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Fatal Fulminant Pneumonia Caused by Methicillin-Sensitive Staphylococcus aureus Negative for Major High-Virulence Factors Following Influenza B Virus Infection.

Masaki K, Ishii M, Anraku M, Namkoong H, Miyakawa R, Nakajima T, Fukunaga K, Naoki K, Tasaka S, Soejima K, Sayama K, Sugita K, Iwata S, Cui L, Hanaki H, Hasegawa N, Betsuyaku T - Am J Case Rep (2015)

Bottom Line: Gram-positive clusters of cocci were detected in the patient's sputum; therefore, he was diagnosed with severe pneumonia and septic shock, and was admitted to the intensive care unit.Despite intensive antibiotic and antiviral treatment, he died of multiple organ failure 5 days after admission.His blood culture from the admission was positive for MSSA, and further analysis revealed that the strain was negative for major high-virulence factors, including PVL and enterotoxins, although influenza B virus RNA was detected by PCR.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT

Background: Increasing evidence has indicated that Staphylococcus aureus pneumonia complicated with influenza virus infection is often fatal. In these cases, disease severity is typically determined by susceptibility to antimicrobial agents and the presence of high-virulence factors that are produced by Staphylococcus aureus, such as Panton-Valentine leukocidin (PVL).

Case report: We describe a rare case of fatal community-acquired pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA), which did not secrete major high-virulence factors and coexisted with influenza type B infection. The 32-year-old previously healthy male patient presented with dyspnea, high fever, and cough. His roommate had been diagnosed with influenza B virus infection 3 days earlier. Gram-positive clusters of cocci were detected in the patient's sputum; therefore, he was diagnosed with severe pneumonia and septic shock, and was admitted to the intensive care unit. Despite intensive antibiotic and antiviral treatment, he died of multiple organ failure 5 days after admission. His blood culture from the admission was positive for MSSA, and further analysis revealed that the strain was negative for major high-virulence factors, including PVL and enterotoxins, although influenza B virus RNA was detected by PCR.

Conclusions: Physicians should pay special attention to patients with pneumonia following influenza and Staphylococcus aureus infection, as it may be fatal, even if the Staphylococcus aureus strain is PVL-negative and sensitive to antimicrobial agents.

No MeSH data available.


Related in: MedlinePlus

(A) Overview of the clinical course and treatment from admission to death. The patient received broad-spectrum antimicrobials, intubation, chest tube insertion, and extracorporeal membrane oxygenation (ECMO). (B) Chest radiographs at the indicated time points following admission.
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f2-amjcaserep-16-454: (A) Overview of the clinical course and treatment from admission to death. The patient received broad-spectrum antimicrobials, intubation, chest tube insertion, and extracorporeal membrane oxygenation (ECMO). (B) Chest radiographs at the indicated time points following admission.

Mentions: Based on this information, the patient was diagnosed with severe pneumonia and septic shock due to suspected acute influenza and Staphylococcal infection. We initiated treatment with intravenous meropenem (1000 mg every 8 h), levofloxacin (500 mg per day), vancomycin (500 mg every 12 h), and peramivir (600 mg per day) (Figure 2A). However, chest radiography revealed that the bilateral pulmonary infiltrates had progressively worsened following admission (Figure 2B). Ten hours after admission, 2 independent blood cultures, which had been initiated at the time of admission, confirmed Staphylococcus aureus infection. Twelve hours after admission, he developed right pneumothorax and a chest tube was inserted, which further aggravated his condition. Thirty hours after admission, hypoxemia had progressed and he required extracorporeal membrane oxygenation. Two days after admission, the bacterium that we isolated from the patient’s blood and sputum was confirmed to be MSSA, and we switched from vancomycin and meropenem to ampicillin and sulbactam (3000 mg every 6 h), based on the results of the antimicrobial susceptibility test. Intravenous immunoglobulin (5000 mg per day) was also administered. However, despite the intensive care, the patient developed disseminated intravascular coagulation at 2 days after admission, and subsequently died of multiple organ failure on day 5 of admission (105 h after admission).


