So You Got A Deadly Infection From Playing In The NFL? Prove It.S

Of all the storylines you expected to be a part of the first half of the NFL season, a workman's comp issue involving a toenail probably wasn't one of them. But it is, and it's actually intriguing in a number of ways, large and small.

The issue involves Tampa Bay Buccaneers kicker Lawrence Tynes, who had a procedure to fix an ingrown toenail on his kicking foot late last July. Several days after the procedure, he noticed his toe was red, swollen, painful, and oozing pus. Team doctors suspected infection, and initially gave Tynes antibiotics to treat it, but the toe didn't improve and a subsequent test on August 9th revealed a potentially dangerous bacteria called MRSA, short for methicillin-resistant Staphylococcus aureus. He soon sought a second opinion at the Hospital for Special Surgery in Manhattan (where I have routinely treated MRSA infections, although I have not treated Tynes) and the diagnosis was confirmed. Then things got weird.

While he was undergoing treatment, the Buccaneers placed Tynes on the non-football injury list, rather than the injured reserve, and the kicker announced that he intended to file a grievance against his team to fight the designation. By not being placed on injured reserve, Tynes stands to lose an accrued season toward his retirement pension. (The team will pay his $840,000 base salary, although they are not technically required to do so.) At the heart of the disagreement is a seemingly straightforward yet utterly complex question: Did Lawrence Tynes contract MRSA at the Tampa Bay Buccaneers facility?

The kicker suggests the answer is clear. "I went to work, I kicked, I practiced, I cold-tubbed, I hot-tubbed, I showered for all those days there," Tynes said, "I come up with MRSA and it's a non-football injury? They're basically trying to exonerate themselves of this, and I'm not going to allow it to happen."

At the moment, the Bucs' culpability is far from certain. To understand why, it helps to know a bit about the infection and where it comes from. Once thought to occur exclusively in healthcare settings and weight rooms, MRSA has gradually crept into our environment, and many of us now carry it anonymously on our phones, on our clothes, or in our nasal passages. You may encounter someone living peacefully with MRSA on your trek home from work today. A problem only arises when the protective skin barrier is compromised. Not surprisingly, football players—who spend their Sundays being dragged to the ground against their will and frequently undergo surgical procedures—are a high-risk population.

On August 28th, Amanda Tynes, Lawrence's wife, tweeted a picture of her husband receiving antibiotics for his MRSA infection along with the following:

I hear my husband is responding "well" to treatment. LOL! He's NOT responding at all yet. This is our #bucslife

As it turns out, Tynes is not the only infected Buccaneer. This seemingly bolsters the case for there having been a bona fide outbreak at One Buc Place, but may ultimately complicate matters. To appreciate the complexities of the situation in Tampa Bay, it helps to revisit the 2003 St. Louis Rams, a team that experienced a similar MRSA outbreak.

After losing to the New York Giants in East Rutherford, New Jersey in Week 1 of the 2003 season, the Rams returned to St. Louis, switched quarterbacks—Marc Bulger took over for the concussed Kurt Warner—and beat the San Francisco 49ers. Then something bizarre happened. Offensive and defensive linemen began showing up for workouts with unusual, poorly healing skin lesions at the sites of otherwise mundane turf burns on point of contact like the elbows, forearms, and knees. The raw lesions appeared infected, and rapidly progressed to large abscesses. MRSA was quickly identified as the cause. Alarmingly, additional cases in members of an opposing team suggested that MRSA was being transmitted during games. The NFL had a problem on its hands: young, healthy players were suddenly developing large abscesses and potentially spreading infection to opponents. The Centers for Disease Control was called in to investigate.

You probably never heard about the Rams MRSA outbreak—the details received little attention from sportswriters—but it was written about extensively in medical journals, including the New England Journal of Medicine. It's worth reviewing what happened in St. Louis because we may soon see something similar in Tampa Bay. To identify possible sources of MRSA exposure, representatives from the CDC sampled surfaces and shared items in the Rams training facility, including weight training equipment, towels, saunas and steam rooms, and water from whirlpools and a therapy pool. After games, they swabbed the areas of the field that were documented to have the highest number of tackles. In addition to examining and disinfecting the Rams training facility, investigators also collected MRSA samples from infected players and performed a type of molecular analysis on the bacteria called DNA profiling. Researchers ultimately concluded that turf burns, among several other factors, contributed to the Rams outbreak, although MRSA was never found on the premises. This point bears repeating: MRSA may be all around us, but it can still be difficult to find.

It may not be enough for Team Tynes to show that MRSA exists at the Buccaneers training facility. To make a compelling case that he acquired the infection at work, genetic analysis of the bacterial DNA will likely need to demonstrate that the strain of MRSA infecting Lawrence Tynes is identical to any MRSA isolates found at the Bucs facility. Even then, the case could remain murky. The MRSA strain may be one that is present all over the United States. Who's to say Tynes didn't pick up the bacteria somewhere else—even in another team's facility? What if MRSA is never found at Bucs camp? What if Tynes's strain is different from that of his teammates? The scenarios are dizzying and Tampa Bay is hardly the only team dealing with the legal ramifications of these infections. (As many have pointed out, since 1999, the Cleveland Browns have had more staph infection lawsuits than playoff appearances.)

In a sense, the Bucs are daring Tynes to prove that his strain of MRSA was picked up at their recently disinfected facility. Based on the Rams' experience, he'll have a hard time proving that he unquestionably acquired MRSA by playing football, even if common sense suggests that he did,and even if more of his teammates develop the infection. His employer certainly can't prove that he didn't, though, and Tampa Bay risks looking ungenerous by being stingy with an injured man's pension. While the team, like the 2003 Rams, was losing a season opener in East Rutherford, New Jersey, Lawrence Tynes remained at home, receiving powerful, potentially toxic antibiotics through a large plastic tube resting just inches from his heart. The team remains winless, and Tynes remains sidelined. For now, this is what constitutes #bucslife.

Matt McCarthy is board-certified in internal medicine. You can follow him on Twitter here.