Dr Lenhardt: MARCoNS
What is MARCoNS?  
Not an intergalactic villain.  
What are MARCoNS?  
They are Multiple Antibiotic Resistant Coagulase negative Staphylococcus bacteria.
            
Millions of people in America have a chronic infection in their sinuses of these robust bacteria. They don’t respond to oral antibiotics and in fact can thrive when people are put on antibiotics over and over again for sinus infections. And probably more common in those that use nasal steroids like Flonase on a regular basis for allergies and chronic sinus issues. Flonase is now OTC (over-the-counter which might create even more resistance.
            
We should always remember to respect microorganisms that have evolved and co-evolved (with us) over millions and billions of years. MARCoNS produce a biofilm that protects it from harm. The colony of bacteria sequester within a thick mucusy substance that antibiotics can’t penetrate.
            
MARCoNS have another survival mechanism. They deplete something called alpha-MSH. Alpha-MSH (or Melanocyte Stimulating Hormone) has many functions and is essential for immune function. One expert called alpha-MSH “the field general of the immune system.”
            
A new patient, Sheila, came in a few months ago and one of her chronic issues involved her sinuses. She had been on many antibiotics and nasal sprays over more than twenty years. She had seen ENT specialists. She had labs, x-rays and CT scans. Her sinus culture came back positive for MARCoNS (but not fungal elements and I often check for both). Her particular subtype of MARCoNS was resistant to six different antibiotics. The most I’ve seen so far is nine.
            
She was started on a compounded nasal spray with bactroban, EDTA (to break up the biofilm so that antibiotics would get through) and gentamicin called BEG spray through Custom Medicine compounding pharmacy in Beverly.
            
At a follow-up visit this past week, we covered a lot of ground and she gave me an update on her sinuses. Six weeks into BEG treatment, she was still getting copious amounts of phlegm out from her sinuses, but less and less over time. The headache and sinus symptoms were improving. Her face was less puffy. Great.
            
She then said that other chronic issues had improved. Her “dry eye” problem was so much improved that she did not need to use her daily eye drops very often any longer. Her ophthamologist was stunned by the improvement on her exam and Sheila says the eye doctor was diligently taking notes about the MARCoNS and planned on looking into it. She, like you probably, have never heard of them.
            
Finally, Sheila said her longstanding struggle with a lack of taste and smell had improved dramatically. She recalled driving up to Maine with her husband and being able to smell the cow manure for the first time in many years. Shit never smelled so sweet. After that, she noted that her ability to taste bitter and sweet was enhanced and gradually improving.
            
So, working on one intractable issue led to improvement in other unexpected areas. It’s all good news right?
            
Actually, no. The week prior I saw a woman with chronic deficiencies in taste positive for MARCoNS who noticed no benefit after a month of BEG spray. Does she need to be on the BEG spray longer? Are the MARCoNS unrelated to her issues? My next intervention for her was oral zinc supplementation and likewise I have seen that help some and not help others who have a lack of taste. Therein lies the challenge of sorting out these underlying issues. 
Better to try though than accept it.
Andrew Lenhardt, MD