Community-Acquired MRSA Pericarditis and Mediastinitis in a Previously Healthy Infant

Abstract

Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections disproportionately affect children, but there are few pediatric reports of pericarditis and mediastinitis caused by CA-MRSA in previously healthy children. Here we report a severe case of CA-MRSA pericarditis with extension to the mediastinum and carotid sheath in a previously healthy 8-month-old infant who was successfully treated with surgical interventions and with a combination of daptomycin and vancomycin. The relatively indolent clinical course in this patient was notable given the significant extent of infection. This case highlights the potential virulence of CA-MRSA in previously healthy children and the importance of early diagnosis, prompt drainage, and appropriate antibiotic coverage.

Purulent Pericarditis Secondary to Methicillin-Resistant Staphylococcus Aureus in a Previously Healthy Infant: A Case Report

“…One of these cases was found in a 2018 case report from the Journal of Pediatric Intensive Care by Sanchez et al who described an 8-month-old infant presenting with a 10-day history of fever and cardiopulmonary distress and was successfully treated with a 2-week course of vancomycin, 5 days of daptomycin and 4 weeks of oral linezolid, while the other two cases were from an article by Lutmer et al in the Annals of American Thoracic Society Journal where the authors reported an 8-year old male and a 7-month old female who both presented with fever and cardiopulmonary distress both effectively treated with a combination of vancomycin, gentamicin and rifampin. 4,8 Similar to our patient, pericardial drainage was performed in all three cases, however, a 4-week course of vancomycin proved enough to effectively treat the infection in our case. Unique to our case, however, is the presence of tamponade physiology.…”

“…[12][13][14] We suspect that our patient was already colonized with MRSA and it has gained access into the blood stream via microabrasions from the skin that may have healed and was therefore missed during the physical examination. 8 Confirmation of patient's MRSA carriage was not carried out.…”

“…9 MRSA purulent pericarditis almost exclusively occurs among individuals with predisposing factors like previous chest trauma, thoracic surgery, intrathoracic focus of infection, and those with immunocompromised states; it is seldom considered in previously healthy children with no risk factors. [2][3][4][5][6]8,11 Our patient did not manifest with signs of overt immunodeficiency. He had an unremarkable past medical, personal, and family histories, and no clues suggestive of a compromised immune function.…”

“…While a number of pediatric literature reports of purulent pericarditis, there is limited data on community-acquired methicillinresistant Staphylococcus aureus (MRSA) as the etiology in children. [1][2][3][4][5][6][7][8] There have been studies demonstrating an increase in the incidence of various community-acquired MRSA infections affecting the pediatric population such as soft tissue infections, sepsis, and pneumonia. We report a case of a previously well immunocompetent 10-monthold male infant with purulent pericarditis secondary to a community-acquired methicillin-resistant Staphylococcus aureus with characteristics of cardiac tamponade.…”

Purulent pericarditis in a patient with community-acquired methicillin-resistant Staphylococcus aureus: a case report with mini-review

“…Pericarditis due to MRSA is a rare event, only a handful of cases (12 patients) have been reported in the literature (Table 1). [6][7][8][9][10][11][12][13][14][15] Our review of literature revealed that patients across all age groups developed MRSA pericarditis (ranging from 7 months to 75 years). Direct spread from intrathoracic focus of infection (myocardial foci, thoracic surgery or contamination from penetrating trauma), hematogenous spread and extension from subdiaphragmatic suppurative focus are the various mechanisms described for the development of purulent pericarditis.…”