title: 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.
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Jie
authors: J
authors: Chen
authors: Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Yanping
authors: Y
authors: Luo
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Shu
authors: S
authors: Zhang
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Zhixin
authors: Z
authors: Liang
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Ying
authors: Y
authors: Wang
authors: Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Ying
authors: Y
authors: Zhang
authors: Department of Microbiology, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Guang
authors: G
authors: Zhou
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China.
authors: Yanhong
authors: Y
authors: Jia
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China. Electronic address: chenliangan301@163.com.
authors: Liangan
authors: L
authors: Chen
authors: Department of Respiratory Medicine, Chinese People's Liberation Army General Hospital, Beijing, PR China. Electronic address: dysheh@sina.com.
authors: Danyang
authors: D
authors: She
mesh_terms: D000293:Adolescent; D001427:Bacterial Toxins / Q000235:genetics; D002681:China; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: Community-acquired methicillin-resistant Staphylococcus aureus; Community-acquired pneumonia; Fosfomycin; Linezolid; Panton–Valentine leukocidin; Teicoplanin