Deadly superbugs now in Colombia

In 2005 a capoeira trainer from Bogotá had a slight blow to his thigh. Although it didn’t seem serious, in 24 hours the injury developed into a tissue-eating skin infection, called necrotizing fascitis. Carlos Álvarez, the infectologist who attended to him, remembers that the patient was placed in the intensive care unit where they removed the skin from his genitals, legs, buttocks and his back in order to save his life. The patient recuperated, but had to subject himself to skin grafts. The cause of such destruction in a healthy 19-year-old man was bacteria called staphylococcus aureus or golden staphylococcus, the most common of the so-called superbugs.

Everyone has those bacteria in the skin, living generally in the nose, armpits and in the perineum. The problem is that they constantly mutate, and thus have an incredible capacity for adaptation and resistance.

“This is Darwin to the maximum. The capacity that the bacteria have to acquire genes makes it a great survivor,” says César Arias, an infectologist at the University of Texas who has been at the forefront of research in Colombia. There are other bacteria that have created resistance, but because of its virulence and ease of transmission, golden staph is what causes the most concern.

With the 2005 case and another that happened months later also in Bogotá, the presence of these super-bacteria in the country was made official. In Colombia, more profound research is needed in order to determine the true number of cases, but a hint that it is fairly extensive is what everyone who has looked into it has found. A team of scientists that is working in a national network of antibiotic resistance found similar cases in the cities of Villavicencio, Cali, Cartagena, Bucaramanga and Ibagué, among others.

In Cartagena for example, the infectologist Wilfrido Coronell from the Bocagrande Hospital says that he saw the first case in December 2007. “It was an 18 month old boy who had infections of the skin and soft tissues. He had abscesses and afterwards developed necrotizing pneumonia and meningitis.” The little boy did not die, but he ended up with serious neurological after-effects and today remains in a vegetative state. According to Coronell, he has seen 14 cases of infected children, two of whom have died in less than 36 hours.
 
Last week an 8-year-old boy was hospitalized because of that. “This patient came in with a fever and skin lesions. He had pain and inflammation in his left knee without having had a previous trauma,” says Coronell. They found the bacteria in his blood and as this edition went to press, after three operations, he remained in intensive care with an uncertain prognosis.

In Cali Ernesto Martínez, president of the Colombian Association of Infectology, says that the situation is as frequent in children as it is in adults and believes that in the last three years at least a dozen patients have died because of the infection. “And they weren’t elderly nor had diabetics, but rather young and healthy people.” That is why he is emphatic in saying that in the country “we are not talking about isolated cases, but rather an important epidemiological problem. Research is needed to understand what factors contribute to its spread in Colombia.”

What most intrigues experts is that the same infection that is attacking in Colombia has wreaked havoc in the United States since 1997 and is known as USA300. It is believed that it could be because of the relationship that the two countries have, in which there is a large number of immigrants and military contingents coming and going, but it is still uncertain. Doctor Arias, who a few weeks ago published an article about the Colombian case in the New England Journal of Medicine, believes that “an infection that used to be easy to treat now is very difficult and the patients are dying before our eyes.”

In hospitals the phenomenon of resistant bacteria began to be seen in the 1960s, but in the last decade the situation has changed. “Generally the bacteria that a person acquires in the hospital are, to put it in one way, ‘dodging’ because they appear in patients who have taken many antibiotics. That’s why that is where more antibiotic resistance is seen. But for a few years now this bacteria began to propagate itself among the community,” Arias explains. Until now it is not very well known how it is transmitted from one person to another, but what is known is that one cause of mutation is the wrong use of antibiotics. In many parts of Colombia its sale is unrestricted. People self-medicate and follow treatment haphazardly.

In the United States the story of USA300, a type that is meticiline-resistant (known in Colombia as resistant to Oxacilina) began at the end of the 1990s. From 1997 to 1999, four children died in Minnesota and in North Dakota and afterwards cases were reported throughout the country. Military personnel, school children, football players, Hurricane Katrina victims and basically anybody developed the illness. In 2006, the Centers for Disease Control and Prevention (CDC) calculated 19,000 deaths caused by the bacteria and 105,000 infections.

It all can start with a small spot on the skin, like a mosquito bite, that becomes more and more red. Afterwards, the patient suffers from fever and in less than 20 hours develops a severe infection. The patient begins to cough, sometimes coughing up blood. It becomes difficult to breath, and the patient ends up with pneumonia and in the worst scenarios necrosis in the lungs and skin. It can also appear as very contagious boils, similar to infected acne, in several parts of the body. The infection can pass to the bones and joints and the most serious is when the microorganism infiltrates the blood. Once there, it can lodge itself in any part of the body. That is the picture that is repeated as much in the Colombia as it is in the United States.

The worst news is that the battle is being lost. Pharmaceuticals take between five and nine years to launch new antibiotics. In the United States, regulations of the Food and Drug Administration (FDA) are so complex that many have abandoned research in that area. But to have an infection does not mean that the person will surely die because each body responds in a different way and an early diagnosis can save lives. That is why the message for the medical community is that it should become informed about the symptoms and be suspicious of any severe infection of the skin or soft tissues accompanied by pneumonia.

When a doctor responds like César Arias, who says that the first thing that should be done is to “pray a lot,” that shows just how serious the situation is. For the moment, the recommendations are to use antibiotics correctly and constantly wash hands so that this “snowball,” as Coronell puts it, does not become bigger.