Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia

Miyashita, Taku; Shimamoto, Yuko; Nishiya, Hajime; Koshibu, Yoji; Sugiyama, Hajime; Ono, Yasuo; Satoh, Takayoshi; Haraoka, Hitomi; Nakano, Junichi; Ohta, Ken; Sato, Tomohide; Morinaga, Naoko; Noda, Masatoshi

doi:10.1007/s101560200014

Cited by 24 publications

(15 citation statements)

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“…However, they are found in a very high proportion of newly emerging CA-MRSA strains, with rates of 77% to 100%, as reported in various studies (19,20,26). The presence of PVL in S. aureus appears to be associated with increased disease severity, ranging from cutaneous infection requiring surgical drainage to severe chronic osteomyelitis and deadly necrotizing pneumonia (7,10,11,14,17,18). In the future, screening for the PVL virulence factor in S. aureus may become a routine laboratory procedure (5).…”

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confidence: 81%

“…A rapidly increasing prevalence of serious CA-MRSA infections and deaths has been reported worldwide (7,10,11,14,17,18), and a simple and rapid method of screening for the identification of S. aureus isolates carrying PVL genes is a crucial first step in controlling the dissemination of this potentially virulent pathogen. Very recently, several groups have developed effective real-time PCR assays for the detection of the PVL genes, alone or in combination with the mecA, spa, or nuc gene (4,13,16,21,23).…”

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confidence: 99%

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Novel Multiplex PCR Assay for Detection of the Staphylococcal Virulence Marker Panton-Valentine Leukocidin Genes and Simultaneous Discrimination of Methicillin-Susceptible from -Resistant Staphylococci

et al. 2006

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confidence: 81%

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confidence: 99%

Novel Multiplex PCR Assay for Detection of the Staphylococcal Virulence Marker Panton-Valentine Leukocidin Genes and Simultaneous Discrimination of Methicillin-Susceptible from -Resistant Staphylococci

et al. 2006

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“…From the 13 sets of primers that have been described, 8 sets target genes in the nonpolymorphic region [2,[28][29][30][31][32][33]. The manufactured molecular kits for detecting PVL genes include the GenoType ® Staphylococcus test (Biocentric) and the DNA microarray S. aureus (ARLE).…”

Section: Microbiological Diagnosismentioning

confidence: 99%

Pragmatic management of Panton–Valentine leukocidin-associated staphylococcal diseases

Gillet

Dumitrescu

Tristan

et al. 2011

International Journal of Antimicrobial Agents

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Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus is associatedwith a broad spectrum of diseases, ranging from common uncomplicated soft tissue infections to severe diseases such as complicated soft tissue infections, extensive bone and joint infections, and necrotizing pneumonia. Specialised management of infection based on the presence of PVL may not be required for mild infections, whereas it could be lifesaving in other settings. Moreover, most severe PVL diseases are recently identified entities and a 'gold standard' treatment from comparatives studies of different therapeutic options is lacking. Thus, recommendations are based on expert opinions, which are elaborated based on theory, in vitro data and analogies with other toxin-mediated diseases. In this review, we consider the potential need for specialised PVL-based management and, if required, which tools should be used to achieve optimal management.

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“…Septic pulmonary emboli are usually associated with rightsided endocarditis or other intravascular disease (2). However, septic pulmonary emboli arising from primary deep tissue infections, such as osteomyelitis, septic arthritis, cellulitis, and, rarely, pyomyositis, have been increasingly described in pediatric patients with CA-MRSA infections (3,7,10). To our knowledge, these associations have not been previously described among adult patients.…”

Section: Patientmentioning

confidence: 90%

“…Soft tissue infections have also been implicated: Miyashita et al reported a case of cellulitis caused by CA-MRSA leading to septic pulmonary emboli (7). Although CA-MRSA has been noted as an increasingly common cause of pyomyositis (8), there have been few reports linking pyomyositis with septic pulmonary emboli.…”

Section: Patientmentioning

confidence: 99%

Septic Pulmonary Emboli and Bacteremia Associated with Deep Tissue Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus

2008

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We report four adult patients who presented with septic pulmonary emboli and community-acquired methicillin-resistant Staphylococcus aureus bacteremia associated with deep tissue infections, such as pyomyositis, osteomyelitis, and prostatic abscess. The patients lacked evidence of right-sided endocarditis or thrombophlebitis. This association, previously described in children, may also be important in adults. CASE REPORTFour adult patients from the community presented to a large urban hospital (John H. Stroger Jr. Hospital of Cook County, Chicago, IL) with septic pulmonary emboli and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) bacteremia from December 2005 to February 2007. Each patient underwent a transesophageal echocardiogram that was negative for endocarditis. In addition, clinical and radiographic evaluations for deep-vein thrombosis were negative. No history or stigmata of intravenous drug use, thrombophlebitis, or prior intravascularcatheter use were found. Instead, each patient was diagnosed with a deep tissue infection or abscess as a possible primary focus of infection.Patient 1. A 36-year-old obese man with type 2 diabetes mellitus presented with 1 week of fever, cough, chest pain, and difficulty walking. Computed tomography (CT) of the chest demonstrated bilateral pulmonary nodules, some cavitary, consistent with septic pulmonary emboli (Fig. 1a). Blood cultures grew MRSA on admission and remained positive for 12 days. Despite receipt of appropriate antimicrobials, the patient remained intermittently febrile for 3 weeks. CT of the abdomen/ pelvis, as well as magnetic resonance imaging (MRI) of the spine did not reveal thrombophlebitis or abscess. On hospital day 25, a gallium scan demonstrated increased uptake in the left thigh. CT of the lower extremities revealed an enhancing fluid collection extending the full length of the left quadriceps muscle, consistent with pyomyositis, without evidence of deepvein thrombosis (Fig. 1c). Surgical drainage revealed grampositive cocci in clusters on Gram stain; the culture (obtained during vancomycin therapy) was negative. The patient defervesced after drainage and recovered with 6 weeks of vancomycin therapy. Patient 2.A 55-year-old man with a history of hypertension, benign prostatic hypertrophy, and chronic rectal hemorrhoids was admitted with urinary hesitancy and rectal pain for 4 days. He had chills, but no pulmonary complaints. On examination, the patient was febrile and had large nonbleeding external rectal hemorrhoids and an enlarged nontender prostate. Blood cultures from the first 6 days of hospitalization were positive for MRSA. Pelvic CT revealed an enhancing cystic lesion in the inferior aspect of the prostate, consistent with a prostatic abscess, without evidence of pelvic thrombophlebitis (Fig. 1d). Pulmonary nodules consistent with septic pulmonary emboli were noted on CT. The patient was treated with 4 weeks of vancomycin and improved without surgical drainage.Patient 3. A 45-year-old man was admitted with acute lo...

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Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia

Cited by 24 publications

References 23 publications

Novel Multiplex PCR Assay for Detection of the Staphylococcal Virulence Marker Panton-Valentine Leukocidin Genes and Simultaneous Discrimination of Methicillin-Susceptible from -Resistant Staphylococci

Novel Multiplex PCR Assay for Detection of the Staphylococcal Virulence Marker Panton-Valentine Leukocidin Genes and Simultaneous Discrimination of Methicillin-Susceptible from -Resistant Staphylococci

Pragmatic management of Panton–Valentine leukocidin-associated staphylococcal diseases

Septic Pulmonary Emboli and Bacteremia Associated with Deep Tissue Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus

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