Community-acquired pneumonia and bacteraemia in a healthy young woman caused by methicillin-resistant Staphylococcus aureus (MRSA) carrying the genes encoding Panton-Valentine leukocidin (PVL)

Torell, Erik; Molin, Daniël; Tano, Eva; Ehrenborg, Christian; Rydén, Cecilia

doi:10.1080/00365540500348945

Cited by 26 publications

(19 citation statements)

References 6 publications

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“…Ninety-two cases of severe S. aureus CAP were reported in 70 articles during the period from 1995 to 2009 from North America (35 cases, 38.0%) [2,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42], Europe (40 cases, 43.5%) [1,7,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74], Asia (11 cases, 12.0%) [75,76,77,78,79,80,81,82], and Australia (6 cases, 6.5%) [83,84,85,86,87,88] (table 1). Data on outcomes were available for 91 patients.…”

Section: Resultsmentioning

confidence: 99%

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

Zhang²,

Huang³

et al. 2010

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Background: Although community-acquired Staphylococcus aureus pneumonia with highly virulent Panton-Valentine leukocidin (PVL)-positive strains, a severe disease with significant lethality, is rare, especially in adult and adolescent patients, recent reports highlight that these infections are on the rise. Objectives: To describe the demographic and clinical features of reported cases of life-threatening community-acquired S. aureus pneumonia with usually PVL-positive strains in adult and adolescent patients, to evaluate the variables related to death, and to select a more appropriate antimicrobial treatment for this potentially deadly disease. Methods: We summarized all of the 92 reported cases and our case. The effect of 5 variables on mortality was measured using logistic regression. Results:S. aureus community-acquired pneumonia (CAP) with usually PVL-positive strains is a severe disease with significant lethality, i.e. 42.9%; a short duration of the time from the onset of symptoms to death, i.e. 5.5 ± 10.1 days, and prolonged hospital admissions, i.e. 33.2 ± 29.5 days. Seventy-three cases have been tested for the gene for PVL, and 71 strains have been found to carry the PVL gene. Logistic regression analysis showed that leucopenia (p = 0.002), influenza-like symptoms or laboratory-confirmed influenza (p = 0.011), and hemoptysis (p = 0.024) were the factors associated with death. Antibiotic therapies inhibiting toxin production were associated with an improved outcome in these cases (p = 0.007). Conclusions: Physicians should pay special attention to those patients who acquired severe CAP during influenza season and have flu-like symptoms, hemoptysis, and leucopenia, and they should consider S. aureus more frequently among the possible pathogens of severe CAP. Empiric therapy for severe CAP with this distinct clinical picture should include coverage for S. aureus. Targeted treatment with antimicrobials inhibiting toxin production appears to be a more appropriate selection.

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Section: Resultsmentioning

confidence: 99%

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

Zhang²,

Huang³

et al. 2010

Respiration

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“…In one study the half-life of MRSA nasal carriage was 40 months (800), and in another, nasal carriage of CA-MRSA isolates could be demonstrated for 2 years or longer (907). In a Swiss hospital, even in the setting of a study of routinely attempted decolonization of MRSA carriers, the median time to clearance was 226 days, and the maximum was 3.3 years.…”

Section: Staphylococcus Aureus As a Commensal Organism: Role Of Asympmentioning

confidence: 99%

“…In the United States, PVL genes have been almost universally detected among CA-MRSA strains causing SSTIs and S. aureus invasive diseases such as community-acquired necrotizing pneumonia (86,190,312,321,540,618,720,917), severe sepsis, and other sometimes fatal infections (6,33,76,133,192,584,636,719,907,917). Among patients with S. aureus pneumonia, higher mortality and an increased likelihood of sepsis, hemoptysis, and pleural effusion were documented for cases caused by a PVL ϩ strain (321).…”

Section: Pvl and Ca-mrsamentioning

confidence: 99%

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

2010

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SUMMARY Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.

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“…Strains of MRSA are among the most noted pathogens currently circulating (9), and these are dominated by a particularly hypervirulent strain of community-associated MRSA (CA-MRSA), USA300, which exemplifies the documented ability of CA-MRSA to cause infections in otherwise healthy individuals and efficient person-to-person spread (10)(11)(12)(13)(14). Consequently, from its first appearance as a CA-MRSA strain in the community setting in the late 1990s, USA300 has now become the predominant strain of S. aureus in both the community and hospital settings across North America (15,16).…”

mentioning

confidence: 99%

Role of Lipase from Community-Associated Methicillin-Resistant Staphylococcus aureus Strain USA300 in Hydrolyzing Triglycerides into Growth-Inhibitory Free Fatty Acids

et al. 2014

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Part of the human host innate immune response involves the secretion of bactericidal lipids on the skin and delivery of triglycerides into abscesses to control invading pathogens. Two Staphylococcus aureus lipases, named SAL1 and SAL2, were identified in the community-associated methicillin-resistant S. aureus strain USA300, which, presumably, are produced and function to degrade triglycerides to release free fatty acids. We show that the SAL2 lipase is one of the most abundant proteins secreted by USA300 and is proteolytically processed from the 72-kDa proSAL2 to the 44-kDa mature SAL2 by the metalloprotease aureolysin. We show that spent culture supernatants had lipase activity on both short-and long-chain fatty acid substrates and that deletion of gehB, encoding SAL2, resulted in the complete loss of these activities. With the use of gas chromatography-mass spectrometry, we show that SAL2 hydrolyzed trilinolein to linoleic acid, a fatty acid with known antistaphylococcal properties. When added to cultures of USA300, trilinolein and, to a lesser extent, triolein inhibited growth in a SAL2-dependent manner. This effect was shown to be due to the enzymatic activity of SAL2 on these triglycerides, since the catalytically inactive SAL2 Ser412Ala mutant was incapable of hydrolyzing the triglycerides or yielding delayed growth in their presence. Overall, these results reveal that SAL2 hydrolyzes triglycerides of both short-and long-chain fatty acids and that the released free fatty acids have the potential to cause significant delays in growth, depending on the chemical nature of the free fatty acid.

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Community-acquired pneumonia and bacteraemia in a healthy young woman caused by methicillin-resistant Staphylococcus aureus (MRSA) carrying the genes encoding Panton-Valentine leukocidin (PVL)

Cited by 26 publications

References 6 publications

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

Factors Associated with the Outcome of Life-Threatening Necrotizing Pneumonia due to Community-Acquired <i>Staphylococcus aureus</i> in Adult and Adolescent Patients

Community-Associated Methicillin-ResistantStaphylococcus aureus: Epidemiology and Clinical Consequences of an Emerging Epidemic

Role of Lipase from Community-Associated Methicillin-Resistant Staphylococcus aureus Strain USA300 in Hydrolyzing Triglycerides into Growth-Inhibitory Free Fatty Acids

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