Superbug-infected child ill for more than 2 weeks

Updated Thu. Nov. 8 2007 6:15 PM ET

CTV.ca News Staff

A toddler being treated for meningitis caused by a new antibiotic-resistant "superbug" has been in hospital for more than two weeks, CTV News has learned.

The unidentified child had been treated in the intensive care unit but is now in a ward room, continuing to battle the infection, officials at the Hospital for Sick Children in Toronto say.

The child is being treated with antibiotics normally reserved for adults, after a litany of antibiotics for children proved ineffective.

Hospital officials stress that the otherwise healthy child acquired the infection in the community -- not in hospital.

The child's infection was caused by a new sub-strain of Streptococcus pneumoniae 19A. It's an emerging "superbug" that has caused dozens of ear infections in Massachusetts and New York State.

Dr. David Williams, the acting Chief Medical Officer of Health in Ontario, says it's still not known how the case emerged since it appears the infected toddler had not traveled out of province before becoming ill.

After trying numerous antibiotics approved for children, doctors eventually turned to the adult-approved drugs levofloxicin, vancomycin, telithromycin and rifampin, all of which appear to be effectively treating the illness. But the child is still quite ill, says SickKids official Dr. Upton Allen, and treatment is continuing.

S. pneumonia is not new in Canada. It causes hundreds of chest and throat infections and ear infections each year. In rare cases, it triggers pneumonia and meningitis, illnesses that are usually easily treated with antibiotics.

The 19A strain is not new either. But doctors say this new subtype of 19A can't be killed off with any of the antibiotics approved for use in children.

"The big issue with this particular strain is that it's multidrug resistant," Dr. Susan Poutanen, an infectious disease consultant at Toronto's Mount Sinai Hospital, told CTV Newsnet.

"It doesn't necessarily look like it's any more aggressive than other Streptococcus pneumoniae family members, but it's certainily more resistant and difficult to treat."

Dr. Michael Pichichero, a professor of microbiology, immunology and pediatrics at the University of Rochester Medical Center, was the first to identify the new 19A super-strain while he was treating children whose ear infections wouldn't clear up.

In October, he published a report in the Journal of the American Medical Association, describing his experience with the superbug. He tried 18 antibiotics approved in the U.S. for children and found that the only drug that worked was levofloxacin (also called Levaquin).

For one child, the cure came too late; the infection led to permanent hearing loss.

Pichichero's team believes the new sub-strain was most likely created by a combination of the superbug's ability to evolve quickly and the over-prescribing of antibiotics, which has led to antibiotic resistance.

The child being treated at SickKids had received all the vaccinations recommended for children, including Prevnar, which offers protection against seven strains of S. pneumoniae.

19A not covered by Prevnar

Since the introduction of Prevnar in 2000, the incidence of pneumonia and meningitis caused by pneumococcus has fallen by at least 69 per cent. As well, difficult-to-treat ear infections have been reduced by 24 per cent.

But Prevnar does not include the 19A strain, nor this new 19A sub-strain and offers no protection against it.

The makers of Prevnar are reportedly aware that the vaccine needs to include 19A and are reformulating their vaccine. Other vaccine makers are working on other formulations that are still being tested.

But it will take two years for a new vaccine to be approved and placed on the market.

In the meantime, doctors are being advised to be aware of this new drug-resistant strain of 19A, and to take action if a patient has a pneumococcal infection that isn't resolving -- such as an ear infection that defies treatment.

Infectious disease expert Dr. Neil Rau told CTV's Canada AM Thursday that, for now, he is not concerned about this new superbug, since this appears to be the first case of an extremely drug-resistant strain causing such a serious infection. But he will watching to see what develops.

"The strain 19A in and of itself is a concern because it's not covered by the vaccine, but if it's really resistant to antibiotics, as this particular clone is... and if we have a lot of that around, we have a bigger concern," he said.

Dr. Allen says it's important that doctors and health officials closely monitor this bug.

"If one doesn't have an appropriate monitoring system... one could find that the strains that are eliminated by the (Prevnar) vaccine are basically eliminated and are quietly replaced by other strains that can cause severe disease."

Dr. Poutanen says ear infections in children are quite prevalent, but it's when the symptoms persist that there is cause for concern.

"Often what will happen is symptoms will go away by themselves because it was a viral infection and the body takes care of it," Putanen told Newsnet.

"It's only if you're given an antibiotic prescription and you're following it properly, and if those symptoms continue to persist, that you'd have to worry you might have this particular strain."

With a report by CTV medical specialist Avis Favaro and producer Elizabeth St. Philip

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Superintendent Mike Berta said the two students and two others were sent home Wednesday when they began to suspect they had the infection.

