Jessamine County

Jessamine teen's rapid decline stunned family

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.

Four such cases were reported in Baltimore during a two-month period in the winter of 2003-04, according to information presented by Dr. John G. Bartlett during the 2005 annual meeting of the American College of Physicians.

Each of those cases occurred in previously healthy individuals without risk factors for staphylococcal infection, and the course of the infection spread rapidly. All four had some type of flu before their bacterial infection; two had Type A flu. Only one of the four died, but two needed below-the-knee amputations.

Dr. Christopher Nelson, associate professor of pediatrics at UK, said such cases are rare — he has seen five in the last few years. Still, Nelson said early diagnosis is key in trying to treat it. If not caught early, mortality can run as high as 80 percent.

"When I teach students, residents or fellow faculty members on MRSA in general, I have a special section on necrotizing pneumonia," Nelson said. "I tell them that if they see a patient who presents with flu-like symptoms and a very rapid downward course, you need to think about MRSA. Early intervention is a key to survival for these patients."

Ryan was the second teen — and the second soccer player — to die from MRSA in the last six months in Central Kentucky. In September, Mckenna Hatchett, a 14-year-old freshman in Clark County, died of MRSA.

Mckenna's parents declined a request for an interview through their lawyer, Jeff Darling. He said Mckenna's case sounds different from Ryan's.

A normal part of our skin

The state Department for Public Health does not track MRSA infections, so it is unknown how many occur in Kentucky. That could change as more cases continue to be reported.

But a study published in the Journal of the American Medical Association estimated that more people died of MRSA infections in 2005 than died of HIV/AIDS. And the number of MRSA-related deaths is much higher than previously thought.

Common staph is present on the skin or in the nostrils of about one in three people, typically without causing illness.

"To a large extent, many of us are colonized with staph and we never have an infection," said Humbaugh, director of the state Division of Epidemiology and Health Planning. "In other words, it's a normal part of our skin."

But the drug-resistant strain can cause painful skin lesions that resemble infected spider bites; toxic-shock syndrome, a blood poisoning that can be fatal; and necrotizing pneumonia.

"There are those few cases that are severe and that we call invasive illness, and those are very severe," Humbaugh said. "In rare cases it can cause pneumonias or bloodstream infections."

In the meantime, health officials can't emphasize enough the importance of good hygiene as a means to prevent MRSA.

The Jessamine school district has emphasized hand washing among students; covering all open wounds with a clean, dry bandage; and avoiding the sharing of personal items including towels, razors, and athletic equipment.

During flu season, it is common practice for the Jessamine schools to use an EPA-approved disinfectant solution on all desks and classroom surfaces. On Tuesday, teachers were asked to use that solution again as an extra measure to prevent the spread of flu and other infectious diseases.

School officials have also had a preliminary discussion with the Jessamine County Health Department about holding a public forum to answer questions about MRSA.

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