Elsevier

Journal of Infection

Volume 51, Issue 4, November 2005, Pages e241-e243
Journal of Infection

Case report
Community-acquired MRSA bacteremic necrotizing pneumonia in a patient with scrotal ulceration

https://doi.org/10.1016/j.jinf.2004.08.028Get rights and content

Abstract

Methicillin-resistant Staphylococcus aureus (MRSA) is being recognized increasingly as a cause of community-acquired infection. The organism usually causes skin and soft tissue infection. Here, we present a patient with community-acquired MRSA pneumonia and review the literature. The patient, a 37-year-old Saudi male with no significant medical history was admitted with fever, respiratory distress and scrotal ulceration. Scrotal swabs and blood cultures grew MRSA. Imaging studies showed necrotizing pneumonia. Physical examination and echocardiographic findings revealed no evidence of endocarditis. The patient was treated successfully with 4 weeks of intravenous vancomycin. The infection appears to have originated in the skin and subcutaneous tissues of the scrotum, and subsequently led to necrotizing pneumonia. Community-acquired MRSA pneumonia has been associated with the production of Panton–Valentine leukocidin.

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) became clinically evident in the 1960s. Early reports documented infection in hospitalized and institutionalized patients.1 The infection occurred mostly in the intensive care units and was common among nursing home residents.

Community-acquired MRSA (CA-MRSA) was initially reported by the CDC in 1981.2 Since then, multiple studies have demonstrated an increasing frequency of CA-MRSA.3 CA-MRSA is defined as the presence of infection on admission or within 72 h of admission to the hospital.4 In a recent meta-analysis, pooled data from 27 retrospective and five prospective studies showed that 86% of patients had health-related risk factors. These factors included recent hospitalization, chronic illnesses requiring frequent hospital visits, nursing home admission, intravenous drug use or contact with a person with a risk factor.5 The percentage of patients with health-related risk factors is likely to be higher than what is quoted in the literature. The current definition of ‘community acquired’ MRSA is limited, since colonization can persist for months or years.6 Most CA-MRSA infections involve the skin and soft tissues.3 Necrotizing pneumonia secondary to CA-MRSA has been described infrequently, and we are not aware of any report of CA-MRSA causing necrotizing pneumonia in Saudi Arabia. Thus, we describe a patient with necrotizing pneumonia and CA-MRSA bacteraemia and discuss the disease.

Section snippets

Case report

The patient was a 37-year-old gentleman. He was married and had four children. He had no significant past medical history, and no history of intravenous drug use. He was admitted with a six-day history of flank and pleuritic chest pain, with fever, chills and scanty blood-tinged sputum.

On examination, he was well-built, alert and oriented to time, place and person. Vital signs revealed a temperature of 39.5 °C, a blood pressure of 54/30, a heart rate of 120/min, and an oxygen saturation of 96%

Discussion

MRSA infections usually occur in individuals with known risk factors such as hospitalization, haemodialysis or intravenous drug use.1 However, as in our patient, MRSA infections had been described in individuals with no known risk factors.7 CA-MRSA, had historically caused skin and soft tissue infections in 93% of affected patients.3 Our patient has shown an unusual presentation. His infection started in the skin and soft tissues of the scrotal area, followed by bacteraemia and haematogenous

Acknowledgements

The authors wish to acknowledge the use of Saudi Aramco Medical Services Organization facilities for the data and study which resulted in this paper. The authors were employed by Saudi Aramco during the time the study was conducted and the paper written.

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