A Fatal Case of Necrotizing Pneumonia Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus

Abstract

USA300 is a predominant community-associated methicillin-resistant Staphylococcus aureus strain causing significant morbidity and mortality. We present here the full annotated genome of a USA300 hypervirulent clinical strain, USA300-C2406, isolated from a patient with a lethal case of necrotizing pneumonia, to gain a better understanding of USA300 hypervirulence.

Diagnosis and treatment of Panton–Valentine leukocidin (PVL)-associated staphylococcal pneumonia

“…Relatively few patients developing necrotising pneumonia have a previous history of skin sepsis themselves [8,12,17,32,37,51,56], although some have close household contacts with skin and soft-tissue infections [34,35,49,57]. A father and daughter were both admitted with necrotising pneumonia; only the daughter survived [35].…”

“…Whilst pyrexia, myalgia and chills suggest a non-specific or viral illness, the clinician should remember that these are features of other staphylococcal toxin production. Four patients who later represented with severe pneumonia were originally discharged from healthcare facilities with symptomatic treatment, only to return later in extremis [11,12,57]. In such cases, perhaps only a raised C-reactive protein (CRP) may alert the clinician that the diagnosis may be more than a simple exacerbation of asthma or bronchitis.…”

“…Haematogenous spread from a concurrent skin focus is uncommon, although some patients may have a history of skin lesions or contact with a person with infected skin lesions [12,16,17,20,27,32,34,35,41,49,51,53,54,56,57].…”

“…Since Gillett et al's report, where only 1 of 16 fatalities was due to MRSA, 35 more cases of fatal PVL-associated MRSA pneumonia have been reported [4,[10][11][12][13][15][16][17][18][19][20][21][22][23][25][26][27][28][29][30][31][32][33][34]37,39,40].…”

“…Furunculosis pre-dated pneumonia in a 52-year-old man [17]. Incision and drainage of a thigh abscess was followed 2 weeks later by fulminant pneumonia in a 28-year-old man [12], and a 12-year-old boy admitted with a 2 cm papule on the lip died of MRSA pneumonia [32]. The time between skin sepsis and pulmonary infection may be as long as 6 months [37].…”