Although all three children were previously healthy, the infection caused severe sepsis, rapid clinical deterioration and bleeding into the adrenal glands, a complication, known as Waterhouse-Friderichsen syndrome, that is usually associated with fulminant bacterial meningitis.
Two of the three bacterial strains were resistant to standard antibiotics. In all three cases, the disease progressed so rapidly that neither standard nor alternative antibiotics had an effect.
"What we saw in these patients is not in the textbooks," said Robert Daum, M.D., professor of pediatrics at the University of Chicago and senior author of the study. "This is the first time this unusual syndrome has been described in patients with a Staph infection."
Such cases, although rare, highlight a disturbing convergence. In the last decade, drug-resistant strains of Staph. aureus have become quite common. At the same time, reports of virulent newer strains of Staph that can cause invasive disease, extensive tissue damage and death have increased.
"These bacteria have picked up genes that enable them to evade most of the drugs we used to employ to treat them," Daum said, "and now they are combining that with genes for various toxins that can cause severe illness."
Until the late 1990s, drug-resistant Staph infections were viewed as a purely hospital-acquired illness. In the 25 February 1998 issue of JAMA, however, a team led by Daum published the first study showing that Staphylococcus aureus infections that were already resistant to many types of antibiotics were being seen in children outside of the hospital environment.