title: Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments.
abstract: We report a case of fatal necrotizing pneumonia and sepsis caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in an otherwise well, 48-year-old Canadian man with type 2 diabetes mellitus who had travelled to Texas. Despite therapy that included intravenous antibiotics, intravenous immune globulin and other supportive measures, the patient succumbed to his illness. Recently, CA-MRSA pneumonia has been reported in several countries. The virulence of this organism may in part be related to its ability to produce toxins, such as Panton-Valentine leukocidin. As rates of CA-MRSA increase worldwide, physicians should be aware of the potential for MRSA to cause life-threatening infections in patients presenting to Canadian emergency departments (EDs). Necrotizing pneumonia caused by MRSA must be considered in the differential diagnosis of acute, severe respiratory illness. Early recognition of this syndrome in the ED may help physicians initiate appropriate antibiotic therapy in a timely manner.
authors.affiliation: Department of Pediatrics, Division of Infectious Diseases, Alberta Children's Hospital, University of Calgary, Calgary, Alberta.
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Vayalumkal
authors.forename: Heather
authors.initials: H
authors.lastname: Whittingham
authors.forename: Otto
authors.initials: O
authors.lastname: Vanderkooi
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Stewart
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
authors.forename: Michael
authors.initials: M
authors.lastname: Mulvey
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
mesh_terms: D001427:Bacterial Toxins; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000382:microbiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D005098:Exotoxins; D017809:Fatal Outcome; D006801:Humans; D007956:Leukocidins; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009336:Necrosis; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis* / Q000382:microbiology; D012772:Shock, Septic / Q000382:microbiology*; D014195:Travel
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin