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    MRSA throat infection
    MrCanz posted:
    Hello Dr. Moser,

    About a month ago (July 20 '09) I recognized several abscesses on the right side of my throat in a "grapevine" like pattern (~1" centrally swollen line with 3-5 abscesses attached) where my tonsils used to be (tonsils removed Dec '07). There was minimal pain (minor tightness to be more exact), little redness, no fever, and a small amount of fatigue. A topical swab revealed nothing more than common staph but a swab of a draining pustule revealed heaps of MRSA. About a week ago (Aug 13 '09) I was prescribed Bactrim but the abscesses were not affected. There have been little to no pustules which is probably due to the antibiotics but may also be because of my expulsion of dairy products as, from what I've heard, they are "pus producers". I went back to the doctors again today (Aug 20 '09) and was prescribed Clindamycin. The doctor did not seem overly concerned as I am not exhibited any pain, extreme redness, fever, or a general feeling of being "sick". My nose and throat were swabbed again and am waiting on the results which I should have in 2-3 days.

    My questions are,

    (1) what is going on in the back of my throat? I know about 1/3 of the population carry MRSA somewhere on their body. Is "my" MRSA merely harboring itself harmlessly in the back of my throat?

    (2) Should I be concerned about the infection spreading, particularly to my joints (jaw mainly), bones, brain etc?

    (3) Why am I not exhibiting any of the classic symptoms of a MRSA infection (pain, fever, etc)? I was told by the doctor today that people with MRSA infections will have them come and go throughout their lives.

    (4) Will the antibiotics kill the MRSA in my throat or will it merely suppress it and reoccur in the future?

    (5) Am I contagious? Should I not be kissing anyone?

    (6) Should the abscesses disappear if the MRSA is killed by the antibiotics or is it synonymous with scar tissue and requires more time to heal?

    I am scheduled to see an ENT on Sept. 1 '09 and would appreciate any advice you might give me in terms of questions I should ask him.

    As a side note, I have been smoking marijuana habitually for about 6 months now up until a week ago when I was put on antibiotics (thought it would interfere with the antibiotics). I have read recent reports of marijuana being effective against MRSA infections and am wondering if the marijuana might account for the lack of symptoms commonly associated with MRSA. What is your take on that hypothesis?

    I appreciate your time in answering my questions.
    Rod_Moser_PA_PhD responded:
    Marijuana effective against MRSA???? I haven't heard that one. My skeptical eyebrows are raised high on that one. And, dairy products are not "pus producers".

    I will do my best to answer your questions in a general fashion. It would not be possible for me to offer you any patient-specific comments since I do not know the details of your case.

    1. I can't tell you what is going on in the back of your throat, namely since I have no way of examining you. Personally, I have not seen MRSA emerge in this fashion. My guess would be that this is not a resident pathogen, but an infection that you have acquired somewhere...from someone....somehow.

    2. Not really. If your MRSA infection (I am assuming community-acquired MRSA and not a hospital pathogen), is under treatment (those drugs are appropriate) and you are in good health, I don't think you should be concerned about an eminent systemic infection.

    3. This, I cannot answer. Symptoms are in the body of the beholder, and everyone is different.

    4. Let's hope this can be completely erradicated. MRSA can colonize in the nose, for instance, in some people, but that does not mean it can colonize in your tonsillar area.

    5. Hold off on kissing, my friend, until you get the okay from your doctors and some negative cultures. Exposure to infectious organisms do not necessarily mean the person exposed with get it. I am exposed to MRSA quite often.

    6. I am not sure I understand your question, but the abscesses should go away with effective treatment.

    I would be very interested in an update after you see the ENT. I don't think you will have any problems coming up with some appropriate questions, since you have been doing your research.
    MrCanz responded:
    Thanks for your response Dr. Moser.

