Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes
Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes
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DOI：
10.1086/427148
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发表时间：
2005-01-01
影响因子：
11.8
通讯作者：
Bartlett, JG
中科院分区：
文献类型：
--
作者：
Francis, JS;Doherty, MC;Bartlett, JG
背景最近世界范围内报道的社区发病性皮肤病、暴发性疖病和与携带Panton-Valentine杀白细胞素（PVL）基因和葡萄球菌盒式染色体mec（SCCmec）IV型的耐甲氧西林金黄色葡萄球菌（MRSA）相关的严重肺炎表明MRSA感染正在演变成与社区相关的问题.迄今为止报告的大多数病例涉及皮肤和软组织感染，严重肺炎是一种相对罕见的现象。在2003 - 2004年冬季的2个月期间，4名健康成年人在没有MRSA感染的典型危险因素的情况下，因严重坏死性MRSA肺炎到2家巴尔的摩医院中的1家就诊。患者的MRSA分离株通过使用脉冲场凝胶电泳的菌株分型和使用多重聚合酶链反应（PCR）的SCCmec分型以及通过PCR检测PVL基因来表征。所有4名患者的MRSA分离株均携带PVL基因和SCCmec IV型元件，属于USA 300脉冲场型。这3个发现是社区发病MRSA菌株的典型特征之一。此外，我们的2例患者同时诊断为甲型流感，这可能有助于他们的表现的严重性。据我们所知，这些患者代表了首次报道的由携带PVL基因的菌株引起的严重社区发病MRSA肺炎的北美成年人。
Background. Recent worldwide reports of community- onset skin abscesses, outbreaks of furunculosis, and severe pneumonia associated with methicillin- resistant Staphylococcus aureus ( MRSA) carrying Panton- Valentine leukocidin ( PVL) genes and the staphylococcal cassette chromosome mec ( SCCmec) type IV indicate that MRSA infections are evolving into a community- related problem. The majority of cases reported to date involve skin and soft- tissue infections, with severe pneumonia representing a relatively rare phenomenon. During a 2- month period in the winter of 2003 - 2004, four healthy adults presented to 1 of 2 Baltimore hospitals with severe necrotizing MRSA pneumonia in the absence of typical risk factors for MRSA infection.Methods. Patients' MRSA isolates were characterized by strain typing with use of pulsed- field gel electrophoresis and SCCmec typing with use of a multiplex polymerase chain reaction ( PCR) assay and detection of PVL genes by PCR.Results. All 4 patients' MRSA isolates carried the PVL genes and the SCCmec type IV element and belonged to the USA300 pulsed- field type. These 3 findings are among the typical characteristics of community- onset MRSA strains. In addition, 2 of our patients had concomitant influenza A diagnosed, which likely contributed to the severity of their presentation.Conclusions. To our knowledge, these patients represent the first reported North American adults with severe community- onset MRSA pneumonia caused by strains carrying the PVL genes.