Dirty Money: Toxigenic and Methicillin-Resistant

Staphylococcus aureus (MRSA) from Used Banknotes

Khalifa Sifaw Ghenghesh, MSc, PhD, DipBact

Najat M. Saed, MSc
*Abdulmulla El-Ghodban, MSc, PhD
Amal Rahouma, BSc
Salaheddin Abeid, BSc

Department of Medical Microbiology, Faculty of Medicine, Tripoli-

Libya.
*Department of Microbiology, Faculty of Science, Eotvos Lorand
University, Budapest-Hungary.

Author for correspondence:

Prof. Khalifa Sifaw Ghenghesh, MSc, PhD, DipBact
Dept. of Medical Microbiology, Faculty of Medicine
Al-Fateh University
P.O. Box 80013
Tripoli - Libya
E-mail: ghenghesh_micro@yahoo.com

To cite this article:

Ghenghesh KS., Saed NM., El-Ghodban A., Rahouma A., and Abeid S. 2001. Dirty
Money: Toxigenic and Methicillin-Resistant Staphylococcus aureus (MRSA) from
Used Bank Notes. Jamahiriya Med J; 1 (2): 54-56.
INTRODUCTION:

Staphylococcus aureus is well established as an important cause of

nosocomial and community-acquired infections.1-3 The reservoirs of infection are

man, animal or environment. Transmission can be direct from person to person,

animal to man or indirect from environment. Although not spore-forming, it may

remain alive in a dormant state for several months when dried in pus, sputum,

bedclothes or dust.4 The organism produces, among other determinants, a

number of toxins that play a major role in its pathogenesis. Seven serologically

distinct enterotoxins (A, B, C1, C2, C3, D, E) are produced by S. aureus that are

associated with food poisoning.5 A community-acquired disease of potentially

serious consequence, toxic shock syndrome, has been attributed to infection or

colonization with S. aureus that produce toxic shock syndrome toxin-1 (TSST-1).6

Furthermore, S. aureus isolates that are resistant to methicillin (MRSA) are

resistant to all β-lactam drugs, and often to aminoglycosides, which makes them

difficult to treat particularly in hospitals.4,7

Due to high inflation rates, among other reasons, people in developing

countries mainly use, and will remain for many years to come, banknotes in their

day-to-day transactions. In these countries, data on the role of contaminated

inanimate articles of common use in the community particularly banknotes in the

transmission of S. aureus and other types of organisms is lacking. The present

study was undertaken to address such an issue.

MATERIALS AND METHODS:

Included in the study 166 used banknotes obtained from different sources

(Table 1) and 31 new bank notes obtained from the Central Bank of Libya,

Tripoli. Each banknote was soaked in sterile phosphate buffer saline for 15

minutes, shook on a vortex for 1 minute and then filtered through a sterile 0.22

μm membrane filter (Sarturious, Germany). The filter was then placed on blood

and mannitol salt agars. Plates were incubated overnight at 37oC. Suspected

colonies were identified by colonial and microscopic morphology. Gram-positive

cocci were tested for coagulase, susceptibility to novobiocin and resistance to

polymyxin B.8 Isolates identified as S. aureus were also, confirmed by the

Staphyltect Plus kit (Oxoid, UK). Isolates that were Gram-negative bacilli further

identified using oxidase and oxidation-fermentation tests and API 20E (bio-

Merieux, France). Isolates of S. aureus were tested against the following

antimicrobial agents (Oxoid, UK) using the disc diffusion method9: ampicillin,

methicillin, fusidic acid, cephaloridine, erythromycin, tetracycline, trimethoprim-

sulphamethoxazole, chloramphenicol, neomycin, gentamicin and vancomycin.

