Dangerous MRSA “superbug” creeps into Nunavut

The microbe known as MRSA, short for “methicillin-resistant Staphylococcus aureus,” cannot be killed by common antibiotics, and may evolve to a stage where it becomes resistant to even the most powerful germ-killers. Health Canada now says the bug is “endemic” in Nunavut. (PUBLIC DOMAIN ILLUSTRATION)

HELEN FALLDING
Winnipeg Free Press
Canwest News Service

WINNIPEG — At first, Lucien Kabvitok thought his son’s leg might be broken. “He was complaining and crying. He couldn’t stretch out his left leg.”

Three weeks later, four-year-old Denzel was dead.

An autopsy showed his body had been invaded by the superbug MRSA, a particularly dangerous variety of staph that is best-known for causing nasty skin boils.

Kabvitok, of Arviat, Nunavut, had never heard of methicillin-resistant Staphylococcus aureus before the bacteria felled his son, and the boy did not suffer from boils.

But the germ was already running rampant in his hometown — as it is in many northern communities with poor living conditions.

Across First Nations communities in Manitoba’s Burntwood health region — comprising the northern half of the province — close to 1,000 positive test results were reported from Aug. 1, 2009 to March 31, 2010.

Dr. Bruce Martin, of the University of Manitoba’s Northern Medical Unit, describes the hard-to-treat problem as an “emerging infection,” meaning it’s fairly new, getting worse and no one quite knows what’s going to happen next.

“It’s very scary for people in the community,” said Shirley Tagalik, chairwoman of the Arviat Health Committee.

After Denzel’s death in August 2007, epidemiologists from the Public Health Agency of Canada flew into Arviat, on Hudson Bay’s west coast, about 140 kilometres north of the Manitoba border.

Their June 2008 report noted MRSA rates in Arviat were 30 times higher than the Canadian average, comparable to the incidence in remote First Nations in Manitoba and Saskatchewan.

Out of 132 cases studied in Nunavut, five were severe enough that patients had to be medevaced and one was fatal.

In the North, where homes are overcrowded, it’s not uncommon to find more than one family member with MRSA, so the University of Manitoba’s Dr. Ethan Rubinstein wants to investigate new treatment methods that would target whole households and social networks.

Kabvitok, who is a traditional carver and seasonal carpenter, turned to the media for the first time this week.

He feels more should have been done to help his youngest child, and worries that other kids might die before their symptoms are taken seriously.

Staff at the health centre in Arviat gave Denzel Tylenol and told his parents the boy should be fine in a few days, according to his father.

But the boy kept crying, so his parents, sensing something was seriously wrong, took him back to the health centre numerous times.

“The nurse on call didn’t want to see us no more,” Kabvitok said, claiming that a nurse referred to his son as a “king” to imply that his parents spoiled him. “That was an insult to the family.”

After Denzel — nicknamed Oh-oh — had been in pain for about two weeks, he and his mother were flown to Churchill. An X-ray showed nothing wrong, so a doctor there suggested more painkillers and sent the child home, according to Kabvitok.

He said his son took Tylenol or Advil three times a day for three weeks, but he was still in pain and couldn’t walk.

“He was a pretty brave boy.”

Denzel’s parents got even more worried when he started sleeping all day.

“We stayed up all night looking after him. By about 3 a.m., when he finally woke up, he said ‘Why is it so dark in here?’ ” Kabvitok recalls.

The statement prompted quick concern. It was an Arctic summer night — meaning it was still bright inside the house.

Kabvitok woke up the nurse on call. “I told her my son can’t see no more.”

The nurse said they’d have to wait until the health centre opened at 8:30 a.m., five hours away.

“When the doctor saw him, everything became emergency,” Kabvitok recalls. “He was medevaced to Winnipeg, but he only made it as far as Churchill.”

An autopsy concluded the boy died from a whole-body inflammation known as sepsis.

Reviews by a Winnipeg Regional Health Authority critical-incident team, the Manitoba medical examiner and the College of Physicians and Surgeons of Manitoba concluded the Churchill Regional Health Authority had done everything it could, said CEO Derry Martens.

In Nunavut, health workers are now trained to consider MRSA when they see unusual lung problems or joint pain. They’ve also been reminded that when a patient keeps coming back to a health centre, it should raise a red flag.

Denzel’s death “has had a big impact on the way we do things,” said Dr. Sandy Macdonald, Nunavut’s director of medical affairs.

News of the little boy’s death is increasing the sense of urgency among health workers in northern Manitoba, who were already alarmed by the boils they treat at nursing stations.

“You get big ugly boils, with one or two little satellite boils. They’re festering and huge and disgusting and painful,” said Dr. Hanka Hulsbosch, who works in Garden Hill, Man. “I’ve seen them to up 10 centimetres.”

When people admitted to hospital have MRSA, they’re kept away from other patients, and staff take extra precautions to avoid spreading the infection.

Yet the rate in Winnipeg hospitals — which serve many northern residents — has been rising every year since 2005.

What is MRSA and how does it spread?

• Danger on contact:Staphylococcus aureus spreads through contact with skin or contaminated surfaces. Not everyone who tests positive for the bacteria has an infection — some just carry the germ and spread it to others.

• Boils or ulcers sometimes start when a scratch or insect bite gets infected, but that’s not usually life-threatening. The antibiotic-resistant version of the bacteria occasionally kills people when it gets further inside the body, causing pneumonia, bone infections, meningitis or sepsis.

• Health Canada says MRSA has become endemic in the past decade in the northern Prairies, Nunavut and parts of Alaska. The number of positive test results will continue to fluctuate, depending on how many people are ill and how many get tested even when they have no symptoms, a Health Canada spokeswoman said in an e-mail.

• To treat MRSA, doctors need to get out the big guns — the most powerful antibiotics they reserve for special cases. They fear germs like MRSA, already resistant to common antibiotics, will evolve to the point where even the strongest antibiotics are no match.

• The best way to stop MRSA from spreading is to wash your hands often. If you have an infection, keep yourself and your house clean. Follow the directions given to you by your doctor or nurse on whether or not the infection site needs to be covered. Only use antibiotics when they are given to you by your doctor or nurse.

Source: Northern Antibiotic Resistance Partnership