title: Systemic CA-MRSA infection following trauma during soccer match in inner Brazil: clinical and molecular characterization.
abstract: Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm(3) and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications.
authors.affiliation: Department of Microbiology and Immunology, Botucatu Institute of Biosciences, UNESP - Univ Estadual Paulista, City of Botucatu, São Paulo State, Brazil.
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Camargo
authors.forename: Maria de Lourdes Ribeiro de Souza
authors.initials: Mde L
authors.lastname: da Cunha
authors.forename: Mariana Fávero
authors.initials: MF
authors.lastname: Bonesso
authors.forename: Fabiana Picoli
authors.initials: FP
authors.lastname: da Cunha
authors.forename: Alexandre Naime
authors.initials: AN
authors.lastname: Barbosa
authors.forename: Carlos Magno Castelo Branco
authors.initials: CM
authors.lastname: Fortaleza
mesh_terms: D016470:Bacteremia / Q000175:diagnosis* / Q000382:microbiology; D001938:Brazil; D017714:Community-Acquired Infections; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics*; D058885:Multilocus Sequence Typing; D012916:Soccer; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D016896:Treatment Outcome