title: [Fatal pneumonia in an adolescent due to community-acquired methicillin-resistant Staphylococcus aureus positive for Panton-Valentine-leukocidin].
abstract: A 15-year-old girl developed a severe Staphylococcus aureus pneumonia following an influenza virus infection. The patient was admitted to a paediatric intensive-care facility because of respiratory and circulatory failure. Despite aggressive therapy, she died on the third day following admission to the intensive care unit due to secondary hypoxic-ischaemic encephalopathy. Blood and respiratory aspirate cultures showed community-acquired methicillin-resistant S. aureus (CA-MRSA) with a normal antibiotic sensitivity except for betalactam antibiotics. PCR-based methods demonstrated that the isolate possessed the Panton-Valentine-leukocidin (PVL) gene, encoding an S. aureus exotoxin that is associated with fulminant necrotising pneumonia. This case shows that clinicians in the Netherlands should also be aware of the possibility of CA-MRSA in patients without risk factors for MRSA carriage. Especially in children and adolescents with an influenza virus infection, pneumonia due to PVL-positive S. aureus strains may be life-threatening.
authors.affiliation: Wilhelmina Kinderziekenhuis, afd. Algemene Intensive Care, Universitair Medisch Centrum Utrecht, Huispost KB 03.023.2, Postbus 85.090, 3508 AB Utrecht. m.vanderflier@lab.azu.nl
authors.forename: M
authors.initials: M
authors.lastname: van der Flier
authors.forename: N B
authors.initials: NB
authors.lastname: van Dijk
authors.forename: A C
authors.initials: AC
authors.lastname: Fluit
authors.forename: A
authors.initials: A
authors.lastname: Fleer
authors.forename: T F
authors.initials: TF
authors.lastname: Wolfs
authors.forename: J P
authors.initials: JP
authors.lastname: van Gestel
mesh_terms: D000293:Adolescent; D001427:Bacterial Toxins; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology; D005098:Exotoxins; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000235:genetics* / Q000378:metabolism; D016106:Methicillin Resistance; D011023:Pneumonia, Staphylococcal / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D013203:Staphylococcal Infections / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000235:genetics* / Q000472:pathogenicity
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin