In my last post (see here if you missed it) I went into detail about how Staphylococcus aureus, referred to from hereon as staph, is able to cause the complications that it does. Here I will give 4 examples of real cases I have seen over the past several years. To protect patient privacy, no identifying information will be provided and I will write in a bit of short hand in some instances. Bear in mind that fortunately, most of us will never personally experience these serious issues. So please don’t be scared! Here goes…
1. Septic arthritis (joint infection) involving artificial joint
A patient who had knee replacement almost a decade ago complained of increasing pain and swelling to the artificial knee. There was also increasing malaise and fever. The patient was admitted to hospital and cultures of the blood and fluid drawn from the knee were positive for staph. The patient was only in their 50s so obviously a cure was desired. The appropriate antibiotics were started and the artificial knee joint was removed and replaced by a temporary joint. Antibiotics were continued for 6 weeks. At the end of this time, the swelling and inflammation of the knee resolved. A couple weeks after finishing antibiotics, when it was determined that there was no residual infection in the joint, a new artificial joint was placed and after recovery, the patient went back to life as usual.
Similarly, another patient presented with an infected artificial knee. However, this patient was in their 80s and very frail, on dialysis. Life expectancy was probably less than 2 years. It was obvious that a complicated orthopedic procedure like I described above, would be too much to tolerate for a frail elderly person. Antibiotics were initially given by drip for the first few weeks to get rid of the infection in the blood, then by mouth indefinitely, to keep the infection in the knee suppressed. At one point the patient accidentally ran out of the antibiotic tablets and in less than 2 months, the infection flared up in the knee and went into the blood stream once again. The treatment cycle was repeated and the patient remained on antibiotics by mouth, until death less than 2 years on.
2. Meningitis (infection of the membranes covering of the brain)
A middle aged patient who suffers from chronic severe lower back pain goes to the pain clinic every month for injections to relieve the pain. One day, patient was found confused by family; taken to hospital and found to have increased pressure in the brain. The fluid was drawn out of the brain to relieve the pressure and when cultured, it grew staph. Patient was then found to have small abscesses along the spinal cord in the area where the injections used to be given (it is from here that the staph spread into the spinal fluid and then around the brain). Blood cultures were also positive for staph. Heavy doses of antibiotics were given for almost 2 months and the patient made a miraculous recovery, except for a bit of weakness from a stroke sustained along the way.
3. Endocarditis (infection of the heart valves)
A patient in their 30s with a long history of injection drug abuse was admitted with fever, cough, chest pain, abdominal pain, and back pain. Blood cultures were positive for staph. Ultrasound of the heart (echocardiogram) showed a big growth (a vegetation) of about 1.5 cm flopping around on one of the heart valves. Because of all the pain, CAT scans were done and showed multiple areas of infection and abscesses in the lungs, abscesses in the spleen, and abscesses in the muscles (psoas muscles) alongside the lower (lumbar) spine.
Two things happened here:
first, pieces of the ‘vegetation’ broke off and showered into the lungs and into the spleen via smaller blood vessels. Because these pieces were themselves infected with staph, after they lodged into the new areas, the staph multiplied with abscesses eventually forming. These pieces of vegetation could have showered into the brain as well, but fortunately that did not happen in this case.
The second thing happening here is, the staph already circulating in the blood got lodged into psoas muscles on both sides of the spine. The bacteria brewed and before long there were 5-6cm abscesses in each psoas muscle causing back pain and difficulty bending at the hips.
Appropriate antibiotics were given but the bacteria took forever to clear from the blood. Additionally, the infected heart valve was starting to weaken causing blood to back up from the heart; in other words, heart failure was developing. As a result, the patient had surgery to get a new heart valve. After almost 2 months of antibiotics, the infection was cured.
Here we were, caught between a rock and a hard place: replace the valve and risk the new valve being infected again if the drug abuse habit was not kicked? Or, let the patient live with heart failure which could kill him sooner rather than later. We did the humane thing and replaced the valve.
Unfortunately the patient did not stick with drug rehab and came back in a few months later with the new valve infected, though with a different bacteria this time. The infection was not as extensive and was treated successfully. The patient was still alive a year later although still one drugs.
4. Osteomyelitis (infection of the bone)
A 40 year old with chronic swelling of the legs presented with infection to one of the ankles for almost a year. Initially there was an abscess caused by staph but after it drained, the residual ulcer was taking a very long time to heal. It turns out that there was surgery on that same ankle joint many years ago after a fracture and there were screws and a plate in place. Scans showed that the bone around the screws was infected (osteomyelitis). Essentially what happened is that the staph infection from the abscess spread to the screws before antibiotics could eradicate it. It then spread to the surrounding bone and for reasons described in the last post a cure would not have happened once those infected screws remained in place. That is why the ulcer was not healing. The patient was referred to an orthopedic surgeon for removal of the screws.
So there you have it… I just went over 4 very complicated ways in which staph infections can present. It may seem scary but as you saw, in many cases a cure is possible. Of course you may be thinking, well…prevention is better than cure! In the next post, I will go over some things you can do to decrease your risk of staph infection. I will also talk a bit about the resistant Staphylococcus aureus, MRSA, that many of you have heard of. Stay tuned!