Lethal necrotising pneumonia in young imunocompetent patient caused by staphylococcuc aureus carrying gene for pantonvalentine leukocidin
Abstract
Background: Staphylococcus aureus (S. aureus) is a major cause of hospital-acquired infections. It secretes many exotoxins, in less then 5 % also Panton-Valentine leukocidin (PVL). S. aureus carrying PVL genes is mainly associated with necrotic lesions of skin and mucosa and can cause severe necrotising community-acquired pneumonia.
Methods: We describe a case of a 30-year-old patient with a history of furunculosis who was admitted to our hospital with atypical lower abdominal pain. A clinical picture of acute abdomen developed and he was operated with no intraabdominal pathology found. A periprocedural respiratory insuficiency and later septic shock developed. S. aureus and Streptococcus pneumoniae were isolated from blood cultures and tracheal aspirate. In spite of all measures taken, high ventilatory support and targeted antibiotic treatment, severe pulmonary dysfunction with bilateral pneumothorax developed and the patient died of respiratory failure. Later genes encoding PVL were found in the isolated strains of S. aureus.
Conclusions: Severe progressive necrotising pneumonia with high mortality can be caused by PVL positive S. aureus in imunocompetent patients. To prevent the future spread of PVL positive S. aureus infection, the measures as known for methicillin-resistant S. aures, should probable be taken.
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References
Archer GL. Staphylococcus aureus: a well-armed pathogen. Clin Infect Dis 1998; 26: 1179–81.
Dinges MM, Orwin PM, Schlievert PM. Exotoxins of Staphylococcus aureus. Clin Microbiol Rev 2000; 13: 16–34.
Genestier AL, Michallet MC, Prevost G, Bellot G, Chalabreysse L, Peyrol S, et al. Staphylococcus aureus Panton-Valentine leukocidin directly targets mitochondria and induces Bax-independent apoptosis of human neutrophils. J Clin Invest 2005; 115: 3117– 27.
Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359: 753–9.
Lina G, Piemont Y, Godail-Gamot F, Bes M, Peter MO, Gauduchon V, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29: 1128–32.
National Committee for Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved Standard M7-A6. 6th ed. Wayne PA: National Committee for Clinical Laboratory Standards; 2004.
Boussaud V, Parrot A, Mayaud C, Wislez M, Antoine M, Picard C, et al. Life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus. Intensive Care Med 2003; 29: 1840– 3.
Klein JL, Petrovic Z, Treacher D, Edgeworth J. Severe community-acquired pneumonia caused by Panton-Valentine leukocidin-positive Staphylococcus aureus: first reported case in the United Kingdom. Intensive Care Med 2003; 29: 1399.
Osterlund A, Kahlmeter G, Bieber L, Runehagen A, Breider JM. Intrafamilial spread of highly virulent Staphylococcus aureus strains carrying the gene for Panton-Valentine leukocidin. Scand J Infect Dis 2002; 34: 763–4.
Alonso-Tarres C, Villegas ML, de Gispert FJ, Cortes-Lletget MC, Rovira Plarromani A, Etienne J. Favorable outcome of pneumonia due to Panton-Valentine leukocidine producing Staphylococcus aureus associated with hematogenous origin and absence of flu-like illness. Eur J Clin Microbiol Infect Dis 2005; 25: 756– 9.
Dufour P, Gillet Y, Bes M, Lina G, Vandenesch F, Floret D. Community-acquired methicillin-resistant Staphylococcus aureus infections in France: emergence of a single clone that produces Panton-Valentine leukocidin. Clin Infect Dis 2002; 35: 819–24.
Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003; 8: 978–84.
Boubaker K, Diebold P, Blanc DS, Vandenesch F, Praz G, Dupuis G. Panton-Valentine leukocidin and staphylococcal skin infections in schoolchildren. Emerg Infect Dis 2004; 10: 121–4.
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