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Staph Cases an ‘Emerging Epidemic’

Times Staff Writers

A painful and virulent skin infection that has plagued Los Angeles County jail inmates is now appearing with increasing frequency throughout Southern California.

Public health officials across the region are warning family doctors and hospitals to be on the lookout for the infection, caused by a new form of Staphylococcus aureus, commonly known as staph.

The infection -- easily misdiagnosed and resistant to antibiotics commonly used to treat skin infections -- causes a skin reaction, usually in the form of lesions or small boils that, if left untreated, can become as large as a softball.

“It’s an emerging epidemic,” said Dr. Gonzalo Ballon-Landa, an infectious disease consultant in San Diego County. “Doctors in California and the whole community are not picking up yet on the fact that [it] is here.”

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The disease has occasionally led to severe blood and bone infections and even pneumonia. While rarely fatal, it was linked to the deaths of four children in the late 1990s.

In the past, such infections have been restricted to the sick and elderly in hospitals and nursing homes. Since 2002, however, jails in Los Angeles County and around the country have struggled to keep a lid on outbreaks among inmates.

Sheriff’s Department and public health officials are expected to report to the Los Angeles County Board of Supervisors today on their efforts to stop the infection inside and outside the jails.

Health officials said they have recently seen otherwise healthy people contract the infection, including athletes, military recruits, children in day care and gay men.

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“Now it just appears to be that being a human being with skin is sufficient,” said Dr. David Talan, chief of Olive View-UCLA Medical Center’s department of emergency medicine.

Authorities have not tracked the spread of the disease because doctors are not required to report cases. But recent studies suggest a rapid increase in the last year or two in infections treated at emergency rooms.

At Olive View, Talan and his colleague Dr. Gregory Moran tracked infections last August. Two years ago, doctors treated just one or two cases in a typical month. But Talan and Moran tallied 28 cases in August -- almost one a day. Those cases accounted for about half of all tested skin infections treated at the hospital.

At the same time, Talan and Moran tallied skin infections at 10 other hospitals in cities including New York, Philadelphia and Atlanta, with similar results. About 60% of tested skin infections were caused by the new strain of staph.

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“We were totally flabbergasted,” Talan said. “This is such a dramatic change, it’s like a sea change.”

Outbreaks of the new strain have been reported in areas from Hawaii to Connecticut, prompting federal health officials to advise doctors to take swabs from patients to test for the bacterium.

“We’re hearing enough anecdotes for it to be safe to say that these skin infections are widespread in the community,” said Nicole Coffin, a spokeswoman with the Centers for Disease Control and Prevention.

Staph is a common bacterium carried by an estimated one in three people, most of whom will not contract an infection. Health authorities believe it is spread by skin-to-skin contact or sharing contaminated items, such as towels.

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The new staph strain -- called methicillin-resistant Staphylococcus aureus, or MRSA -- is one of a growing number of bacteria that have developed resistance to common antibiotics.

The bacterium is thought to cause infection when it enters the skin in a tear or opening, making athletes who are prone to turf burns, such as football players, particularly vulnerable.

Chelsea Johnson, 30, said she noticed a pimple on her right cheek soon after arriving at the Orange County Jail in 2003. Within three days, her face had swelled. She felt feverish. A nurse looked at her, she said, but did not prescribe any medication.

Johnson, a disc jockey, left jail after six days. But it wasn’t for another four months, despite visits to doctors, that a staph infection was diagnosed. By that point, it had covered her face and her body.

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“I felt like a leper,” she said. “I just didn’t want to go outside. I couldn’t live my daily life.”

In Orange County, health officials recently published warnings about staph in their newsletter for doctors. The San Bernardino County Public Health Department formed an informal task force to discuss how to treat the infection.

And in San Diego County, health authorities have warned physicians not to be misled by a strange phenomenon associated with the infections: Most patients initially complain they have a spider bite.

“We realized that the nice spiders of San Diego were being blamed for something they didn’t do,” said Ballon-Landa, San Diego’s infectious disease consultant and former president of the Infectious Disease Assn. of California.

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Ballon-Landa said he treated a pipe fitter on Thursday who had a red bump on his hand and thought he had been bitten by a spider. The man had to be hospitalized and the abscess drained.

Dr. Elizabeth Bancroft, a medical epidemiologist working for the Los Angeles County public health agency, met earlier this month with directors of homeless shelters to warn them about the infection. She also sent advisories to gyms and schools on how to prevent its spread: good hygiene and thorough washing.

This strain of staph appears to be more virulent than others. “It’s a tough disease to get rid of,” Bancroft said. “Sometimes it ping-pongs around in a family.”

Bancroft has also monitored the spread of staph in the Los Angeles County jails, among the largest outbreaks in the nation. The jails first identified the problem in 2002, when they reported 921 inmates with the disease. In 2003, 1,849 contracted the infection. Last year, there were 2,480 new cases.

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Bancroft said there is no evidence that the jails have significantly spread the disease into the rest of the community, even though it is prevalent among the homeless and intravenous drug users, some of whom are in and out of jail.

Along the corridors of Men’s Central Jail in downtown Los Angeles, posters hang every 10 yards with gruesome color photos of sores and abscesses, a stark warning to inmates and sheriff’s deputies.

On the jail’s third floor, 15 inmates with the worst open sores are housed in single-man cells. On a recent day, the smell of disinfectant hung in the air. Two inmates lay in clinic rooms having their wounds swabbed and drained by jailhouse nurses.

The isolation is part of the jail’s strategy to keep the infection from spreading. Inmates are now asked if they have any sores when they are first booked into the jail. About a quarter of new cases involve inmates who had the disease before entering the jails, officials said.

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“It is a concern to us, and we’re doing everything we can to address it,” said Sheriff’s Chief Chuck Jackson, who heads the department’s Correctional Services Division. “We don’t want to send it out to the community. But it’s not a perfect world, and we’re not going to catch it every time.”


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