Archive for October 9, 2015

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

Int J Infect Dis. 2014 Sep;26:17-21.

Chen J1, Luo Y2, Zhang S1, Liang Z1, Wang Y1, Zhang Y2, Zhou G2, Jia Y1, Chen L3, She D4.

Author information

1Department of Respiratory Medicine, Chinese People’s Liberation Army General Hospital, Beijing, PR China.

2Department of Microbiology, Chinese People’s Liberation Army General Hospital, Beijing, PR China.

3Department of Respiratory Medicine, Chinese People’s Liberation Army General Hospital, Beijing, PR China. Electronic address: chenliangan301@163.com

4Department of Respiratory Medicine, Chinese People’s Liberation Army General Hospital, Beijing, PR China. Electronic address: dysheh@sina.com

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.

abstract

http://www.ijidonline.com/article/S1201-9712(14)01465-9/abstract

PDF

http://www.ijidonline.com/article/S1201-9712(14)01465-9/pdf

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October 9, 2015 at 9:33 am

Whole genome analysis of a community-associated methicillin-resistant Staphylococcus aureus ST59 isolate from a case of human sepsis and severe pneumonia in China.

PLoS One. 2014 Feb 20;9(2):e89235.

Qu T1, Feng Y2, Jiang Y2, Zhu P3, Wei Z1, Chen Y2, Otto M4, Yu Y2.

Author information

1State Key Laboratory for Diagnosis and Treatment of Infectious Disease, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

2Department of Infectious Diseases, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

3Department of Clinical Medicine, Zhejiang Medical College, Hangzhou, Zhejiang, China.

4Pathogen Molecular Genetics Section, Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America.

Abstract

We report a case of necrotizing pneumonia in a young patient caused by community acquired-methicillin resistant Staphylococcus aureus (CA-MRSA) in a teaching hospital in the People’s Republic of China.

The patient had a typical clinical presentation and was successfully treated with antibiotics and intravenous immunoglobulin. A CA-MRSA strain, named SA268, was isolated from the blood of the patient.

The isolate was susceptible to most antimicrobial agents, except cephalosporins, penicillins, and β-lactamase inhibitor combinations.

Multi-locus sequence typing (MLST) assigned SA268 to ST59, a clone widely spread in eastern Asia. The strain was positive for Panton Valentine Leukocidin (PVL)-encoding genes and SCCmec type V. We sequenced the complete genome of the SA268 isolate.

The genome of SA268 was almost identical to that of the Taiwanese ST59 CA-MRSA strains M013 and SA957. However, we observed several differences in gene composition, which included differences in the SCCmec element and several lipoprotein genes that were present in the Taiwanese strains but absent from SA268

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3930696/pdf/pone.0089235.pdf

October 9, 2015 at 9:31 am

Staphylococcus aureus meticilino resistente adquirido en la comunidad: una nueva amenaza

Rev. Amer. Med. Respiratoria OCT-DIC 2012 V.12 N.4

Lautaro de Vedia, Nicolás Lista, Gabriela Piovano, Valeria Amaya Akkauy, Alejandra Rodríguez, María José Eusebio, Juan Carlos Cisneros, Raúl Prieto

Institución: División Asistencia Especial, Departamento de Atención Intensiva al Paciente Infectado Crítico (DAIPIC), Hospital F.J. Muñiz- Buenos Aires

Correspondencia: Lautaro de Vedia

Correo electrónico: lautarodevedia@gmail.com

Objetivos

Conocer la frecuencia de Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-AC) en neumonía adquirida en la comunidad (NAC); examinar sus características clínicas – evolutivas y analizar factores de riesgo.

Pacientes, material y métodos

Estudio retrospectivo, descriptivo, observacional, realizado en una unidad de cuidados intensivos respiratorios entre 2006 y 2012.

Resultados

Se evaluaron 180 pacientes con NAC con diagnóstico etiológico.

Etiologías más frecuentes

Streptococcus pneumoniae (50.5%), Haemophillus influenzae (18.3%) y SAMR-AC (12.2%, 22 casos). La neumonía por SAMR-AC se presentó en individuos jóvenes, mayoritariamente hombres. En el 81.8% de los casos el foco primario fue infección de piel y estructuras relacionadas (IPER), 95.4% presentó criterios clínicos de sepsis, 72.7% tuvo compromiso radiológico bilateral y 45.5% desarrolló derrame pleural. El 40.9% requirió ventilación mecánica y el 45.4% utilizó drogas vasoactivas. El 81.8% de los pacientes no alcanzó criterios de estabilidad clínica al cabo de la primer semana y la mortalidad fue del 36.3%, significativamente superior al resto de los microorganismos (8.8%, p<0,001). Los factores clínicos asociados con mayor riesgo de SAMR-AC fueron la presencia de IPER concomitante, compromiso radiológico bilateral, presencia de criterios clínicos de sepsis, edad inferior a 30 años y requerimiento de drogas vasoactivas. Los factores que se asociaron con mortalidad en NAC fueron la etiología por SAMR-AC y el compromiso radiológico bilateral.

Conclusiones

La neumonía por SAMR-AC es una patología emergente, asociada a elevada morbimortalidad. Debe ser considerada en pacientes jóvenes, con presencia concomitante de IPER, compromiso radiológico bilateral, criterios clínicos de sepsis o necesidad de drogas vasoactivas.

FULL TEXT

http://www.scielo.org.ar/scielo.php?pid=S1852-236X2012000400001&script=sci_arttext

PDF

http://www.scielo.org.ar/pdf/ramer/v12n4/v12n4a01.pdf

October 9, 2015 at 9:29 am


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