| Specialization among infectious disease experts has | | | | documented among Staphylococcus aureus. Originally |
| worked against an in depth understanding of the | | | | highly susceptible to penicillin type antibiotics (known |
| complexities of different pathogens working | | | | as beta-lactams and commonly represented by the |
| cooperatively to cause serious and even fatal human | | | | antibiotic methicillin), many hospital acquired |
| infections. The anticipated human epidemic of an | | | | Staphylococcus aureus are now methicillin resistant. In |
| avian derived strain of H5N1 influenza should be a | | | | addition, they are resistant to many other types of |
| wake up call to address this important question. | | | | antibiotics commonly used in the hospital setting. |
| Influenza can render the body particularly susceptible | | | | Examples of resistance to the toxic "antibiotic of last |
| to certain types of bacteria that can thereby flourish; | | | | resort" (vancomycin) are now showing up in |
| and could potentially become the driving force of a | | | | Staphylococcus aureus and other bacteria in certain |
| continuing worldwide pandemic. Prominent among | | | | hospitals. |
| these bacteria, are toxin producing Staphylococcus | | | | The PVL toxin producing Staphylococcus aureus has |
| aureus, some of which can be resistant to various | | | | started on the path of becoming antibiotic resistant. |
| antibiotics, including methicillin. | | | | At present most community associated isolates are |
| Pioneering research during the 1918 influenza epidemic | | | | resistant to methicillin (CA-MRSA). In time, they will |
| clearly identified a virus component as the initiating | | | | surely become resistant to a wider range of |
| cause of illness. Yet there are ample indications that | | | | antibiotics by simply exchanging genetic information |
| bacteria were responsible for "the gravity of the | | | | with hospital associated bacteria (HA-MRSA). The |
| secondary pulmonary complications," and the | | | | only barrier left to widespread severe infection, is the |
| "common causes of death." The idea of a mixed | | | | normally non-tissue invasive quality of Staphylococcus |
| infection is contained in the oft quoted letter written | | | | aureus. Influenza infection can provide such an |
| by a military physician in 1919. | | | | opportunity by destroying the cells lining the air |
| "Camp Devens is near Boston, and has about 50,000 | | | | passages. Examples of fatal illness from a combination |
| men, or did have before this epidemic broke loose.... | | | | of regular influenza with CA-MRSA have been |
| This epidemic started about four weeks ago, and has | | | | reported with little emphasis of a portend of what |
| developed so rapidly that the camp is demoralized | | | | could occur in the face of an influenza epidemic and |
| and all ordinary work is held up till it has passed..... | | | | multiple antibiotic resistant, PVL toxin producing |
| These men start with what appears to be an | | | | bacteria. Worse still, this is but one example of the |
| ordinary attack of LaGrippe or Influenza, and when | | | | enormous risks posed by pathogens teaming up in a |
| brought to the Hosp. they very rapidly develop the | | | | biological warfare against mankind and his animals. |
| most viscous type of Pneumonia that has ever been | | | | What should be done? Foremost is an all out attack |
| seen. Two hours after admission they have the | | | | on the emergence of toxin producing and/or multiple |
| Mahogany spots over the cheek bones, and a few | | | | antibiotic resistant bacteria. Financial incentives exist |
| hours later you can begin to see the Cyanosis | | | | for developing additional antibiotics to replace those |
| extending from their ears and spreading all over the | | | | for which resistance has developed. This approach |
| face, until it is hard to distinguish the coloured men | | | | should give way to a more common sense approach |
| from the white. It is only a matter of a few hours | | | | of preventing infection through decontaminating areas |
| then until death comes, and it is simply a struggle for | | | | in which harmful bacteria reside. |
| air until they suffocate. It is horrible. One can stand it | | | | A lack of awareness of decontamination strategies |
| to see one, two or twenty men die, but to see | | | | among Government and public health officials is |
| these poor devils dropping like flies sort of gets on | | | | apparent in their recommendations of simply using |
| your nerves. We have been averaging about 100 | | | | alcohol hand washing and short acting oxidizing agents |
| deaths per day, and still keeping it up. There is no | | | | such as bleach. Far more preferable is to use agents |
| doubt in my mind that there is a new mixed infection | | | | such as phenols and their derivatives that can retain |
| here, but what I don't know." | | | | antibacterial activity over many months. Surveillance |
| Among the bacteria commonly cultured were | | | | for toxin producing and antibiotic resistant bacteria |
| Pneumococcus, Streptococcus and Staphylococcus. | | | | need to be in place in hospitals and settings where |
| While H1N1 influenza virus has been retrieved from | | | | large numbers of individuals assemble. Examples |
| victims of the 1918 epidemic, no formal study has | | | | include jails, schools, churches, sporting amenities, and |
| been reported of possible toxin producing bacteria | | | | workplaces where skin trauma is likely to be |
| from this period. | | | | encountered. A comprehensive hygiene program, |
| The vast majority of bacteria are essentially harmless | | | | such as the one offered by Preventec inc., in Atlanta |
| to mankind. Bacteria can, however, become infected | | | | GA, should be instituted at such facilities and its |
| with their own sets of viruses, some of which can | | | | effects monitored. |
| transfer toxin producing capacities to otherwise | | | | The benefits of this type of program may well |
| relatively harmless bacteria. Bacteria viruses can also | | | | extend to other types of infectious agents, including |
| transfer the capacity of bacteria to resist certain | | | | viruses and fungi. An additional complication of the |
| types of antibiotics. The combination of toxin | | | | 1918 influenza epidemic was the subsequent |
| producing capacity with antibiotic resistance is now | | | | occurrence of neurological diseases, including a |
| occurring, especially among Staphylococcus aureus. Of | | | | Parkinson-like syndrome known as encephalitis |
| great concern is a toxin complex known as | | | | lethargica. Underappreciated research implicated a |
| Panton-Valintine-Leucocidin or PVL. This toxin can | | | | herpes-like virus in this illness. Swine flu vaccination |
| easily incapacitate the host inflammatory response by | | | | triggered another set of neurological diseases, most |
| directly killing white blood cells (leucocytes). The toxin | | | | prominently a Guillain Barre syndrome that are also |
| can also destroy otherwise healthy tissues if the | | | | consistent with a virus activation process. Viruses |
| bacteria producing the toxin can gain entry into the | | | | that are not effectively recognized by the immune |
| tissues. The PVL toxin was originally detected in | | | | system are prevalent within the community. |
| antibiotic susceptible bacteria. | | | | Termed stealth adapted viruses, they undoubtedly |
| Antibiotic resistance among bacteria is a consequence | | | | contribute to outbreaks of community acquired |
| of genetic selection of the surviving bacteria in | | | | infectious illnesses with prominent neurological and/or |
| patients treated with various antibiotics. These | | | | psychiatric manifestations. Bacterial genes have been |
| resistance genes become commonplace especially if | | | | identified in cultures of stealth adapted viruses and |
| carried by bacteria infecting viruses. The emergence | | | | atypical bacteria have been isolated from stealth |
| of these bacteria is mainly seen in hospitals and other | | | | adapted virus infected patients. The term viteria |
| healthcare facilities. Indeed, a major risk factor from | | | | refers to viruses capable of breaching the genetic |
| hospital admission is acquiring a multiple antibiotic | | | | barrier between bacteria and human or animal cells. |
| resistant bacterial infection. The phenomenon is well | | | | |