Community-acquired methicillin-resistant Staphylococcus aureus: a potential diagnosis for a 16-year-old athlete with knee pain

OBJECTIVE

This case report aims to raise awareness in chiropractic physicians of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in adolescents who participate in sports activities and to alert the chiropractic physician of the necessity to consider potential diagnoses that are not within their typical clinical heuristic.

CLINICAL FEATURES

A 16-year-old adolescent girl entered the clinic with a complaint of left knee pain that had an insidious onset during her involvement in sports activities. Later that same day, her knee became enlarged, red, and had pustular formations with a discharge. She was taken to an urgent care facility and subsequently diagnosed with MRSA. Her history included treatment of a left knee musculoskeletal condition 6 weeks prior to which she had responded favorably.

INTERVENTIONS AND OUTCOMES

She was treated medically with an aggressive course of antibiotic therapy and excision of the furuncle. The chiropractic physician played a role in patient education and notifying local school authorities of the case.

CONCLUSION

Doctors of chiropractic must prepare themselves for the unexpected and remain open to diagnostic possibilities outside of the normal scope of practice. Knee pain or cellulitis of any type may require additional diagnostic and patient care protocols to make the correct diagnosis. With the incidence of community-acquired MRSA increasing at an alarming rate, it is certainly a diagnosis doctors of chiropractic should be aware of when treating patients, especially those involved in sports activities.

Reduced growth of Alaskan white spruce in the twentieth century from temperature-induced drought stress

The extension of growing season at high northern latitudes seems increasingly clear from satellite observations of vegetation extent and duration. This extension is also thought to explain the observed increase in amplitude of seasonal variations in atmospheric CO2 concentration. Increased plant respiration and photosynthesis both correlate well with increases in temperature this century and are therefore the most probable link between the vegetation and CO2 observations. From these observations, it has been suggested that increases in temperature have stimulated carbon uptake in high latitudes and for the boreal forest system as a whole. Here we present multi-proxy tree-ring data (ring width, maximum late-wood density and carbon-isotope composition) from 20 productive stands of white spruce in the interior of Alaska. The tree-ring records show a strong and consistent relationship over the past 90 years and indicate that, in contrast with earlier predictions, radial growth has decreased with increasing temperature. Our data show that temperature-induced drought stress has disproportionately affected the most rapidly growing white spruce, suggesting that, under recent climate warming, drought may have been an important factor limiting carbon uptake in a large portion of the North American boreal forest. If this limitation in growth due to drought stress is sustained, the future capacity of northern latitudes to sequester carbon may be less than currently expected.