Fatal Fulminant Pneumonia Caused by Methicillin-Sensitive Staphylococcus aureus Negative for Major High-Virulence Factors Following Influenza B Virus Infection.

Masaki K, Ishii M, Anraku M, Namkoong H, Miyakawa R, Nakajima T, Fukunaga K, Naoki K, Tasaka S, Soejima K, Sayama K, Sugita K, Iwata S, Cui L, Hanaki H, Hasegawa N, Betsuyaku T - Am J Case Rep (2015)

(A) Overview of the clinical course and treatment from admission to death. The patient received broad-spectrum antimicrobials, intubation, chest tube insertion, and extracorporeal membrane oxygenation (ECMO). (B) Chest radiographs at the indicated time points following admission.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4514331&req=5

f2-amjcaserep-16-454: (A) Overview of the clinical course and treatment from admission to death. The patient received broad-spectrum antimicrobials, intubation, chest tube insertion, and extracorporeal membrane oxygenation (ECMO). (B) Chest radiographs at the indicated time points following admission.
Mentions: Based on this information, the patient was diagnosed with severe pneumonia and septic shock due to suspected acute influenza and Staphylococcal infection. We initiated treatment with intravenous meropenem (1000 mg every 8 h), levofloxacin (500 mg per day), vancomycin (500 mg every 12 h), and peramivir (600 mg per day) (Figure 2A). However, chest radiography revealed that the bilateral pulmonary infiltrates had progressively worsened following admission (Figure 2B). Ten hours after admission, 2 independent blood cultures, which had been initiated at the time of admission, confirmed Staphylococcus aureus infection. Twelve hours after admission, he developed right pneumothorax and a chest tube was inserted, which further aggravated his condition. Thirty hours after admission, hypoxemia had progressed and he required extracorporeal membrane oxygenation. Two days after admission, the bacterium that we isolated from the patient’s blood and sputum was confirmed to be MSSA, and we switched from vancomycin and meropenem to ampicillin and sulbactam (3000 mg every 6 h), based on the results of the antimicrobial susceptibility test. Intravenous immunoglobulin (5000 mg per day) was also administered. However, despite the intensive care, the patient developed disseminated intravascular coagulation at 2 days after admission, and subsequently died of multiple organ failure on day 5 of admission (105 h after admission).

Bottom Line: Gram-positive clusters of cocci were detected in the patient's sputum; therefore, he was diagnosed with severe pneumonia and septic shock, and was admitted to the intensive care unit.Despite intensive antibiotic and antiviral treatment, he died of multiple organ failure 5 days after admission.His blood culture from the admission was positive for MSSA, and further analysis revealed that the strain was negative for major high-virulence factors, including PVL and enterotoxins, although influenza B virus RNA was detected by PCR.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

ABSTRACT

Background: Increasing evidence has indicated that Staphylococcus aureus pneumonia complicated with influenza virus infection is often fatal. In these cases, disease severity is typically determined by susceptibility to antimicrobial agents and the presence of high-virulence factors that are produced by Staphylococcus aureus, such as Panton-Valentine leukocidin (PVL).

Case report: We describe a rare case of fatal community-acquired pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA), which did not secrete major high-virulence factors and coexisted with influenza type B infection. The 32-year-old previously healthy male patient presented with dyspnea, high fever, and cough. His roommate had been diagnosed with influenza B virus infection 3 days earlier. Gram-positive clusters of cocci were detected in the patient's sputum; therefore, he was diagnosed with severe pneumonia and septic shock, and was admitted to the intensive care unit. Despite intensive antibiotic and antiviral treatment, he died of multiple organ failure 5 days after admission. His blood culture from the admission was positive for MSSA, and further analysis revealed that the strain was negative for major high-virulence factors, including PVL and enterotoxins, although influenza B virus RNA was detected by PCR.

Conclusions: Physicians should pay special attention to patients with pneumonia following influenza and Staphylococcus aureus infection, as it may be fatal, even if the Staphylococcus aureus strain is PVL-negative and sensitive to antimicrobial agents.

No MeSH data available.


Related in: MedlinePlus