    My MRSA may be community acquired but after I had my tonsils removed (2-3 months after the operation) I started developing staph infections on my skin, namely the armpits. These infections were not identified as MRSA however and have not become severe. In fact, a simple draining of the area and a dab of Neosporin completely eliminates them before they grow too large.

    In regards to marijuana being effective against MRSA infections, this is a fairly new study that has not gone under any human trials as of yet but research has been done in this area. Here is a link that you may find interesting.

    I will keep you updated on my condition and the diagnosis/prognosis of my ENT.

    Thanks again for you time
    MrCanz responded:
    Just a thought,

    What if MRSA is merely hitching a ride on another type of condition in my throat? It would appear that new lesions, abscesses etc. are forming on the left side of my throat now. Again these are not painful and are not red. In fact, the area looks almost exactly like it did before I had my tonsils taken out. Obviously I do not have my tonsils there anymore but what if the type of infection that infected my tonsils has reoccurred?

    Can you give me any type of throat condition, for purely educational and study purposes, that might cause abscesses or masses to form in the tonsillar region?

    Upon further research I have compared my throat to pictures of benign tonsillar masses. The relationship is almost identical, from a purely visual comparison. Again, not as a official diagnosis obviously, but what is the likelihood that the masses in my throat may be representative of a benign mass, given the rate at which they are occurring (span of about 1 month) and the lack of symptoms relevant to an infection?

    Rod_Moser_PA_PhD responded:
    Hitching a ride? No, I don't think so. As far as the appearance of those "abscesses", I can tell you that what often appears as lumps and bumps in the throat, especially in the tonsillar area may not be abscesses, but merely residual lymph tissue. Depending on how your tonsils were removed, it is not uncommon to have residual tissue back there. The true nature of this cannot be fully appreciated by a description, as you know, and only partially appreciated on a photograph....this MUST be directly viewed. Has your ENT considered removing any of this additional tissue that is considered to be abscesses or new lesions?

    I really can't give you a name of a condition that you could research. Every person and every medical condition is really unique. You may not find any case that is identical to yours.

    Have you considered getting an official second opinion by an ENT that did not remove your tonsils? Why were your tonsils removed in the first-place?
    MrCanz responded:
    My tonsils were removed due to infection. My ENT said that bits of food and other stuff gets lodged back there with the tonsils which usually leads to infection. I am not sure what type of infection it was. A swab at the time revealed nothing bacterial as far as I can remember.

    I will consider a second opinion if my ENT is unable to diagnose my problem.

    I managed to snap a few pics of my throat. The protrusions on the right side of my throat (left side in pictures) are my major concern. The red patches (right side in picture) seem to come and go but were also a concern of the doctor I saw. There are some small bumps and craters that cannot be appreciated by the picture but I figure the pictures are somewhat representative of what is going on in the back of my throat. I realize that an official diagnosis cannot be determined by simply viewing some pictures but any speculations would be taken as just that, nothing more.

    Here is a link to the photo album (click for larger pictures)

    - Thanks so much
    Rod_Moser_PA_PhD responded:
    Taking photos inside the mouth with an accurate representation of color, as well as eliminating distracting shadows is really not possible with normal photo equipment. You need a circle-flash and high-resolution images, and even that, it is not a good substitute for a first-hand look -- where the examiner can view from several angles, touch those areas, etc. Some bumps and craters are normal....

    I am sorry, but I cannot make any type of conclusion based solely on your photos, but I commend you for giving this a try. Keep working with your ENT until this issue has been solved.
    MrCanz responded:
    Thanks for all your help Dr. Moser.

    If I may ask another question, not specifically pertaining to my condition. With your experience with infections of the throat, or infections in general, is it possible for a bacteria to "wall" itself off, in pus pockets etc., so that antibiotics would either be less effective or ineffective all together?

    I guess what I'm saying is, even if a bacteria is susceptible to a certain antibiotic, what defense mechanisms might a bacteria take, if any, to protect itself?

