title: Enterovirus D68 and Panton-Valentine Leukocidin-Positive Staphylococcus aureus Respiratory Coinfection with Fatal Outcome.
abstract: A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swabs and lung tissue submitted to the Centers for Disease Control and Prevention (CDC) were positive for Enterovirus D68 (EV-D68). Blood and lung cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were submitted to the CDC and were found to be positive for the toxin Panton-Valentine leukocidin. We describe a fatality related to invasive toxin-mediated MRSA associated with EV-D68 coinfection, along with the clinical, laboratory, and autopsy findings, which provided important clues, prompting further investigation at the CDC to arrive at the correct diagnosis.
authors.affiliation: 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Sanjita
authors.initials: S
authors.lastname: Ravishankar
authors.affiliation: 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Kimberle
authors.initials: K
authors.lastname: Chapin
authors.affiliation: 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Alexander-Scott
authors.affiliation: 3 Department of Pediatric Surgery, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Hale
authors.initials: H
authors.lastname: Wills
authors.affiliation: 4 Department of Emergency Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.|5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Merritt
authors.affiliation: 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Jacobson
authors.affiliation: 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Kleris
authors.affiliation: 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Alhinai
authors.affiliation: 5 Department of Pediatrics, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Ivona
authors.initials: I
authors.lastname: Sediva
authors.affiliation: 3 Department of Pediatric Surgery, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Muratore
authors.affiliation: 2 Department of Infectious Diseases, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Leonard
authors.initials: L
authors.lastname: Mermel
authors.affiliation: 1 Department of Pathology and Laboratory Medicine, Lifespan Academic Medical Center & Alpert Medical School of Brown University, Providence, RI 02903, USA.
authors.forename: Shamlal
authors.initials: S
authors.lastname: Mangray
mesh_terms: D001344:Autopsy; D001427:Bacterial Toxins / Q000302:isolation & purification*; D002423:Cause of Death; D002648:Child; D060085:Coinfection; D030016:Enterovirus D, Human / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000175:diagnosis / Q000628:therapy / Q000821:virology*; D005098:Exotoxins / Q000302:isolation & purification*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000302:isolation & purification*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D011237:Predictive Value of Tests; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy / Q000821:virology*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000628:therapy
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: disease outbreaks; enterovirus; leukopenia; methicillin-resistant Staphylococcus aureus; respiratory insufficiency