title: Necrotizing pneumonia due to clonally diverse Staphylococcus aureus strains producing Panton-Valentine leukocidin: the Czech experience.
abstract: A prospective study (2007-2013) was undertaken to investigate clinical features and prognostic factors of necrotizing pneumonia caused by Staphylococcus aureus producing Panton-Valentine leukocidin (PVL) in the Czech Republic. Twelve cases of necrotizing pneumonia were detected in 12 patients (median age 25 years) without severe underlying disease. Eight cases occurred in December and January and the accumulation of cases in the winter months preceding the influenza season was statistically significant (P < 0·001). The course of pneumonia was very rapid, leading to early sepsis and/or septic shock in all but one patient. Seven patients died and mortality was fourfold higher in those patients presenting with primary pneumonia than with pneumonia complicating other staphylococcal/pyogenic infection elsewhere in the body. The S. aureus isolates displayed considerable genetic variability and were assigned to five lineages CC8 (n = 3), CC15 (n = 2), CC30 (n = 2), CC80 (n = 1), and CC121 (n = 3) and one was a singleton of ST154 (n = 1), all were reported to be associated with community-acquired infection. Four strains were methicillin resistant. The high case-fatality rate can only be reduced by improving the speed of diagnosis and a rapid test to detect S. aureus in the airways is needed.
authors.affiliation: Department of Experimental Biology,Faculty of Science,Masaryk University,Brno,Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Rájová
authors.affiliation: Department of Experimental Biology,Faculty of Science,Masaryk University,Brno,Czech Republic.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-3950-675X
authors.initials: R
authors.lastname: Pantůček
authors.affiliation: Reference Laboratory for Staphylococci,National Institute of Public Health,Prague,Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Petráš
authors.affiliation: Reference Laboratory for Staphylococci,National Institute of Public Health,Prague,Czech Republic.
authors.forename: I
authors.initials: I
authors.lastname: Varbanovová
authors.affiliation: Department of Experimental Biology,Faculty of Science,Masaryk University,Brno,Czech Republic.
authors.forename: I
authors.initials: I
authors.lastname: Mašlaňová
authors.affiliation: Department of Infectious Diseases,3rd Faculty of Medicine,Charles University,Prague,Czech Republic.
authors.forename: J
authors.initials: J
authors.lastname: Beneš
mesh_terms: D000293:Adolescent; D000328:Adult; D001427:Bacterial Toxins / Q000096:biosynthesis*; D017714:Community-Acquired Infections / Q000382:microbiology; D018153:Czech Republic; D005098:Exotoxins / Q000096:biosynthesis*; D005260:Female; D014644:Genetic Variation; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000096:biosynthesis*; D008168:Lung / Q000473:pathology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000235:genetics / Q000378:metabolism*; D008875:Middle Aged; D009336:Necrosis / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D011379:Prognosis; D011446:Prospective Studies; D012621:Seasons; D012772:Shock, Septic / Q000382:microbiology*; D013211:Staphylococcus aureus; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: Community-acquired pneumonia; Panton–Valentine leukocidin; Staphylococcus aureus; necrotizing pneumonia; septic shock