Factors Predicting Mortality in Necrotizing Community-Acquired Pneumonia Caused by Staphylococcus aureus Containing Panton-Valentine Leukocidin

Abstract

Airway bleeding, erythroderma, and leukopenia are associated with fatal outcome from Panton-Valentine leukocidin-positive S. aureus necrotizing pneumonia. More work is needed to develop more efficacious therapy against this highly lethal disease.

Parapneumonic Empyema Deaths during Past Century, Utah

“…aureus is increasingly recognized as a signifi cant cause of complicated pneumonia. A recent study from France demonstrated a mortality rate of >50% in patients infected with S. aureus that contained Panton-Valentine leukocidin (PVL), which caused necrotizing pneumonia (37). A study among children from Houston demonstrated a marked increase in complicated pneumonia in patients with PVL-containing S. aureus infection (29).…”

Clinical Feature: Community-acquired Pneumonia Caused by Panton-Valentine Leukocidin-positive Staphylococcus aureus

“…In addition, while leucopenia, a high level of serum creating kinase and C-reactive protein (>200 g/L), and a negative pneumococcus and Legionella antigen test can make invasive disease doubtful, it is simple and useful for physicians to estimate the pathogen by examining sputum Gram stains and verifying grape-like clusters. The characteristic feature of rapid progression to fatal pneumonia is hemoptysis, alveolar hemorrhage, leucopenia, hypoxia, and influenza-like illness, mainly in young adults and healthy children [12].…”

Management of Community-Acquired Pneumonia in Hospitalized Children

“…National hospitalization rates for empyema in US children increased from 3 to 6 per 100,000 following the release of PCV-7 [49]. Experts posit that increased rates of complicated pneumonia result from more accurate diagnostic techniques and changes to the spectrum of pathogens responsible for pediatric CAP, as nonvaccine pneumococcal serotypes replace the conjugate vaccine serotypes and virulent strains of Staphylococcus aureus become more prevalent [50,51].…”

“…Neurocognitively impaired children may be at increased risk for aspiration of these pathogens from the upper respiratory or GI tracts. Staphylococcus aureus is well described as a cause of severe necrotizing pneumonia in the literature, and is associated with leukopenia, erythroderma, purulent cough, and pulmonary hemorrhage [51,63].…”