    Rod_Moser_PA_PhD responded:
    MRSA, as you know, is an example of a bacteria that has adapted to many antibiotics, qualifying it as a "super bug". The throat can be a bacterial and viral soup -- and contain many different types. The presence of a certain bacteria on a throat cultures does not automatically imply that this bacteria is the smoking gun for an infection.

    Yes, bacteria can adapt and abscesses, with their relatively poor blood supply, can be more resistant than some other infections. It is really not likely that an infection will literally "wall off" in the pharynx, making antibiotics ineffective. The pharynx has an excellent blood supply, so any localized infection should be effectively treated, assuming you do not have a resistant bug.
    MrCanz responded:
    According to my ENT it is likely that residual lymph tissue has been reinfected. His official diagnosis was tonsillitis and even though my tonsils were removed, lymph tissue probably still remained and has since been reinfected.

    He gave the analogy of infected tonsils to that of a large forest fire and a residual lymph infection to that of a smaller, more contained fire.

    He also mentioned that the infection would not spread to the surrounding tissue, such as the muscles etc.

    He wrote me a prescription for Doxycycline and said if antibiotics are ineffective that surgery to "smooth out" the area and remove more lymph tissue would be a likely course of action.

    In your opinion, and with your experience with tonsillitis, is MRSA a likely cause of infection? Again, pus (watery pus, not oozy or thick pus) gathered from the draining infected area revealed predominantly MRSA bacteria. My ENT did not seem to be alarmed or concerned at this and said that I was most likely a carrier.

    I thank you for your time in analyzing my situation. If you have any further comments, questions, or advice as per my official diagnosis, I'm all ears.
    Rod_Moser_PA_PhD responded:
    Is MRSA a likely cause? No, MRSA would be a rare cause, but if your cultures or tissue samples keep showing MRSA, it has to be considered as a potential pathogen. Of course, if you are a MRSA carrier, you would tend to have positive cultures every time.

    When was the last time this was cultured? And, doxycycline usually does not help MRSA or even strep, but I would need to see your culture and sensitivity report. Did the ENT take another culture?

    So, are you going to consider the surgical option?
    MrCanz responded:
    My throat was cultured 12 days ago, while I was on my 7th day of a 10 day Bactrim course. My throat continued to show MRSA. The antibiotic sensitivity test showed:

    MrCanz responded:
    The last post seemed to have been cut off. Am I not allowed to list antibiotic sensitivity results on this board?

    I will try and modify my post... please stand by...
    MrCanz responded:
    My throat was cultured 12 days ago, while I was on my 7th day of a 10 day Bactrim course. My throat continued to show MRSA. The antibiotic sensitivity test showed:

    MrCanz responded:
    My throat was cultured 12 days ago, while I was on my 7th day of a 10 day Bactrim course. My throat continued to show MRSA. The antibiotic sensitivity test showed:

    Trimethoprim/Sulphamethoxazole "Less than equal to" 1 S.

    I was prescribed Clindamycin by a regular M.D. but was reluctant to take it due to the risk of pseudomembranous colitis. The antibiotic sensitivity test showed:

    Clindamycin "Less than equal to" 0.5 S.

    The antibiotic sensitivity test for Tetracycline showed:

    Tetracycline "Less than equal to" 2 S.

    So, as it would seem, my MRSA appears to be most susceptible to Clindamycin. However, the Bactrim seemed to be ineffective against my MRSA. My ENT said today that Clindamycin is usually ineffective against MRSA anyway, however, Bactrim usually is. I requested a broad spectrum Tetracycline based on which described Tetracycline as being able to permeate tissue better. He gave me a 15 day course of Doxycycline and said if it doesn't work, then it doesn't work.

    I will consider the surgical option if it becomes necessary. From what I've been able to gather from 2 M.D.'s and my ENT is that my condition is not critical and I appear to be asymptomatic. However, I do not like having something going on in the back of my throat and may take the surgery on that fact alone.

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