Placing the NFL's Lawrence Tynes' MRSA Problem Under the Microscope

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Placing the NFL's Lawrence Tynes' MRSA Problem Under the Microscope
Lawrence Tynes' PICC can be seen in his right arm as he holds a plastic bulb filled with antibiotics. Courtesy: Amanda Tynes' Twitter (@AmandaTynes9).

Not all medical concerns in the NFL are as readily visible as head injuries or blown-out knees, and some—like Tampa Bay Buccaneers kicker Lawrence Tynes' MRSA infection—may initially go completely unseen.

Literally.

According to ESPN's Chris Mortensen, the Bucs sanitized their facilities after tests revealed Tynes and teammate Carl Nicks contracted MRSA infections. MRSA is a strain of bacteria that is infamous throughout the medical community, as it can cause extremely serious, sometimes life-threatening infections. It is also difficult to treat.

Mortensen also reports Tynes recently underwent surgery on an infected toe to as part of his treatment.

Four days after the news first surfaced, free-agent running back Brandon Jacobs tweeted his concern about doctors needing to place a peripherally inserted central catheter or "PICC" line in Tynes' heart to fight the infection:

Sounds scary, right?

It most certainly is.

Yet it's also a good sign.

Well, sort of. Let's take a closer look.

 

What Is a Staph Infection?

Simply put, bacteria are everywhere.

In your nose. In your mouth. On your skin.

Even on the mouse you used to click on this article.

Different bacteria prefer different locations, and one of the most common skin bacteria is Staphylococcus aureus—the "SA" in MRSA—or "staph" for short.

Staphylococcus aureus are extremely small—much smaller than even a red blood cell. Photo from Wikimedia Commons.

Ordinarily, staph does not cause any problems. The skin serves as a near-perfect barrier, preventing it from entering the body.

However, cuts, wounds or other openings in the skin can let staph in, and occasionally, an infection forms as a result.

Most of the time, the body confines staph to the outermost levels of the skin, limiting the infection to minor conditions such as folliculitis—the scientific name for a pimple—or impetigo—the name for one type of infected blisters.

Nonetheless, if a cut is deep or large enough, staph can cause cellulitis—a more serious infection of the deeper skin layers. The skin becomes red, warm, swollen and painful, and the infection often requires antibiotics for complete resolution.

 

Okay...Then What's So Special About MRSA?

Decades ago, doctors used to treat staph infections with penicillin and other similar antibiotics, such as methicillin.

Little did they know how clever staph would turn out to be.

The antibiotic methicillin is no longer in widespread use.

As physicians continued to treat staph with penicillin-class antibiotics, some strains altered their genetic profiles in response. For example, they began to produce a protein that allowed them to sidestep the mechanism by which penicillin and methicillin halt bacterial growth.

In other words, the strains became resistant to them. As such, they were named "methicillin-resistant Staphylococcus aureus," or MRSA for short.

Additionally, though the theory is controversial, MRSA tends to produce more serious infections than its counterpart, methicillin-sensitive Staphylococcus aureus (MSSA). It is worth emphasizing, however, that MRSA is an umbrella term for likely innumerable different varieties of methicillin-resistant staph, each with its own level of nastiness.

 

Can't You Just Use a Different Antibiotic to Treat MRSA?

Well, yes.

Doctors have several effective drugs at their disposal to treat MRSA—vancomycin, sulfamethoxazole-trimethoprim, linezolid and doxycycline, for example.

How long the effectiveness of those drugs will last before bacteria develop new resistances, however, is one of the most important unanswered questions in medicine today.

 

What Happened to Lawrence Tynes?

As Mortensen states, Tynes needed surgery on his infected toe. According to a later ESPN report, Tynes originally attributed his situation to an ingrown toenail, but doctors ended up finding an infection that needed to be scraped off his toe bone.

Ouch.

Though medical details aren't available to the public, by reading between the lines, it seems likely Tynes suffered from MRSA osteomyelitis—or a MRSA infection in the bone.

