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The bug that can kill within hours

By Paul Burnell
BBC File On 4

Patients under 40 are especially vulnerable to PVL
Harry was a fit and healthy 27-year-old, who thought he was suffering from flu-like symptoms after a foot infection but within hours his life was hanging in the balance.

As he struggled for breath doctors at the Royal Devon and Exeter Hospital diagnosed pneumonia and contacted consultant microbiologist Marina Morgan, who recognised immediately that Harry might be suffering from the infection PVL (Panton Valentine leukocidin).

His chances of survival were rated as less than 50/50 at one stage.

PVL is a toxin which is produced by Staphylococcus Aureus bacteria (the same bug family as MRSA) and destroys white blood cells.

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It can spread to the lungs causing fatal pneumonia, or lead to blood poisoning or necrotising (flesh-eating) infections.

People under 40 are especially vulnerable to this infection.

The first fatality in the UK came in 2005 when a Royal Marine soldier, Richard Campbell-Smith aged 18, died after cutting his leg in training. The following year a patient and health care worker died in Stoke-On-Trent.

"Doctors suggested I might lose my foot, I think at that time I wasn't really aware, of how ill I was," Harry told BBC File On 4.

Fortunately Harry, unlike some who have been affected by this bug, has suffered no lasting effects.

Superbug fight

As hospitals battle with superbugs like MRSA and C-Diff, some microbiologists are concerned about the growing incidence of PVL-MRSA in the community and whether enough priority is being given to spot and prevent it.

"I am seeing a dramatic increase in ordinary PVL," said Dr Morgan, who expects this to lead to a rise in the mutant strain of MRSA.

Prompt diagnosis is essential but as she explained, "In the early stages it is easy to miss."

The Health Protection Agency is charged with co-ordinating health protection across the UK, with its English-based centre for infections liaising closely with its equivalent in Scotland, Wales and Northern Ireland.

Its monitoring of PVL related diseases in England and Wales identified more than , 1,361 cases last year, a threefold increase on the previous year.

It would be quite wrong if we allow these things to develop and of course history tells us that it we do neglect these bugs, we neglect them at our peril

Professor Hugh Pennington

Professor Brian Duerdan, the Inspector of Infection Control at the Department of Health, admits however that many aspects of this virulent bug are a mystery.

"We do know that it spreads in the community amongst close contacts, families, people who share the same sporting events.

"But we still need to know a lot more about its exact prevalence in the community," he said.

However there are microbiologists who fear too little funding is being devoted to a bug, which would be extremely difficult to control if it hit epidemic proportions.

Hugh Pennington, Emeritus Professor at the University of Aberdeen, and President of MRSA Action, told the BBC that the HPA lacks the resources to keep proper surveillance on outbreaks of infection from this strain of bugs.

Richard Campbell-Smith
Richard Campbell-Smith: Scratch led to death

"The scandal here is that we know what to do, the technology's there to spot these things as they are appearing and we know how to react to them.

"It would be quite wrong if we allow these things to develop and of course history tells us that it we do neglect these bugs, we neglect them at our peril."

Suspect PVL samples are sent to two laboratories one in Colindale and the other in Glasgow, with test results available three days at the earliest.

Mircrobiologists such as Professor Richard James, from the University of Nottingham, said new rapid diagnostic techniques should be used in hospitals.

Epidemic fear

Prof Duerdan however said the government strategy is not merely based on PVL testing but on enabling medical staff to diagnose it clinically.

The fear remains however that the UK could suffer a similar level of infection, to the USA where some microbiologists say it has reached epidemic proportions.

"I think the HPA and the government are doing a fair amount to deal with this. The problem is that this is one bug you cannot afford to be complacent with," said Dr Morgan.

"The longer the bug is ignored, the longer it has to mutate to change into some other form and to produce other toxins."

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