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Excerpt: 'Superbug: The Fatal Menace of MRSA'

NPR

Published March 23, 2010 at 12:00 PM EDT

Superbug: The Fatal Menace of MRSA: Cover Detail

Chapter 1

The First Alert

Tony Love's knee ached.

The rangy, round-headed thirteen-year-old had banged into a friend a week ago while they were playing volleyball in the school gym. They crashed to the floor together, arms and untied shoelaces flying, and Tony scraped his elbow. After school, he and his mother and his grandmother had bandaged the cut and shrugged it off. He was a teenager, after all; Clarissa Love, his mother, expected her son to be rambunctious. It was mid-September 2007. The weather was still hot south of Chicago and Tony was still in summer mode, twitching behind his desk at school until the bell rang and he could burst out and work it off. The scratch was no big deal, and Tony was tough; he was the second child of six, and the only boy until his baby brother, the youngest, had come along. Tony saw himself as the man of the family, keeping his sisters in line while Clarissa, who was thirty, worked as an aide for the disabled.

The elbow had healed up after a few days, but then his left knee started to hurt. Now it was hot and so swollen he couldn't bend his leg. When he tried to put his weight on it, it throbbed like his heart had gone down behind his kneecap. Clarissa had gone away for a few days, so her mother Sandra put the oldest sister in charge of the other children, hooked Tony's arm around her shoulder, and steered him out to the car. He leaned on her heavily, hopping on his good leg and wincing when the other foot hit the ground.

At the little local hospital, the emergency room doctor listened to Tony's story and shrugged. It was probably a sprain, he said; take the boy home, give him Motrin, wrap the knee in hot towels, and it would be better in a few days. They staggered home.

It did not get better. Four days later, Tony's left knee still hurt, and his left foot and both of his hands did too. His hip joints ached so much he didn't want to walk, not even to the bathroom. He didn't want to eat, either. A thirteen-year-old boy with no appetite; to his grandmother, that was the biggest warning sign of all. She checked his temperature and found it was 104. Frightened, she hauled him out to the car and took him to the next-biggest local hospital, a few miles further south. The ER staff there checked his vital signs and listened to his story: the scrape, the fever, the lethargy, the joint pain for more than a week, the not wanting to eat or pee.

They were a little worried, they told his grandmother. Tony's pulse and blood pressure looked normal and his breathing was fine, but the fever indicated an infection, and his kidneys weren't working as well as they should. The hospital was willing to admit him, but to be safe, the ER staff thought they ought to take him to a children's hospital. There was a very good one, they said, back toward the city, at the University of Chicago, and they called an ambulance.

It was the end of the workday, and Clarissa met Tony and her mother at Comer Children's Hospital, a gleaming new glass pile just off the university's park-like main boulevard. The ambulance crew that brought them rolled Tony straight up to the medical floor, and the nursing staff began admitting him, checking his vital signs again and going over his paperwork from the smaller hospital. The ER staff there had suspected that Tony had osteomyelitis, a bone infection that could be caused by several kinds of bacteria. It was a serious condition, but not rare, and it was treatable, requiring that he get the right drugs for whichever bacteria were infecting him and be monitored by someone who understood the disease in children.

But while they were talking, Tony's condition abruptly got worse. He became agitated and confused; then he began breathing fast and deep. His skin had been radiating heat from the fever, but it turned cold as quickly as if someone had parked him in front of an air conditioner. The medical staff around him recognized the signs: the bacterial infection was spilling over into his bloodstream, and his immune system's spiraling reaction was slowing his pulse and crashing his blood pressure. In half an hour, he had gone from a sick kid to a kid in crisis.

A nurse phoned urgently upstairs to the pediatric intensive care unit, checking for an open bed that had all the monitoring equipment they would need. The technicians kicked the gurney's brake locks and got him rolling, skidding past the curvy computer stations and the kid-friendly bright red columns. Tony was sliding into septic shock, and that was an emergency. Inside his body, chemicals released by his immune system were triggering a cascade like dominos falling. They were stretching the firm walls of his blood vessels, making them porous, and fluid was leaking out into his tissues. Blood cells were clumping and clogging his capillaries, and his oxygen-starved organs were beginning to fail. Clarissa felt her stomach cramp in fear. In front of her eyes, her son was dying.

In the ICU, the staff sedated Tony and slid a tube down his throat, turning the hard work of breathing over to a ventilator. They threaded IVs into his veins and hooked him to bags of fluids, plugging in four drugs to bring back his blood pressure and stimulate and stabilize his heart rate, and four more drugs to contain whatever bacteria were revving his immune system into overdrive.

To his bewildered mother and grandmother, the swirl of controlled chaos around Tony was as inexplicable as his sudden collapse; the ICU staff seemed to be trying everything, hoping it would bring him back from the brink. No diagnosis was possible yet. They had been in the hospital barely an hour, not long enough for test results to make it down to the lab and back. But the medical staff had a strong suspicion of what could bring a healthy boy down so quickly, and the clue lay in one of the drugs they ordered pushed into his veins. It was called vancomycin, and it was famous in hospitals as a drug of last resort. They used it against a bacterium that had learned to protect itself against most of the other drugs thrown at it, a particularly dangerous variety of staph called methicillin-resistant Staphylococcus aureus — MRSA, for short.

Staph, the short form of the family name Staphylococcus, is an ancient organism with a vast arsenal of tricks and defenses, some of them newly learned, others as old as man. It is unpredictable, dynamic, potentially deadly — and for more than a decade, it had been the obsession of a small group of University of Chicago researchers. Geographic accident had brought Tony to a place that understood how to help him, but it was far too soon to know whether he had arrived in time.