Two cases of severe necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus
Yusuke Tomita1) Osamu Kawano1) Hidenori Ichiyasu1)3) Takakazu Fukushima2) Kouichirou Fukuda2) Mineharu Sugimoto1) Hirotsugu Kohrogi3)
1)Department of Respiratory Medicine, Kumamoto Saishunso National Hospital 2)Department of Respiratory Medicine, Kumamoto City Hospital 3)Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Medical and Parmaceutical Sciences, Kumamoto University
We present 2 cases with severe necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. The patients were a 89-year-old man and a male student of 15 years of age. Chest X-rays and CT scans demonstrated multiple consolidations with cavitary lesions showing necrotizing pneumonia. MRSA strains were isolated from the sputum cultures on admission in these patients who did not have any established risk factors for MRSA infections such as history of hospitalization, surgery, hemodialysis, the presence of a permanent indwelling catheter or percutaneous medical device, and residence in a long-term care facility. These patients thus satisfied the international criteria for CA-MRSA presented by the Centers for Disease Control and Prevention (CDC). Unfortunately, the first case died of CA-MRSA pneumonia in spite of intensive treatments including anti-MRSA antibiotics. Unlike the severe CA-MRSA cases in western countries, Panton-Valentine leukocidin (PVL) genes were not detected in the present cases, suggesting that factors other than PVL had a significant effect on the severity of necrotizing pneumonia. To the best of our knowledge, this is the first report of severe necrotizing pneumonia caused by CA-MRSA in Japan.
Community-acquired methicillin-resistant Staphylococcus aureus Necrotizing pneumonia Panton-Valentine leukocidin
Received 平成19年9月12日
JJRS, 46(5): 395-403, 2008