Community-acquired necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus producing Panton–Valentine leukocidin in a Chinese teenager: case report and literature review

Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has now been established as an important community-acquired pathogen. Although necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA) strains producing Panton–Valentine leukocidin (PVL) has been reported with increasing frequency in many countries, it has been reported in only a few children younger than 1 year of age in Mainland China. Methods: We describe a case of life-threatening necrotizing pneumonia due to PVL-positive CA-MRSA in a 15-year-old previously healthy female who presented with high fever, shivering, a dry cough, and dyspnea. Details of the clinical outcomes, microbiological data, and therapies for this patient were collected and compared with those of cases reported in the literature on CA-MRSA. Results: Computed tomography (CT) findings showed cavitary consolidations in both lungs and bilateral pleural effusion. MRSA strains isolated from the patient's sputum and pleural fluid were susceptible to most non-β-lactam antimicrobial agents except for clindamycin and erythromycin. Both of these isolates tested positive for the mecA gene as well as PVL genes, and were identified as ST59-MRSA-SCCmec type IV-spa type t437. The patient was treated successfully with linezolid, fosfomycin, and teicoplanin. Conclusions: To our knowledge, this is the first report from Mainland China of necrotizing pneumonia due to PVL-positive CA-MRSA among those aged older than 1 year. CA-MRSA necrotizing pneumonia should be considered in the differential diagnosis of severe community-acquired pneumonia, particularly in previously healthy individuals.

Keywords

• Community-acquired methicillin-resistant Staphylococcus aureus
• Community-acquired pneumonia
• Panton–Valentine leukocidin
• Linezolid
• Teicoplanin
• Fosfomycin