title: Emergence of community-acquired meticillin-resistant Staphylococcus aureus strain USA300 as a cause of necrotising community-onset pneumonia.
abstract: Meticillin-resistant Staphylococcus aureus (MRSA), usually known as a nosocomial pathogen, has emerged as the predominant cause of skin and soft-tissue infections in many communities. Concurrent with the emergence of community-acquired MRSA (CA-MRSA), there have been increasing numbers of reports of community-acquired necrotising pneumonia in young patients and others without the classic health-care-associated risk factors. Community-onset necrotising pneumonia due to CA-MRSA is now recognised as an emerging clinical entity with distinctive clinical features and substantial morbidity and mortality. A viral prodrome (eg, influenza or influenza-like illness) followed by acute onset of shortness of breath, sepsis, and haemoptysis is the most frequent clinical presentation. The best treatment of this partly toxin-mediated disease has not been clearly defined. Whereas cases of CA-MRSA pneumonia have now been reported from almost every continent, the overall burden of disease of this emerging syndrome remains incompletely described. We report two related cases of community-onset pneumonia due to the MRSA USA300 genotype and review the literature regarding the emergence of CA-MRSA pneumonia.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30303, USA. ahidron@emory.edu
authors.forename: Alicia I
authors.initials: AI
authors.lastname: Hidron
authors.forename: Cari E
authors.initials: CE
authors.lastname: Low
authors.forename: Eric G
authors.initials: EG
authors.lastname: Honig
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D001427:Bacterial Toxins / Q000235:genetics; D002981:Clindamycin / Q000627:therapeutic use; D021821:Communicable Diseases, Emerging / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D005098:Exotoxins / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007442:Intubation, Intratracheal; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D046915:Penicillin-Binding Proteins; D011023:Pneumonia, Staphylococcal / Q000188:drug therapy / Q000382:microbiology* / Q000503:physiopathology; D014481:United States; D037521:Virulence Factors
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D046915:Penicillin-Binding Proteins; D037521:Virulence Factors; C487789:mecA protein, Staphylococcus aureus; D002981:Clindamycin