Community Acquired MRSA: That ain't no spider bite!

“The itsy bitsy spider crawled up the waterspout; down came the rain and washed the spider out.”

Recently, a colleague of mine and I were discussing all the crazy things we have seen in our years of practice, recounting the infamous precursor to most trauma incidents: “Hey guys, watch this!” After we both ran the gamut of one-upping each other, there was a pause in the conversation, and he asked, “So how many spider bites have you seen?” I thought for a moment, mentally searching my files and came up with a startling number . . . “ONE!” He nodded and said, “Me too.”

Although a true spider bite is as rare as hen’s teeth in my practice, I have seen its doppelganger again and again: community acquired MRSA. This common but serious condition—medically diagnosed as community associated methicillin-resistant Staphylococcus aureus but called CA-MRSA (or just MRSA) in the lay community—is on the rise in athletes and causing concerns in primary care and sports medicine physicians. MRSA is usually a mild superficial skin infection that may cause folliculitis, small abscesses, cellulitis, carbuncles and tissue destruction. They typically develop spontaneously and are so frequently mistaken for and diagnosed as spider bites that they often go untreated until they become dangerous. At its onset, MRSA is very hard to differentiate from common minor bites and abrasions, especially in children. Not until they take on a red ring indicating infection (called cellulitis) do people begin to realize the “spider bite” may not actually be what it seems.

MRSA soreThe rub with MRSA is that it’s a resistant bacterium that does not respond to local wound care or first line antibiotics. Because it isn’t self-limiting, it can result in further complications in the patient, including bony involvement, lung and liver involvement, and sepsis. Also, athletes commonly and unknowingly pass MRSA to teammates through direct skin exposure, by borrowing personal items and even by training on the same equipment. For this reason, athletes, daycare and school students, and military personnel are at a higher risk of infection than the general public.

Most Staph infections, including MRSA, appear as a bump or infected area that may be:

  • Red
  • Swollen
  • Warm to the touch
  • Painful
  • Draining
  • Accompanied by fever

If you experience these signs or symptoms, the lesion should be covered with a bandage and you should promptly have it assessed by a doctor. It is especially important to contact a doctor if the possible MRSA infection is accompanied by a fever.

Prevention is the best treatment of MRSA. These infections can reach epidemic proportions in a locker room and can be extremely hard to eradicate. In general, every athlete should keep any wounds covered to prevent its spread to others, but should you suspect you have MRSA, draw a circle around the suspicious spot and watch to see if the swelling or redness extends outside the circle over the next couple days. If it does, you should seek medical attention.

Other recommendations include:

  • Wash hands frequently.
  • Disinfect non-clothing surfaces with bleach.
  • Athletes should shower immediately after participation in training.
  • Athletes should not share personal hygiene items.
  • Wash towels and uniforms in hot water after use and dry completely in a dryer.
  • Report possible infections to coaches, athletic trainers, school nurses and parents.

Hands being washed at sink

The first question every infected athlete asks is, “When can I return to play, doc?” The answer to this question depends on the extent of the infection and how easily others can be insulated from transmission. The National Collegiate Athletic Association (NCAA) guidelines for a MRSA infection state that players can return to play after they have been on appropriate antibiotics for 72 hours and experience two days without a new lesion. Even during the treatment process, the wound should be kept securely bandaged and frequently checked by the trainer to ensure the wound isn’t exposed during athletic participation. Athletes are not the only people who can become infected with MRSA, of course, but the same protocol should be followed for anyone who is diagnosed.

Different sources can cause skin lesions and result in MRSA. Most cases of MRSA can be sufficiently treated by localized wound care, good hygiene and vigilance. “Prevention is worth a pound of cure” is a good adage to follow here. Be proactive about your own body, and watch any lesions you may develop carefully. See something suspicious? It’s probably not a spider bite . . .

See you on the field.