitals, ICU’s, and death. Most young people (2-60) recover uneventfully if treated promptly with antibiotics, but complications including infections in the pleural space (around the lungs) or pericardial space (around the heart) can be life-threatening or permanently disabling even in healthy individuals. Older people, or those with chronic illnesses affecting their lungs or immune system, are particularly susceptible to the organism.

The Pneumovax is recommended for persons over 65, OR with diabetes, asthma, COPD or emphysema, or taking steroids for any reason. When it initially came out, the recommendation for for it to be a one-time for life immunization. That has since been modified to every 10 years (along with tetanus/diphtheria).

There is a new pneumococcal vaccine intended to protect kids against the strains of Pneumococcus most often responsible for ear infections and meningitis. I don’t really know any more than that, though…

Sue from El Paso

Experience is what you get when you didn’t get what you wanted.

Besides the obvious flu vaccine, do all the things your mom told you to do.

  • Get the rest you need, somewhere between 6-9 hours for most adults.
  • Don’t try to operate your body on low-octane fuel. Eat right. Supplement with a multi-vitamin if you’re worried about missing things. Maintain your weight where it should be.
  • Think about what gets on your hands & avoid putting that into your mouth/nose/eyes. Wash your hands frequently.
  • Encourage sick colleagues to go home & take their germs with them instead of making them feel guilty for dumping on you.
  • Don’t worry, be happy. Psychologic issues & stress seem to adversely affect the immune system. Depression certainly does.
  • If all this fails, & you think you did get the flu, contact your doc promptly. New drugs can shorten to course IF begun promptly - the sooner the better, but they are felt to be of little use more than 48 hours after onset of symptoms.

:wink: But of course, you knew that…

Fever blisters are due to Herpes, but a different strain than the one usually associated with genital lesions.

HSV1 (Herpes simplex virus, type 1) usually causes oral lesions, or can cause a linear array of vesicles (small blisters) on the hands, called a herpetic whitlow.

HSV2 causes most genital disease. Obviously, there are ways in which these 2 strains could find their way to the wrong place…

Here’s a link to a Mayo article describing fever blisters & canker sores:
http://www.mayohealth.org/mayo/9610/htm/canker_s.htm

Hope by the time you read this, you’re felling better.

The pneumonia vaccine is also recommended for people who are in high exposure jobs, such as health care workers and teachers. (And that’s touching the public, not just being in the same room with them.)

Originally, it was just the elderly who were recommended to get it – but I think mostly because supplies were limited at first and theirs was a greater need. That would also explain the original ‘for life’ application of the shot. The elderly weren’t expected to live long enough to need a booster 10 years later. :eek:

Peace.

Majormd:

Thank you very much for the link. It was very informative and made me feel a little better about fever blisters. It sounds like I had a pretty bad case. I am thirty-three and was glad to read that these buggers seem to decrease with age. Thanks again.

I got the flu shot this year & got the flu that it covers, or seems to anyway. However, it is a much much milder version for me. whew.