- The Washington Times - Tuesday, July 10, 2001

Elaine Evans' experience with the bacterial infection staphylococcus — staph for short — began with what she thought was a pimple. A simple pimple on the left side of her face that suddenly grew hard and large enough to interfere with her eyesight.
"It felt like a walnut," she says, thinking back to those worrisome days in May when what she calls "that thing on my face" ballooned into the worst medical mystery of her life.
Ms. Evans, 60, a garden designer, seldom is ill ("getting sick is a luxury if you are a single mother as I had been earlier in life") and never before had been hospitalized in an emergency, so she didn't at first do anything to deal with the problem. Besides, spring is a busy time in her trade, and she didn't want to interrupt her schedule to see a doctor. She is an Arlington-based independent contractor working under the professional name of Delightful Gardens.
She changed her mind when the lump got worse .
"If I had it in a different location, I don't believe I would have paid as much attention," Ms. Evans says. Normally, she has clear unblemished skin so she thinks now that vanity, not alarm, caused her to seek help for what she at first imagined was a reaction to some sort of allergy. Because she didn't have a regular doctor, she drove to an emergency care center in McLean and was given a prescription for an oral antibiotic called Augmentin.
"They said to watch this thing, that it could be dangerous. But I was busy installing a garden and didn't think about it. The next morning this thing was huge. I don't scare easily, but I just looked and thought, 'There is something really wrong here.'"
Fortuitously, Ms. Evans had done a garden recently for a Spring Valley couple, both of whom are medical doctors. She had gone to the husband, Dr. Daniel Young, who does general internal medicine with the Spring Valley Primary Practice group, for the required medical checkup prior to a trekking trip to Nepal. She called him at 4 p.m. on a Monday, described her symptoms, and was told to come to his office at once — an hour away in late afternoon traffic. He said he would wait for her.
"He took one look at me and told me to go to Sibley Hospital, that he would see me there in a few minutes," she recalls. "I then asked him, stupidly, 'Do you know what this is?' I got told at the hospital that I had an ocular cellulitis. What does that mean to most people? Nothing."
Staph infection from an unknown source had settled in layers of skin near a vulnerable part of her body close to the brain. "Complications for a patient aren't good," says Dr. Young, who asked Dr. Michael Johnson, an infectious disease specialist who works in the same building, to consult in the case.
"You really only have three or four days to help a patient before they could get into trouble," Dr. Young says. "Because of how veins drain around the eyes and bridge of the nose, one of the complications is the infection can spread causing inflammation of the brain. That is why we get fairly aggressive about treatment if the patient is not responding."
Ms. Evans was treated intravenously in the hospital with an antibiotic called Rocephin (generic name, ceftriaxone) that Dr. Young explains as "a remote cousin of penicillin new in the past 10 years." She was told to spend the night for observation.
"They called me antibiotic-naive," she says with a laugh. "And when Dr. Johnson said it was in the fatty tissue, I said, 'Excuse me. I find that offensive. Can you find a different way to explain that to me?' He was really cute and said, 'Now Elaine, that does not mean your face is fat.'"
Dr. Young would employ a newer, more powerful drug called vancomycin only if necessary, he says, "because the side-effect profile is not a good one. It can cause kidney damage and other things you have to be aware of." It's far better, he says, to try others first and "to move up the ladder."
Ms. Evans had no pain, Dr. Young explains, because the swelling had not persisted long enough. The redness and hardness was the body's inflammatory response to the bacterial infection and interfered with the normal blood flow.
"They described it the way you would describe it to a little kid," she says. "They said the staph infection is smart, so it's trying to hide and build a case around itself and that is why it is so hard to kill. I got three injections in the hospital, or maybe only two. I came in one night and left the next night about 6 p.m.
"I asked what would happen if the lump didn't go down and I was told I would have to have a CT scan to see how deeply the thing had gone into my head, because there is no physical barrier between your eye socket and the brain. I was a good girl. They didn't have to do one because they saw it go down. And then they let me go home after another injection. I would get an injection for every 24 hours, treating myself at home."
Ms. Evans was sent to the Infusion Center in Spring Valley where patients are given outpatient IV equipment that she describes as "a sweet little sleeve and some pressurized balls so you don't need a pump. You attach the ball to the tube in your arm and sit with a pillow while the medicine goes in."
She kept the IV in her arm for five or six days before it was determined that she was cured and out of danger.
"I responded quickly because I'm from the generation that has not had a lot of drugs," Ms. Evans surmises. "I could count on one hand the number of times I've had penicillin. And yet I had been to a Third World country for several weeks last year and never got sick. This was so completely unexpected. Most things we do we recognize cause and effect. If I step on a rusty nail without a tetanus shot, I stand a good chance to get an infection. I've punctured my skin. But why this thing — how and why?"

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