Furthermore, isolates were also tested for their ability to produce staphylococcal

enterotoxins (A, B, C and D) and toxic shock syndrome toxin-1 (TSST-1) using

the Staphylococcal Enterotoxin Test Kit (SET-RPLA, Oxoid, UK) and the

Staphylococcal Toxic Shock Syndrome Toxin Test Kit (TST-RPLA, Oxoid, UK)

respectively.
RESULTS:
S. aureus was isolated from 61(37%) used banknotes and from 1(3%)

new banknote. The difference in the isolation rates of S. aureus from the used

and new notes is statistically significant (P<0.001, Chi-squares test). Distribution

of S. aureus and S. epidermidis from used banknotes according to their source is

shown in Table 1 and according to the value of the banknote used is shown in

Table 2. Other organisms isolated were Escherichia coli from 5 (3%) used

banknotes, Klebsiella species from 3 (1.8%), Pseudomonas species from 20

(12.1%), other Gram-negative bacilli from 8 (4.8%) and one each of α- and β-

Streptococci (0.6%). Of the 50 S. aureus isolates tested for their antibiotic

resistance, 72% were resistant to ampicillin, 4% to methicillin, 44% to fusidic

acid, 36% to cephaloridine, 24% to erythromycin, 26% to tetracycline, 38% to

trimethoprim-sulphamethoxazole, 16% to chloramphenicol and 2% to neomycin

and all were sensitive to gentamicin and vancomycin. Furthermore, of 20 isolates

examined only 1 (5%) was enterotoxigenic (produced toxin B, SEB) and 6 (30%)

produced TSST-1.

DISCUSSION:

It is believed that 30-50% of healthy adults colonized with S. aureus, with

10-20% being persistently colonized.10,11 Low standard of hygiene in developing

countries and certain human habits, including nose picking and tongue licking

while counting banknotes, may explain the high rate of isolation of S. aureus from

used banknotes in the present study. Furthermore, we found that the source and

the value of the banknotes had no effect on isolation rate of S. aureus from such
items. The results obtained show that used banknotes may be considered as a

method of transmission of toxigenic and MRSA in the community. Although,

MRSA emerged in hospitals and remains largely a nosocomial pathogen,12

several studies have shown that introduction of these organisms from the

community into hospitals resulting in serious outbreaks is not uncommon

phenomenon.13,14 MRSA-contaminated used banknotes may play a role in such

outbreaks particularly in developing countries.

To reduce the transmission of pathogenic organisms by banknotes,

authorities responsible for their issuing and printing (i.e. central banks and other

agencies) should educate the public on the proper use of such items. However,

making frequent hand washing a habit in human communities might be the best

solution.

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antibiotic resistance in methicllin-resistant Staphylococcus aureus. Lancet i,

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pour le Depistage, l'Etude et la Prevention des Infections Hospitalieres, 1991

to 1995. (1996) Methicillin-resistant Staphylococcus aureus epidemiology and

control in Belgian hospitals. Infection Control and Hospital Epidemiology 17,

503-508.
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Methicillin-resistant Staphylococcus aureus: implications for the 1990s and

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detection of bacterial toxins. Journal of Applied Bacteriology 84 (Suppl.), 98-

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(1981) Identification and characterization of an exotoxin from Staphylcoccus

aureus associated with toxic shock syndrome. Journal of Infectious Diseases

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the community: who's watching? Lancet 346, 132-133.

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Table 1. Distribution of Staphylococcus species from used

banknotes according to their source.

________________________________________________________

Source of used No No. (%) positive for

banknotes studied S. aureus S. epidermidis

________________________________________________________

Shops 44 24 (54.5) 7 (15.9)

Vegetable market 30 8 (26.7) 5 (16.7)

Faculty of Medicine:

cafeteria 34 15 (44.1) 14 (41.2)

photocopy centre 15 10 (66.7) 4 (26.7)

Others 43 5 (11.6) 8 (18.6)

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Total 166 62 (37.3) 38 (22.9)

________________________________________________________
Table 2. Distribution of Staphylococcus species from used

banknotes according to their value.

________________________________________________________

Value of used No. No. (%) positive for:

banknotes studied S. aureus S. epidermidis

________________________________________________________

1/4 dinar 35 15 (42.9) 5 (14.3)

1/2 dinar 27 13 (48.1) 6 (22.2)

1 dinar 85 25 (29.4) 24 (28.2)

5 dinars 10 4 (40.0) 2 (20.0)

10 dinars 9 5 (55.6) 1 (11.1)

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Total 166 62 (37.3) 38 (22.9)

________________________________________________________