Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton–Valentine leukocidin in a Chinese teenager: case report and literature review

Chen, Jie; Luo, Yanping; Zhang, Shu; Liang, Zhixin; Wang, Ying; Zhang, Ying; Guang, Zhou; Jia, Yuhua; Chen, Liangan; She, Danyang

doi:10.1016/j.ijid.2014.02.025

Cited by 34 publications

(30 citation statements)

References 29 publications

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“…Other common pathogens include Haemophilus influenzae , Chlamydia pneumoniae , Klebsiella pneumoniae and Staphylococcus aureus ; but Pseudomonas aeruginosa and Acinetobacter baumannii are infrequently isolated . In China, only a small number of cases of community‐acquired methicillin‐resistant S. aureus (CA‐MRSA) pneumonia are reported in children and teenagers . CA‐MRSA was not identified in the antimicrobial resistance surveillance of community‐acquired respiratory tract pathogens in adults conducted in 2009–2010 .…”

Section: Section 1 Definition and Diagnosis Of Capmentioning

confidence: 99%

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Cao

Huang

She

et al. 2017

Clinical Respiratory J

185

181

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Community‐acquired pneumonia (CAP) in adults is an infectious disease with high morbidity in China and the rest of the world. With the changing pattern in the etiological profile of CAP and advances in medical techniques in diagnosis and treatment over time, Chinese Thoracic Society of Chinese Medical Association updated its CAP guideline in 2016 to address the standard management of CAP in Chinese adults. Extensive and comprehensive literature search was made to collect the data and evidence for experts to review and evaluate the level of evidence. Corresponding recommendations are provided appropriately based on the level of evidence. This updated guideline covers comprehensive topics on CAP, including aetiology, antimicrobial resistance profile, diagnosis, empirical and targeted treatments, adjunctive and supportive therapies, as well as prophylaxis. The recommendations may help clinicians manage CAP patients more effectively and efficiently. CAP in pediatric patients and immunocompromised adults is beyond the scope of this guideline. This guideline is only applicable for the immunocompetent CAP patients aged 18 years and older. The recommendations on selection of antimicrobial agents and the dosing regimens are not mandatory. The clinicians are recommended to prescribe and adjust antimicrobial therapies primarily based on their local etiological profile and results of susceptibility testing, with reference to this guideline.

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Section: Section 1 Definition and Diagnosis Of Capmentioning

confidence: 99%

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Cao

Huang

She

et al. 2017

Clinical Respiratory J

185

181

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“…Cases of NP in children occur globally and have been reported from North America [4,7,9,10,19,20,26,28,29], Latin America [26,38], UK [22,35], Europe [5,6,14,16,30,33,40], Middle East [3,12,27,31,37], Asia [8,11,17,21,24,25,32,36,39], and Australia [23]. Tables 1 and 2 show that the typical child with either NP or PNP is aged between 2 and 5 years and, except for studies from Taiwan [32,39], is equally likely to be male or female.…”

Section: Epidemiologymentioning

confidence: 99%

“…In establishing infection, S. aureus expresses surface proteins that mediate adherence and impair local defences, while later in the infection secreted exotoxins disrupt epithelial barriers and immune cell function responses, thereby facilitating tissue invasion [64]. Although it has long been recognized as an important cause of NP, interest in this pathogen was renewed by recent studies linking strains expressing the virulence factor, Panton-Valentine leukocidin (PVL), with severe forms of this disease in previously healthy children and adults [8,15,23,30,65]. In many cases these PVL-producing isolates were also MRSA strains.…”

Section: Microbiologymentioning

confidence: 99%

“…First reported in adults with severe pneumonia in the 1940s, NP was not described in children until 1994 when a small case series of four patients was published [3]. Since then, descriptions of NP have included individual case reports [4][5][6][7][8][9][10][11][12] and small retrospective series of 2-18 cases [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] with few publications involving larger numbers of affected children. Although still regarded as uncommon, the incidence of NP (as with other more common forms of complicated pneumonia, parapneumonic effusion [PPE] and empyema) may be increasing [18,22,[28][29][30][31][32].…”

Section: Introductionmentioning

confidence: 99%

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Necrotizing pneumonia: an emerging problem in children?

2017

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BackgroundIn children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae.ReviewNP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral–bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5–6 months following diagnosis. Increased knowledge of NP’s pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention.ConclusionIt is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.

