The case was identified in a 33-year-old male psychotic patient admitted to Tak Sin Hospital about seven months ago with a severe skin infection that was extremely resistant to antibiotics.

He was then suspected to have the Community-Acquired Methi-cillin-Resistant Staphylococcus aureus (MRSA) when a medical laboratory technician familiar with this bacterial infection recognised it and sent his sample for advanced testing by Siriraj Hospital.

In June, Siriraj found that the man had a similar type of MRSA to that in the US, said Dr Chanwit Tribuddharat, an expert with the Department of Microbiology, who isolated this case.

The patient is missing because he was discharged from hospital before the genetic analysis was complete and it was concluded that he had MRSA.

"We have been trying to trace him, yet to no avail," said Chanwit. "It remains uncertain if he's in a psychiatric hospital or at home. Actually, it is not known even from which psychiatric hospital he was sent to Tak Sin."

The isolated MRSA in Thailand was a mutated form of the disease that was still less virulent than the one that has plagued the US, despite their similarities, said Chanwit.

Over the past seven to eight years, MRSA has become a medical hot issue in the States, said Dr Pisespong Patamasucon, a professor of paediatrics with the University of Nevada's School of Medicine.

That was since the Centres for Disease Control and Prevention (CDC) confirmed that the bacterial infection came to be acquired in communities rather than in hospitals as in the past, he said.

Unlike the mutated strain commonly found in chronic patients in hospitals, the community-acquired MRSA is far more virulent and easily passed from one person to another.

The new infection is commonly found in young and healthy people such as athletes rather than old patients with chronic diseases and being tube-fed in hospital as in the old strain, he said.

The number of new MRSA cases in the US has been rising steadily due to the high mobility of the new strain resulting in extremely easy transmission through direct contact.

Now about 59 per cent of patients attending American hospitals with skin infections turn out to have community-acquired MRSA, with up to 25 per cent needing lengthy treatment to recover.

The symptoms of the disease range from soft-skin tissue infection to deadly infection in the blood stream and pneumonia.

Patients with MRSA infection in the bone, for example, need to be treated with strong and expensive antibiotics such as Vacomycin, which costs about Bt900 per day, for about half a year.

Pisespong warned that available drugs were not totally reliable due to the high and fast rate of drug resistance developed in the new MRSA.

"And not all doctors know the disease, not to mention the fact that the disease itself is not easy to recognise without a specific lab test," he said, adding that many cases of the new MRSA in the States were misdiagnosed as "spider bites" and the patients were wrongly treated.

It was even more frightening to find out that the new strain could be easily passed by sharing gym equipment with a carrier, said the doctor.

The other groups of people commonly found to have MRSA in the US include prison inmates, children, gay men and fencers, he said, adding that the disease could be carried by humans without symptoms yet could be easily passed to others for up to three years.

Therefore, he said, it was highly worrying that Thailand would follow suit in about five years, given the number of tourists arriving in the country every day.

"What do those tourists love about Thailand? A must is a spa or massage that could pass the disease to the therapist," warned Pisespong. He recommended that those who work as spa or massage therapists should wash their hands as frequently as doctors and nurses in infectious disease wards.

"It's coming, for sure - the rest is a matter of how well we are preparing to deal with it," said Pisespong.

Arthit Khwankhom

The Nation