How did that come about?

Mike Ehrmann/Getty Images
Buccaneers guard Carl Nicks also contracted a MRSA infection.

One potential scenario is that Tynes did, in fact, have an ingrown toenail that allowed MRSA—apparently present somewhere in the Bucs' training facility—to enter his toe. As time elapsed, the MRSA spread deeper and deeper into his toe until it reached the bone.

 

What Did Doctors Likely Do to Treat Him?

Controlled MRSA infections—such as minor skin infections in an otherwise healthy patient—require simple oral antibiotic treatment, if anything.

On the other hand, uncontrolled MRSA infections—such as one in the bone—require prompt treatment, because if they spread into the bloodstream, patients can become very sick very quickly. In fact, untreated MRSA bloodstream infections are almost invariably fatal.

Fortunately, if started early enough, intravenous (IV) antibiotics—such as the aforementioned vancomycin—are usually effective at helping the body fight off MRSA infections.

That said, antibiotics are only helpful if doctors control the infection source. In Tynes' case, it appears the source was his toe bone.

By surgically scraping the infection from the bone, doctors physically removed the vast majority of the infection from Tynes' body.

 

What's This PICC Thing Brandon Jacobs Is Talking About?

Since bacteria are microscopic, surgeons cannot guarantee the complete removal of every single MRSA bacterium from the bone during surgery.

On the other hand, antibiotics can.

To prevent bacteria lingering on the bone after surgery from spreading, Tynes probably needs daily antibiotics through an IV. Unfortunately, patients generally cannot leave the hospital with a simple IV catheter in the arm as their sole route of receiving antibiotics, as it can fall out, clog or fail.

The answer?

The peripherally inserted central catheter, or PICC.

A PICC is a long tube doctors thread into a vein in the arm, through that vein as it continues into the shoulder and finally into the superior vena cava—the largest vein in the body that brings blood back to the heart from the upper body.

Look very closely. This X-ray shows the proper placement of the end of a PICC—marked by the blue arrow. It sits right where the superior vena cava meets the heart. Photo from Wikimedia Commons and edited by the author.

PICCs are much more reliable for antibiotic administration than IVs, and they allow patients to leave the hospital to finish a multiple-week antibiotic course.

 

Does Tynes Needing a PICC Mean His Infection Is Very Serious or Life-Threatening?

Actually, probably not.

Since bacteria in the bloodstream can latch onto the PICC tubing and create a new infection source altogether, the placement of a PICC suggests physicians believed Tynes' blood was clear of bacteria at the time.

In other words, a PICC line into the heart is a good sign, not a bad one.

Also, though the procedure itself is not trivial, patients leave hospitals with PICCs very frequently once doctors no longer think inpatient monitoring is necessary.

 

What's the Take-Home Message?

How concerned were you when you heard about Lawrence Tynes' MRSA infection?

Submit Vote vote to see results

The spread of MRSA is an extremely concerning problem in the medical community—the likely reasoning behind, according to ESPN's Adam Schefter, the Patriots are also sanitizing their locker room this week. The Bucs visited the Patriots earlier this month.

Additionally, any serious MRSA infection has the potential for dire consequences and needs medical attention.

However, while Tynes' condition remains tenuous, he is making at least some progress relative to how bad it could be.

As of Wednesday, Tynes is no longer in the hospital—evidenced by a photo his wife, Amanda, posted on Twitter—the best sign of all. The PICC can be seen coming out of his upper-right arm.

Fortunately, otherwise-healthy patients will usually recover from MRSA osteomyelitis if caught early enough, but it can take several weeks of continued antibiotics through an IV or PICC, depending on the extent of the infection. Eventually, Tynes' doctors will likely switch him to an oral antibiotic combination.

Until he completes those antibiotics, however, he technically is not disease-free. That means—as Mrs. Tynes points out—he might still have a long way to go.

 

Dr. Dave is a resident physician at the University of Washington. Information discussed above is based on his own knowledge and experience treating MRSA skin, bone and blood infections.


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