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Sunday, Mar. 15, 2009

Jessamine teen's rapid decline stunned family

MRSA INFECTION FOLLOWED FLU

NICHOLASVILLE — Ryan Robinson went from a healthy, 17-year-old soccer player at the peak of his form to another victim of a deadly drug-resistant strain of bacteria — all within the span of five days.

It's something his stepfather still cannot fathom.

"It's a surreal experience," Michael Brown said Thursday, two days before Ryan's Saturday funeral. "It's not something you can plan for."

Ryan died Tuesday. His rapid deterioration in health stemmed from MRSA, a strain of staph that is aggressive and typically harder to treat because it is resistant to commonly used antibiotics.

Until the beginning of this decade, MRSA, short for methicillin-resistant Staphylococcus aureus, was largely confined to hospitals. But in the last few years, there has been an increase in cases of drug-resistant staph among the general public, including jails, the military and athletic teams.

Athletes are at risk because they "are more likely to be in a crowded condition," said Dr. Kraig Humbaugh, an epidemiologist with the state Department for Public Health.

Athletes are also more likely to have abrasions, cuts and scrapes — the skin breaks that bacteria can enter — and they are more likely to come into contact with shared items such as towels, razors or practice jerseys, Humbaugh said.

Contrary to initial reports, Brown said Ryan did have some injuries.

"He had different scrapes and scratches on his legs, and he also had a large cut on his hand where he had been cleated in a game," he said. "I'm not suggesting that that is the point of entry because we don't know, obviously."

The speed of Ryan's deterioration is something that stunned the community and his classmates at West Jessamine High School, where he was a junior.

Brown said Ryan played soccer on March 5 and, other than a dry cough, there was no indication that the teen had any problem.

The next morning, Ryan awoke "throwing-up sick." So Brown said Ryan's mother, Patti Brown, took him to Lexington Clinic's Jessamine Medical Center near Wal-Mart in Nicholasville.

"They diagnosed him with the flu" and gave Ryan something to curb his vomiting. They also gave him a prescription for Relenza, an inhaler for Type A flu, Brown said.

"They told us to bring him back in three to five days if he wasn't feeling better," he said.

On Saturday, Ryan appeared to be getting worse, so the Browns took him to St. Joseph-Jessamine RJ Corman Ambulatory Care Center, a facility that opened earlier this year off the U.S. 27 Bypass in Nicholasville.

"They put him on oxygen and started some IVs with broad-spectrum antibiotics," Brown said. "After a couple of minutes they decided to intubate him (put a tube down his throat) because he was having such a hard time breathing."

St. Joseph-Jessamine suspected Ryan might have pneumonia, so they transferred him to the University of Kentucky Chandler Hospital in Lexington, where he was admitted to a pediatrics intensive care unit, Brown said.

There he was put on a respirator for his lungs and a life support system that did the work of his heart, Brown said. He said Ryan was not conscious from the time he left Nicholasville because he had been given a sedative so he would not fight the tube threaded down his throat.

"There was one point on Saturday that he responded to a request to squeeze a hand," Brown recalled.

In his last hours, Ryan was surrounded by family. He died Tuesday afternoon, shortly after life support was turned off.

"One of the things the physician did say to us that I think is important for other families is that a flu immunization is something that would have been beneficial," Brown said. As Brown understands it, flu weakened Ryan's immune system and thus provided an opportunity for MRSA to attack more aggressively.

"We hope other parents get flu shots for their children," Brown said.

Trying to fight MRSA

Doctors did not wish to comment specifically on Ryan's case, citing confidentiality. But medical journals and Web sites in recent years have cited rare cases of a "staphylococcal necrotizing pneumonia" following an influenza illness. Such pneumonia destroys healthy lung tissue and can be fatal within 72 hours.