The two students who were diagnosed with it have been told by doctors they are OK to come back to school. Berta said he has not heard from the other two students.

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Girl's death warns that flu, staph can be deadly pairing.

Health experts, doctors advise people to get a flu shot, wash hands, stay home when sick.

Click-2-Listen

By Mary Ann Roser
AMERICAN-STATESMAN STAFF
Sunday, October 28, 2007

GEORGETOWN — Even as she ran into the emergency room behind the gurney carrying her daughter, Ellen Johnson clung to the idea that healthy 16-year-olds don't die of flu.

"I still believed she was going to make it," Johnson said, as she sat on the sofa in her home next to her ex-husband, Michael Johnson, and his wife, Elvira Johnson. Photographs of Kaylin Mae Johnson, their smiling dark-eyed daughter who liked to dance and "mother" her many friends, stood on the table in front of them.

FAMILY PHOTO

(enlarge photo)

Kaylin Mae Johnson died at 16 after getting both flu and staph.

Brian K. Diggs
AMERICAN-STATESMAN

(enlarge photo)

Ellen Johnson, at home in Georgetown, thought her daughter Kaylin Mae would recover from flu in February. After the teen's death, the family found she also had staph.

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Kaylin died Feb. 13, four days after she fell ill at Georgetown High School from what doctors said was flu, her family said.

Her parents and younger brother, Payden, learned months later, when the autopsy report was completed, that she also had Staphylococcus aureus, a bacteria that most likely infected her after she caught influenza. It caused severe pneumonia that ravaged her lungs and poisoned her blood.

Medical experts say what happened to Kaylin is uncommon.

But cases like hers are starting to get the attention of national health authorities who are concerned about the spread of staph infections in communities around the country and the increasing prevalence of methicillin-resistant Staphylococcus aureus, or MRSA, a type of staph that is resistant to some antibiotics.

The CDC received reports from Louisiana and Georgia that 10 patients had contracted flu and MRSA-triggered pneumonia in December and January and six had died. The CDC highlighted the cases in one of its national Morbidity and Mortality Weekly Reports, saying the 10 cases were "a higher number than expected for the two-month period" in those states.

Staph is a common bacteria found on the skin and in the noses of healthy people, .....   In extreme cases, it can invade the organs and cause a fatal infection.

No one knows where Kaylin picked up staph. Ellen Johnson said she took Kaylin to an urgent care clinic Feb. 10, the day after she fell ill at school. Kaylin was prescribed the antiviral drug Tamiflu to reduce her symptoms, and seemed to get better, but then got worse, Johnson said.

Two days later, on Feb. 12, Kaylin complained her throat was terribly sore, and a pediatrician who saw her that afternoon prescribed two painkillers, Johnson said. The next morning, Kaylin's grandmother had trouble waking her, Johnson said, and Kaylin was so weak that a neighbor had to carry her to the car.

At the pediatrician's office, Kaylin had to be given oxygen, Johnson said.

Elvira Johnson, Kaylin's stepmother, said Kaylin later went into cardiac arrest in an ambulance before being flown to a San Antonio hospital, where she died an hour after arrival.

Kaylin's parents said they hope her story will help other parents and doctors recognize a dangerous illness early on. Kaylin was the kind of person who was always helping others, Ellen Johnson said.

Updated: var wn_last_ed_date = getLEDate("Nov10, 2007 1:36 AM EST"); document.write(wn_last_ed_date); Nov 10, 2007 01:36 AM EST

Ontario's acting chief medical officer of health issued an alert yesterday for doctors in Ontario and across Canada, after a Toronto toddler fell ill with meningitis caused by a rare, hard to treat, superbug.

The memo, issued to each of the province's medical officers of health as well as to Health Canada, warns doctors to be aware of the multi-drug resistant 19A sub-strain of pneumococcus, a bacteria commonly known to cause ear infections in children and in more serious cases, meningitis.

While there have been 48 cases of the 19A strain reported in Ontario since December, a 14-month-old infant being treated at the Hospital for Sick Kids in Toronto is the first reported case in Canada of a child contracting the multi-drug-resistant, sub-strain of the bacteria.

Susan Poutanen, a microbiologist and infectious disease consultant at Toronto's Mount Sinai Hospital said David Williams's memo should not be cause for alarm for parents but will help medical professional better track cases by making doctors more alert to the possibility they may be dealing with the hard-to-treat bug.

"The general public should not be concerned," Poutanen said.

"Right now we are only seeing a handful of cases at most. But the numbers are increasing in the U.S. so it is likely we will see an increase here, too."

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Updated: var wn_last_ed_date = getLEDate("Nov12, 2007 5:09 PM EST"); document.write(wn_last_ed_date); Nov 12, 2007 05:09 PM EST