Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin in a Chinese teenager: case report and literature review.

Abstract

BACKGROUND:

Methicillin-resistant Staphylococcus aureus (MRSA) has now been established as an important community-acquired pathogen. Although necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA) strains producing Panton-Valentine leukocidin (PVL) has been reported with increasing frequency in many countries, it has been reported in only a few children younger than 1 year of age in Mainland China.

METHODS:

We describe a case of life-threatening necrotizing pneumonia due to PVL-positive CA-MRSA in a 15-year-old previously healthy female who presented with high fever, shivering, a dry cough, and dyspnea. Details of the clinical outcomes, microbiological data, and therapies for this patient were collected and compared with those of cases reported in the literature on CA-MRSA.

RESULTS:

Computed tomography (CT) findings showed cavitary consolidations in both lungs and bilateral pleural effusion. MRSA strains isolated from the patient's sputum and pleural fluid were susceptible to most non-β-lactam antimicrobial agents except for clindamycin and erythromycin. Both of these isolates tested positive for the mecA gene as well as PVL genes, and were identified as ST59-MRSA-SCCmec type IV-spa type t437. The patient was treated successfully with linezolid, fosfomycin, and teicoplanin.

CONCLUSIONS:

To our knowledge, this is the first report from Mainland China of necrotizing pneumonia due to PVL-positive CA-MRSA among those aged older than 1 year. CA-MRSA necrotizing pneumonia should be considered in the differential diagnosis of severe community-acquired pneumonia, particularly in previously healthy individuals.

• Authors: Jie Chen, Yanping Luo, Shu Zhang, Zhixin Liang, Ying Wang, Ying Zhang, Guang Zhou, Yanhong Jia, Liangan Chen, Danyang She
• Journal: International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases (Int J Infect Dis) Vol. 26 Pg. 17-21 (Sep 2014) ISSN: 1878-3511 [Electronic] Canada
• PMID: 24980464 (Publication Type: Case Reports, Journal Article, Review)
• Copyright: Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Bacterial Toxins
• Exotoxins
• Leukocidins
• Panton-Valentine leukocidin

Topics

• Adolescent
• Bacterial Toxins (genetics)
• China
• Community-Acquired Infections (diagnosis, drug therapy, microbiology)
• Exotoxins (genetics)
• Female
• Humans
• Leukocidins (genetics)
• Methicillin-Resistant Staphylococcus aureus (genetics, isolation & purification)
• Pneumonia, Bacterial (diagnosis, drug therapy, microbiology)
• Staphylococcal Infections (diagnosis, drug therapy, microbiology)