Involvement of Methicillin-Susceptible Staphylococcus aureus Related to Sequence Type 25 and Harboring pvl Genes in a Case of Carotid Cavernous Fistula after Community-Associated Sepsis

Abstract

Staphylococcus aureus encoding Panton-Valentine leukocidin (PVL) genes has become the cause of life-threatening infections.We describe a case of carotid cavernous fistula after bacteremia in a 12-year-old male, caused by a methicillin-susceptible S. aureus isolate carrying the pvl, fnbA, and ebpS genes and related to sequence type 25 (ST25). The patient's condition was complicated by pleural empyema and osteomyelitis in the right femur. The patient was discharged in good clinical condition after 160 days of hospitalization. CASE REPORTA previously healthy 12-year-old male who practices kung fu was admitted on 5 December 2009 to the adolescent unit of a hospital located in Rio de Janeiro, Brazil. He was admitted with a history of 7 days of fever and muscle pain in his right thigh. Clinical signs and symptoms observed at the time of admission revealed severe sepsis and pyomyositis. During a physical examination, his axillar temperature was 37.9°C, with blood pressure of 180/90 mm Hg, a pulse of 136 beats per min, and respiration of 60 per min. Jaundice, abdominal pain, and dehydration were also observed. There was also focal pain in the right ankle and thigh. On admission, the laboratory findings revealed leukocytosis with 22,000 cells/mm 3 (90% polymorphonuclear leukocytes [PMN] with 23% bands), a hematocrit level of 25%, a hemoglobin level of 8.4 g/dl, and a platelet count of 140,000/mm 3 . The blood biochemical test results were as follows: glucose, 62 mg/dl; aspartate aminotransferase, 52 U/liter; alanine aminotransferase, 40 U/liter; bilirubin total level, 9.73 mg/dl, with conjugate at 6.45 mg/dl; urea, 62 mg/dl; creatinine, 1.2 mg/dl. Amylase, ␥-glutamyltransferase, alkaline phosphatase, and creatine phosphokinase (CPK) were normal. Arterial blood gas results were as follows: carbon dioxide tension (pCO 2 ), 31; oxygen tension (pO 2 ), 66; HCO 3 , 20; base excess (BE ϩ ), 2.8; oxyhemoglobin saturation (sat O 2 ), 93%; pH (hydrogen ionic potential), 7.43. A chest X-ray showed bilateral interstitial infiltrate. After blood cultures and serologic tests (cytomegalovirus [CMV], Epstein-Barr virus [EBV], HIV, hepatitis viruses, syphilis, and toxoplasmosis) were obtained, intravenous therapy was initiated with vancomycin at 1 g every 12 h (q12h), ceftriaxone at 1 g q12h, and clindamycin at 600 mg q6h. Continuous positive airway pressure (CPAP) was started for ventilatory support. Additional exams with computed tomography (CT) scan imaging showed multiple areas of pulmonary consolidation and pleural effusion. Ultrasonography confirmed myositis in the right thigh, and a transthoracic echocardiogram showed no valve vegetation. In the second day after his admission, a S. aureus strain (confirmed by catalase and coagulase tests) was isolated from two blood culture sets. Antimicrobial susceptibility testing (3) revealed that the isolates were susceptible to all the antimicrobials tested, including oxacillin. The antibiotics were changed to oxacillin. As the patient persisted with fever, tachypnea, and focal pain, he wa...

Whole-Genome Sequencing Analysis of Methicillin-Resistant Staphylococcus simulans Causing Surgical Site Infection

“…The genome of CJ16 contains several genes that might be of relevance to skin survival, in keeping with the identity of S. simulans as an opportunistic pathogen. Predicted adhesion proteins involved in colonization and host protein binding, such as autolysin, fibronectin-binding protein ( fnbA ), elastin-binding protein ( ebpS ) ( 15 ), cell wall-anchored protein ( sasA , sasF , and sasH ) ( 16 ), and several additional genes encoding host protein-binding motifs were identified in the genome. Adhesion-encoding genes have been commonly identified in S. aureus isolates, and they have been recognized as being more associated with invasive infections ( 15 ).…”

Staphylococcus aureusCausing Tropical Pyomyositis, Amazon Basin, Peru

“…This ST has been detected in bovine and human isolates in the United Kingdom ( 14 ), and an ST25 PVL–positive MSSA was detected in a patient in Brazil with life-threatening sepsis with pneumonia and myositis ( 15 ). ST25 PVL–positive isolates are thought to be rare in Peru: in 2008–2009, only 6 (3.6%) of 169 MSSA blood isolates from hospitalized patients in Lima (non-tropical area of Peru) harbored spa type t078 or related spa types (C. Garcia, unpub.…”

Characterisation of a Staphylococcus aureus Isolate Carrying Phage-Borne Enterotoxin E from a European Badger (Meles meles)

“…An earlier study on European wildlife identified four isolates among 29 examined animals [ 6 ]. Three were identified as CC425 (a lineage also known from various animals, see below and [ 6 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ] and one was assigned to CC25 (previously found in humans, [ 46 , 47 , 48 ]). A recent study from Spain [ 49 ] did not identify S. aureus in the twelve badgers examined, and another one from Northern Ireland failed to detect MRSA in badgers [ 50 ].…”