By Mary Ann Roser
The Austin American-Statesman
Copyright 2007 The Austin American-Statesman
GEORGETOWN, Texas — 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.
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 U.S. Centers for Disease Control and Prevention is encouraging vigilance — and prevention.
“We are definitely concerned about those infections, and that’s one of the reasons why we are strongly urging people to get flu shots,” said Dr. Arjun Srinivasan, a medical epidemiologist at the CDC. “That’s a fantastic way to avoid complications.”
Because staph infections and flu are not required to be reported to the state or federal governments, the CDC can’t say how widespread the two are in combination or how many people get pneumonia triggered by staph.
But CDC epidemiologist Jeff Hageman said the MRSA-related pneumonia in flu patients appears to be a growing problem.
It’s unclear what type of staph Kaylin had because tests were not performed to find out.
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, but it can cause boils that require antibiotics. Staph can become more dangerous in a person whose immune system is already weakened by another illness, such as flu. In extreme cases, it can invade the organs and cause a fatal infection.
Dr. Leonard Weiner , an MRSA expert and director of pediatric infectious diseases at the State University of New York in Syracuse , said he believes the risk of getting both is low.
“I’m concerned people will take away from this a connection (between) flu and subsequent staph and assume it happens all the time,” Weiner said. “It’s still pretty rare.”
Schools across Texas, including many in Travis, Williamson and Hays counties, have recently sent letters home to parents alerting them to staph cases — some of them involving MRSA — in students. No deaths have been reported, and schools said they were disinfecting athletic equipment, locker rooms and other areas where students have close contact.
Up to 40 percent of school-age children are believed to carry MRSA , said Gabriela Bowden, an assistant professor at the Institute of Bioscience and Technology at Texas A&M University’s Health Science Center in Houston.
In Central Texas, hospitals say they’re seeing more cases of MRSA.
Dr. Pat Crocker, chief of emergency medicine at Dell Children’s Medical Center, said 65 percent to 70 percent of the skin and soft tissue infections they see in the ER are MRSA.
The Seton Family of Hospitals, which owns Dell Children’s and other hospitals around Central Texas, treat 3,700 cases of MRSA a year, Crocker said, and the more serious cases require hospitalization and intravenous antibiotics. That’s not counting patients who get MRSA while in a hospital, he said.
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.
“What a great person she was,” Elvira Johnson said. “The only place we can visit her now is the cemetery.”
What should parents and doctors look for?
“It is vital for anybody who has the flu and anybody who is taking care of somebody who has the flu to be extremely concerned with the symptoms: Is this person recovering?” said Bowden, the Texas A&M researcher.
Fever caused by staph is often higher than a flu fever, she said, and if someone with flu appears to recover, only to get worse, that’s a sign of trouble. If the person is hard to wake up or has trouble breathing, go to the hospital immediately, Bowden said.
Dr. Richard Wenzel, chairman of internal medicine at Virginia Commonwealth University and president of the International Society for Infectious Diseases, said he worries that with the spread of MRSA, more people with influenza will also get pneumonia caused by a staph infection.
“I think we underreport that kind of thing,” said Wenzel, author of “Stalking Microbes: A Relentless Pursuit of Infection Control .”
“This is the thing that keeps physicians awake at night.”