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.
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: firstname.lastname@example.org
4Department of Respiratory Medicine, Chinese People’s Liberation Army General Hospital, Beijing, PR China. Electronic address: email@example.com
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.
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.
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.
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.
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