Ahead of her question to ministers in the Lords on Wednesday, Baroness Masham of Ilton writes for ePolitix.com on the dangers of PVL, a toxin that destroys white blood cells.
Two years ago, I went to a symposium in Nottingham on infections and I was made aware of Panton Valentine Leukocidin (PVL) MRSA.
PVL is a toxin that is produced by Staphylococcus aureus/MSSA/CA-MRSA if strains carry a gene containing the genetic code for this toxin.
PVL is a potent toxin which is produced by some bacteria from the family Staphylococcus and which destroys white blood cells that normally fight infections.
Methicillin sensitive Staphylococcus aureus (MSSA) can be treated with the frontline antibiotic Methicillin, but Methicillin resistant Staphylococcus aureus (MRSA) is immune to the effects of the antibiotic.
If PVL toxin is produced, it poses a serious risk to health when produced by the MRSA strain. MRSA infections often target elderly people in hospitals who have weakened immune systems, but PVL CA–MRSA strains also affect young healthy people and children associated with the community.
The increasing penetration of CA-MRSA in the community requires disseminating information to primary care providers about the potential severity of this infection, methods for rapid and accurate diagnosis and a need to rapidly implement appropriate empiric and definitive treatment regimens.
If MRSA or MSSA has been found, further testing in a reference laboratory can confirm the presence of PVL. In the rare cases of severe infection caused by Staphylococcus aureus, the bacterium may be cultured from blood, lungs or other tissues and the investigated to see if it produces PVL toxin.
PVL infections tend to attack the skin and cause painful boils and abscesses which in most cases can be treated with antibiotics. In some cases, PVL infections spread to the lungs and causes fatal pneumonia. It can also cause blood poisoning.
Marina Morgan, consultant medical microbiologist at the Royal Devon and Exeter hospital, said PVL-MRSA is a particular threat because it is spreading outside hospitals where doctors were not familiar with it. A lot of patients die because it is unexpected. A doctor will probably prescribe a standard antibiotic that will not kill it, so it has time to get worse. The bottom line is it is coming and it is going to spread.
PVL-MRSA can only be tackled with treatments which attack the bacteria on three fronts. The drugs must kill the bacteria, destroy their ability to make PVL toxins and mop the toxins released into the bloodstream.
A few months after the symposium, a 19-year-old art student, who was the son of a friend of mine, died within a few days of becoming ill with flu like symptoms. His death was said to be leukaemia but it seemed identical to what I had heard was PVL MRSA.
Necrotising pneumonia with septic conditions can kill in a few days. Groups of fit young people who are involved with close contact sports such as wrestling, rugby, judo and military training camps, gyms, prisons, children's playgrounds and nurseries are all places of risk. People should not share contaminated items such as towels. Cuts and grazes of the skin should be kept clean and covered and everything should be kept as clean as possible.
Extracorporeal Membrane Oxygenation (ECMO), also known as extracorporeal life support, is indicated for respiratory or cardiac failure unresponsive to all other measurers and is only used for very seriously ill patients, some with PVL. There are a few specialised centres including one at Great Ormond Street for babies and children.
I feel that there is a great danger of community-acquired necrotising/haemorrhagic pneumonia with such events such as the Olympic Games.
My question aims to make people aware of the increasing penetration of CA-MRSA in the community, which requires disseminating information to primary care providers about the potential severity of this infection, methods for rapid and accurate diagnosis and the need to rapidly implement with the appropriate empiric and definitive treatment regimens.
I will be asking the government if they will make PVL-MRSA a notifible condition and send out guidelines to GPs, health workers, teachers and sports clubs – many of whom have not heard of PVL CA–MRSA.
Dods Parliamentary Communications Ltd