Test results from the Centers for Disease Control and Prevention confirmed that well-known Maori entertainer Rhonda Bryers died of the drug-resistant "superbug" that has been attracting national attention.

Bryers, 55, died Sept. 28 at her 'Aiea Heights home after falling ill from an infection caused by methicillin-resistant Staphylococcus aureus, or MRSA, said Honolulu Medical Examiner Dr. Kanthi De Alwis.

Bryers did not have any external wounds or other obvious entry points for the bacteria, which is probably why she was not diagnosed with a staph infection before her death, De Alwis said. Because she died unexpectedly at home, her death was investigated by the medical examiner.

Bryers used just her first name, Rhonda, on stage.

Deputy Medical Examiner Dr. Gayle Suzuki said she believes this is the only MRSA case her office has seen in at least five years. The medical examiner investigates cases where the victim dies at home. There have been other MRSA-related deaths in hospitals.

MRSA infections can range from mild skin infections such as pimples and boils to more severe infections of the bloodstream and lungs. Because the infection usually is transmitted via contact with contaminated items, good hygiene, especially thorough hand-washing, remains the best defense against acquiring the bacteria, experts said.

Suzuki said a 51-year-old O'ahu woman died at home of a staph infection in July, but it did not involve MRSA. Just as in Bryers' case, the woman complained of flu-like symptoms but did not have a festering wound or other apparent entry point.

Staph infections are not a reportable illness in Hawai'i, so there are no government data on how many cases or deaths have occurred here. Department of Health spokeswoman Janice Okubo said that in preparation for staph becoming a notifiable condition, her agency is developing a system to provide basic data on infections.

The private, nonprofit Hawaii Health Information Corp. reported 2,112 MRSA hospitalizations in 2006, a more than twentyfold increase from 1995, when only 97 hospital cases were reported. A CDC study released last month said MRSA caused more than 94,000 life-threatening infections and nearly 19,000 deaths in the United States in 2005.

De Alwis said that at the time Bryers succumbed to sepsis, the infection was rampant in her bloodstream and had ravaged her internal organs.

OTHERS STRICKEN

Bryers' son, John Ruddock, only yesterday learned that his mother had MRSA. He said three other people living in the house were sick with pneumonia before Bryers fell ill with a 105-degree fever, chills and other flu-like symptoms. "We were all getting sick at the same time, and she caught it last," he said. "Everyone thought it was the flu."

After several days, Bryers went to her physician, who prescribed antibiotics, he said. Two to three days later, she died at home.

Ruddock, 20, said that the day before his mother died she complained of body aches but did not appear to be gravely ill. "She seemed pretty fine," he said.

Bryers had undergone surgery in August and fully recovered, said Ruddock, in a telephone interview from New Zealand, where he is recording an album of island and reggae music.

De Alwis said she does not believe the surgery was a factor in how Bryers acquired the staph infection, which remains a mystery. Bryers also did not have any other health conditions before she got sick, she said.

BACTERIAL INFECTIONS

Infectious disease expert Dr. Alan Tice said it is well known that viral influenza is a setup for bacterial infections with staph, pneumococcus, and Hemophilus influenza.

"I have seen people with an apparent viral infection, especially influenza, develop a severe bacterial infection a few days later, likely due to immune depression from the virus. Some die and staph is a common culprit," he said.

About 30 percent of people carry the bacteria on their skin or in their nasal passage without symptoms. Infections normally occur when the staph bacteria enter the body through a cut in the skin, but it is not uncommon for there to be no obvious external infection, said Tice, a private physician who also works at the University of Hawai'i John A. Burns School of Medicine.

"Even patients admitted to the hospital with staph in their blood may have no obvious entrance wound, but it is not a big surprise, with a third of people harboring it normally," Tice said. "Just picking your nose or masticating might do it."

Only about 5 percent of all staph infections involve antibiotic-resistant strains, according to Tice. He said researchers still have a lot to learn about infectious diseases, including staph, "and the extraordinary micro-environment we live and die in."

Staph infections, including MRSA, occur most frequently in people in hospitals and healthcare facilities such as nursing homes and dialysis centers who have weakened immune systems, and in those who have undergone medical procedures in the previous year.

Pacific Islanders, the elderly and the homeless have been found to be more susceptible.

Reach Christie Wilson at cwilson@honoluluadvertiser.com.