Enterovirus D68 and Panton-Valentine Leukocidin–Positive Staphylococcus Aureus Respiratory Coinfection with Fatal Outcome

Abstract

A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swabs and lung tissue submitted to the Centers for Disease Control and Prevention (CDC) were positive for Enterovirus D68 (EV-D68). Blood and lung cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were submitted to the CDC and were found to be positive for the toxin Panton-Valentine leukocidin. We describe a fatality related to invasive toxin-mediated MRSA associated with EV-D68 coinfection, along with the clinical, laboratory, and autopsy findings, which provided important clues, prompting further investigation at the CDC to arrive at the correct diagnosis.

An Autopsy Case of Pulmonary Mucormycosis in a Previously Healthy 16-Month-Old Pediatric Decedent

“…A new question, as posed in the case described by Ravishankar et al, 13 involves scenarios with co-infections working against the health of a patient. Although their case involved a bacterial co-infection, it highlights the need to consider how co-infections with multiple agents may impact the health of patients and increase their susceptibility to poor health outcomes.…”

Panton-valentine leukocidin Staphylococcus aureus severe infection in an infant: a case report and a review of the literature

“…Since 2010, we have identified 15 reported cases of paediatric PVL-SA severe infections and Table 1 summarizes the main results of these reports regarding the clinical presentations, radiological findings, treatment and outcome [2][3][4][5][15][16][17][18][19][20][21][22][23].…”

“…Follow by sepsis and respiratory distress Synovitis with knee joint effusion and signs of medullary osteomyelitis in the proximal tibia (MRI). Intravenous vancomycin and oral linezolid MRSA ST30 7 weeks Multiple surgical drainage Complete resolution Ravishankar, 2016, USA [ 21 ] 1 10-years, F Emesis that progressed to respiratory distress, pallor and perioral cyanosis, and near syncope upon standing Not performed Intravenous vancomycin and ceftriaxone MRSA genotype not clarified Not applicable None Death Irenji, 2018, United Kingdom [ 22 ] 1 13-years, M Severe right-side groin pain irradiated to his right leg and lower abdomen. Poor general condition, vomiting Iliac muscle abscess (ultrasound) Abscesses anterior and posterior to the iliac crest (MRI) Bilateral consolidation within the lung fields (CT) Intravenous flucloxacillin and cefotaxime followed by intravenous linezolid and clindamycin.…”

Post-mortem microbiology in sudden death: sampling protocols proposed in different clinical settings

“…The samples collected should be sent to the laboratory within 2 hours when stored at room temperature and within 48 hours when stored in refrigeration in adequate transport media [22]. When PMM is conducted to exclude infection, a minimal microbiological protocol depending on the conditions surrounding death, as reported by Fern andez-Rodríguez et al (12) should be applied, and conservation of snap-frozen tissues from different locations permits later molecular microbiological analyses if, eventually, an infection is confirmed or suspected as COD [23].…”