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Staphylococcal Disease
The Staphylococci
Invasion
Membrane-damaging toxins
Staphylokinase
Capsular Polysaccharide
Protein A
Leukocidin
Exotoxins
Beginning with the use of the penicillin in the 1940's, drug resistance
has developed in the staphylococci within a very short time after
introduction of an antibiotic into clinical use. Some strains are now
resistant to most conventional antibiotics, and there is concern that
new antibiotics have not been forthcoming. New strategies in the
pharmaceutical industry to find antimicrobial drugs involve identifying
potential molecular targets in cells (such as the active sites of enzymes
involved in cell division), then developing inhibitors of the specific
target molecule. Hopefully, this approach will turn up new
antimicrobial agents for the battle against staph infections. Indeed,
since 2003, alternatives to vancomycin have been approved for
treatment of MRSA.
MRSA
MRSA are strains of the Staphylococcus aureus that are resistant to
the action of methicillin and related beta-lactam antibiotics (e.g.
penicillin, oxacillin, amoxacillin). MRSA have evolved resistance not
only to beta-lactam antibiotics, but to several classes of antibiotics.
Some MRSA are resistant to all but one or two antibiotics, including
vancomycin. Reports of VRSA (Vancomycin-Resistant Staph aureus) or
VRSA are troublesome in the ongoing battle against staph infections.
MRSA infections that occur in otherwise healthy people who have not
been recently (within the past year) hospitalized or had a medical
procedure (such as dialysis, surgery, catheters) are categorized as
community-associated (CA-MRSA) infections. These infections are
usually skin infections, such as abscesses, boils, and other pus-filled
lesions.
Studies have shown that rates of CA-MRSA infection are growing fast.
In 1999, four children in Minnesota and North Dakota were reported to
have died from fulminant CA-MRSA infections One study of children in
south Texas found that cases of CA-MRSA increased 14-fold between
1999 and 2001. By 2007, CA-MRSA was the most frequent cause of
skin and soft-tissue infections seen in emergency departments in the
United States.
Although most MRSA cases are skin and soft-tissue infections, some
are more serious with septicemia and pneumonia. It was reported in
2005 that previously healthy adolescents without any predisposing risk
factors presented more frequently with severe Staph infections (mostly
the USA 300 strain) since 2002.
More people in the U.S. now die from MRSA infection than from AIDS.
Methicillin-resistant Staphylococcus aureus was responsible for an
estimated 94,000 life-threatening infections and 18,650 deaths in
2005, as reported by CDC in the Oct. 17, 2007 issue of The Journal of
the American Medical Association. The national estimate is more than
double the invasive MRSA prevalence reported five years earlier. That
same year, roughly 16,000 people in the U.S. died from AIDS,
according to CDC.
Treatment
Vaccines
pneumonia
Colonization: cell-bound (protein) adhesins
Invasion:
Invasins: staphylokinase, hyaluronidase
Other extracellular enzymes (proteases, lipases, nucleases,
collagenase, elastase. etc.)
Resistance to phagocytosis: coagulase, leukocidin, hemolysins,
carotenoids, superoxide dismutase, catalase, growth at low pH
Resistance to immune responses: coagulase, antigenic variation
Toxigenesis: Cytotoxic toxins (hemolysins and leukocidin)