Three Chicago-area children have died of a toxic shock syndrome-like illness caused by a superbug they caught in the community and not in the hospital, where the germ is usually found.
The cases show that this already worrisome staph germ has become even more dangerous by acquiring the ability to cause this shocklike condition.
"There's a new kid on the block," said Dr. John Bartlett of Johns Hopkins University School of Medicine, referring to the added strength of the superbug known as methicillin-resistant staphylococcus aureus, or MRSA.
"The fact that there are three community-acquired staph aureus cases is really scary," continued Bartlett, an infectious disease specialist.
The Chicago deaths were described in Thursday's New England Journal of Medicine.
Health officials do not yet know how the drug-resistant staph causes this new syndrome, but it appears to be rare, said Dr. Clifford McDonald, an epidemiologist with the federal Centers for Disease Control and Prevention.
However, doctors should be on the lookout for shock-like cases caused by MRSA, said Dr. Robert Daum, a pediatrician at the University of Chicago who co-authored the study.
In 1999, drug-resistant staph infections killed four healthy children ranging in age from 1 to 13 years old in Minnesota and North Dakota. Since then, doctors have actively looked for such infections in their community.
In the cases reported in Thursday's medical journal, the baby and two toddlers who died were otherwise healthy before they were separately admitted to a Chicago hospital with pneumonia-like symptoms between 2000 and 2004. Doctors believe the children probably inhaled the germ.
The children died within a week of being hospitalized, and autopsies showed they suffered from shock and bleeding in the adrenal gland. The infections were caused by MRSA, which is usually not associated with the syndrome.
Until recently, drug-resistant staph infections were limited to hospitals and other health care settings where they can spread to patients with open wounds and cause serious complications.
But infectious disease specialists say a growing number of community-acquired resistant staph infections have struck healthy people outside of hospitals in recent years.
Doctors in Los Angeles treated 14 people with necrotizing fasciitis, informally known as flesh-eating bacteria, caused by the resistant germ.
And in Corpus Christi, Texas, doctors have seen community-acquired resistant staph cases jump from 10 cases a year in the 1990s to more than 400 in 2003.
The first Chicago death occurred in 2000 when a 15-month-old girl was diagnosed with severe pneumonia. She died eight hours later. In 2003, a 9-month-old girl was hospitalized with fever and breathing problems. Her condition deteriorated and she died six days later. A year later, a 17-month-old boy was admitted with respiratory problems and died the next day.
In all three cases, the victims' conditions progressed from pneumonia to shock.
On the Net: New England Journal: www.nejm.org