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“…Panton-Valentine leukocidin (PVL) toxin, which is an important virulence factor of S. aureus, may cause serious necrotizing infections with high mortality (56%-63%) in healthy and young individuals [12] . Therefore, epidemiological studies uncovering the clonal spread of S. aureus strains in the hospital and community settings are crucial [13,14] .…”

Section: Introductionmentioning

confidence: 99%

Comparison of Cefoxitin Disc Diffusion and Phoenix Automated System with mecA/mecC PCR for Determination of Methicillin Resistance in Staphylococcus aureus Isolates and Investigation the Presence of PVL Gene

Arıcı¹,

Bayraktar²

2019

mjima

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Introduction:A fast and accurate determination of methicillin resistance in Staphylococcus aureus strains is vital. This study aimed to compare the sensitivity and specificity of the cefoxitin disc diffusion (CDD) test and BD Phoenix automated system considering mecA/mecC positivity as the gold standard and to investigate the presence of Panton-Valentine leukocidin (PVL) toxin gene, a crucial virulence factor of S. aureus strains. Materials and Methods: Overall, 179 Staphylococcus aureus strains from various clinical samples were included. Antibiotic sensitivity was tested using the Phoenix automated system and by applying the Kirby-Bauer disc diffusion method for cefoxitin (30 μg). The mecA, mecC, and PVL presence was determined using the conventional multiplex polymerase chain reaction method. mecA/mecC positivity was considered as the gold standard. Statistical analysis was performed using SPSS 15.0 for Windows (Chicago, IL, USA). Results: Overall, 91 strains (50.8%) were mecA positive and identified as methicillin resistant Staphylococcus aureus (MRSA). No isolates containing the mecC gene were detected. The Phoenix automated system falsely identified six methicillin-sensitive S. aureus (MSSA) isolates, which were mecA and mecC negative as MRSA. The sensitivity and specificity of the CDD test were found to be 100% in determining MRSA, and the sensitivity and specificity the Phoenix automated system were 100% and 93.2%, respectively. The PVL positivity rate in MRSA and MSSA strains was 6.5% and 7.4%, respectively. All PVL-positive strains were isolated from the skin and soft tissues. Conclusion:The CDD test is a reliable method for routine procedures. Methicillin-sensitive strains can be determined as MRSA via the Phoenix automated system. Nevertheless, mecC-controlled MRSA should not be excluded from methods used for determining methicillin resistance. Panton-Valentine leukocidin toxin gene should be determined to enable clinicians to understand the infection severity. Giriş: Staphylococcus aureus kökenlerinde metisilin direncinin hızlı ve doğru bir şekilde belirlenmesi hayati öneme sahiptir. Bu çalışmada, mecA/ mecC pozitifliği altın standart kabul edilerek, sefoksitin disk difüzyon (CDD) testinin ve BD Phoenix otomatize sisteminin duyarlılık ve özgüllüklerinin karşılaştırılması ve S. aureus kökenlerinin önemli bir virülans faktörü olan Panton-Valentine lökosidin (PVL) toksin geni varlığının araştırılması amaçlandı. Gereç ve Yöntem: Çeşitli klinik örneklerden elde edilmiş toplam 179 S. aureus suşu çalışmaya dahil edildi. Antibiyotik duyarlılığı, Phoenix otomatize sistemi ve sefoksitin (30 μg) için Kirby-Bauer disk difüzyon yöntemi uygulanarak test edildi. mecA, mecC ve PVL genlerinin varlığı konvansiyonel Staphylococcus aureus İzolatlarında Metisilin Direncinin Belirlenmesinde Sefoksitin Disk Difüzyon ve Phoenix Otomatize Sisteminin mecA/mecC PZR Yöntemi ile Karşılaştırılması ve PVL Gen Varlığının Araştırılması Abstract Öz

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Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton–Valentine leukocidin in a Chinese teenager: case report and literature review

Cited by 34 publications

References 29 publications

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Diagnosis and treatment of community‐acquired pneumonia in adults: 2016 clinical practice guidelines by the Chinese Thoracic Society, Chinese Medical Association

Necrotizing pneumonia: an emerging problem in children?

Comparison of Cefoxitin Disc Diffusion and Phoenix Automated System with mecA/mecC PCR for Determination of Methicillin Resistance in Staphylococcus aureus Isolates and Investigation the Presence of PVL Gene

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