That Ain't No Spider Bite

Staphylococcus autreus is common bacteria found on human skin that causes no harm under normal circumstances. However, if the bacteria enter the body through the skin, such as a cut or ingrown hair, it can cause an infection, which appears typically as a boil but sometimes as an abscess.

What is commonly called a "spider bite" by both offenders and sometimes-medical staff is ALMOST ALWAYS a staph infection in the form of a boil. And mis-diagnosis can lead to improper treatment. In TDCJ an in many other places in the U.S. there is a strain of staph infection spreading quickly, which is called MRSA a Methicillin-resistant Staphylococcus. In the past Penicillin was used to treat staph. Then after a time some strains became resistant to penicillin and a new drug Methicillin was developed.

Once again some strains found ways to resist Methicillin. This is why MRSA (Methicillian Resistant) Staph Aureus infections are now being seen.

Last year alone there were almost 4,000 cases of MRSA reported in TDCJ. This does NOT include all the cases where an offender for one reason or another chooses not to go to the medical dept. Therefore the actual number is much likely much higher.

Since this resistant strain is quickly spreading, this year the number of reported cases is expected to be noticeably more than last year.

HOW IT SPREADS

While the staph aureus bacteria can be found on many surfaces, it primarily colonizes on the human skin and spreads easily by direct skin to skin hand contact.

Certain people are more prone to staph infections. Those include those who have underlying diseases such as HIV, Obesity, diabetes, cancer, etc and those who have been taking antibiotics for a prolonged period of time. Handwashing is the most effective method in preventing its spread. If the inmate is misdiagnosed and treated for a spider bite, not only will the inmate be charged $3 co-pay, but also in most cases they WILL NOT receive the proper medication for the staph infection.

The inmate needs to make sure that the infection is properly diagnosed as a boil or staph infection. Sometimes this is difficult since there are still medical personnel who will insist that it is a spider bite, not a boil. The inmate must convince them otherwise if they want proper treatment.. One way is to insist a culture be done.

Once you have been diagnosed it is equally important the inmate receives the PROPER MEDICATION. The medical staff may prescribe Cephalexin (Keflex) for MRSA.THIS DRUG DOES NOT WORK AGAINST MRSA!!! Although is was an acceptable drug on previous strains, it is not effective against this new strain.

In a letter dated Nov 7, 2002 Michael Kelly M.D. director of preventive medicine for TDCJ noted,"The policy was changed to recommend that Keflex nor be used for initial therapy based on analysis of our surveillance data on all staph infections. That policy change is in the process of being distributed to the units with a cover memo that points out the change".

Since Keflex does work, what should be prescribed instead? The TDCJ Health Services Division Control Manual (Effective Date 11/1/02 Number B-14,16 Page states, ("Based" on culture surveillance, most MRSA isolates in TDCJ will be susceptible to either TMP/SMX (e.g) Bactrim DS or clindamycin. Bactrim is recommended for initial treatment pending receipt of (culture and sensitivity test) results usually within 2-3 days.) Continue treatment with a single antibiotic based on drug susceptibility results.

If inmate is allergic to Trimethoprim or Sulfa, Clindamycin is the  suggested alternative for initial therapy. It is imperative ALL the prescribed medication is taken, since failure to do so can result in the bacteria remaining in your system.

  • Inmate must notify medical of the staph infection
  • Make sure it is diagnosed as a boil or staph infection----NOT a spider bite.
  • If they argue insisting it is a spider bite...insist on a culture to make sure you will receive the proper treatment and medication.
  • Take ALL medication to avoid more resistant forms. MRSA is quickly spreading.