title: The Challenge of Diagnosing and Treating Staphylococcus aureus Invasive Infections in a Resource-limited Sub-Saharan Africa Setting: A Case Report.
abstract: BACKGROUND
  Community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) is responsible for the majority of skin and soft-tissue infections. CA-MSSA can also cause life-threatening infections, possibly in relation to particular virulence factors, including Panton-Valentine leukocidin (PVL).
  
  
  METHODS
  We describe a severe CA-MSSA necrotizing pneumonia complicated with multifocal osteomyelitis, pericardial effusion and endocarditis in a 6-year-old boy admitted to a Mozambican hospital. Staphylococcus aureus isolation and antibiotic susceptibility testing were performed by conventional microbiology. Additionally, microarray assay was used for molecular characterization.
  
  
  RESULTS
  Blood culture confirmed the presence of S. aureus susceptible to most antimicrobial agents, including methicillin. Molecular characterization confirmed the presence of PVL, together with alpha and beta haemolysin genes.
  
  
  CONCLUSIONS
  To our knowledge, this is the first reported case of disseminated CA-MSSA disease with confirmed PVL exotoxin in sub-Saharan Africa. PVL-positive CA-MSSA should be considered in the differential diagnosis of community-acquired pneumonia, making laboratory testing a higher priority.
authors.affiliation: EAP Sardenya-Hospital de la Santa Creu i Sant Pau, Barcelona, 08025, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Rovira
authors.affiliation: Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital 12 de Octubre, Madrid, 28041, Spain.
authors.forename: Elisa F
authors.initials: EF
authors.lastname: Cooke
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929.
authors.forename: Helio
authors.initials: H
authors.lastname: Mucavele
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929.
authors.forename: Antonio
authors.initials: A
authors.lastname: Sitoe
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain.
authors.forename: Lola
authors.initials: L
authors.lastname: Madrid
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264.
authors.forename: Tacilta
authors.initials: T
authors.lastname: Nhampossa
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Garrine
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929.
authors.forename: Sergio
authors.initials: S
authors.lastname: Massora
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929.
authors.forename: Anelsio
authors.initials: A
authors.lastname: Cossa
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 Instituto Nacional de Saúde, Ministério de Saúde, Maputo, Mozambique, CP264.
authors.forename: Inacio
authors.initials: I
authors.lastname: Mandomando
authors.affiliation: Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique, CP1929 ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, 08036, Spain quique.bassat@cresib.cat.
authors.forename: Quique
authors.initials: Q
authors.lastname: Bassat
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins; D002648:Child; D017714:Community-Acquired Infections / Q000188:drug therapy; D004452:Echocardiography; D005098:Exotoxins; D006801:Humans; D007956:Leukocidins; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010019:Osteomyelitis / Q000382:microbiology*; D010493:Pericarditis; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D016896:Treatment Outcome; D037521:Virulence Factors
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors
keywords: Panton–Valentine leukocidin; Staphylococcus aureus; Sub-Saharan Africa; community-acquired infections; necrotizing pneumonia; virulence factors