Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult
Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult
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DOI：
10.1016/j.annemergmed.2005.05.023
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发表时间：
2005-11-01
影响因子：
6.2
通讯作者：
Perdreau-Remington, F
中科院分区：
文献类型：
--
作者：
Frazee, BW;Salz, TO;Perdreau-Remington, F
20 世纪 90 年代美国出现这种病原体后不久，就有报道称儿童中出现了由社区相关的耐甲氧西林金黄色葡萄球菌 (MRSA) 引起的严重肺炎。 Panton Valentine 杀白细胞素基因存在于大多数与社区相关的 MRSA 中，被认为可以增强金黄色葡萄球菌引起坏死性肺炎的能力。尽管社区相关的耐甲氧西林金黄色葡萄球菌（MRSA）以及相关的皮肤和软组织感染在美国迅速传播，但成人严重肺炎的报告却很少。我们描述了一个健康年轻人的病例，他最初因典型的社区获得性肺炎而接受左氧氟沙星门诊治疗。他很快又回到急诊科 (ED)，患有迅速致命的坏死性肺炎，伴有咯血、白细胞减少和败血症综合征，这是由携带 Panton Valentine 杀白细胞素基因的社区相关 MRSA 引起的。该病例凸显了这种肺炎的典型特征，以及在急诊室评估和治疗重症肺炎时考虑 MRSA 的必要性。它还提出了这样的问题：在社区相关 MRSA 流行率较高的社区中，这种形式的肺炎的发病率是否可能会增加，以及是否应该修改当前的肺炎治疗指南。
Severe pneumonia caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA) was reported in children soon after this pathogen emerged in the United States in the 1990s. Genes for Panton Valentine leukocidin, which are present in the majority of community-associated MRSA, are thought to enhance the ability of S aureus to cause necrotizing pneumonia. Despite the rapid spread throughout the United States of community-associated MRSA and related skin and soft-tissue infections, reports of severe pneumonia in adults have been rare. We describe a case of a healthy young adult who initially was treated as an outpatient with levofloxacin for what appeared to be typical community-acquired pneumonia. He soon returned to the emergency department (ED) with rapidly fatal necrotizing pneumonia, associated with hemoptysis, leukopenia, and sepsis syndrome, that was caused by community-associated MRSA carrying genes for Panton Valentine leukocidin. This case highlights the typical features of this form of pneumonia and the need to consider MRSA when evaluating and treating severe pneumonia in the ED. It also raises the question of whether the incidence of this form of pneumonia might be increasing in communities with a high prevalence of community-associated MRSA and whether current pneumonia treatment guidelines should be modified.