Systemic CA-MRSA infection following trauma during soccer match in inner Brazil: Clinical and molecular characterization
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2013-07-01
Autores
Camargo, Carlos Henrique [UNESP]
Cunha, Maria de Lourdes Ribeiro de Souza da [UNESP]
Bonesso, Mariana Fávero [UNESP]
Da Cunha, Fabiana Picoli [UNESP]
Barbosa, Alexandre Naime [UNESP]
Fortaleza, Carlos Magno Castelo Branco [UNESP]
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Resumo
Even though community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) was described a decade ago, reports from Brazil are scarce and cases occurred in large urban centers. We report MRSA sepsis in a 16-year-old male from a small town and who had no history of exposure to healthcare or recent travel. After trauma during a soccer match, he presented swelling in the right thigh, which evolved in a month to cellulitis complicated by local abscess, orchitis and pneumonia. The patient presented severe sepsis, with fever and respiratory failure. Laboratory findings included blood leukocyte counts above 40,000/mm3 and thrombocytopenia. He was submitted to mechanical ventilation and therapy with vancomycin and imipenem. He had a slow but favorable response to therapy and was discharged after six weeks of hospitalization. MRSA grew from blood cultures and respiratory aspirates obtained before antimicrobial therapy. The isolate belonged to sequence type 5, spa type t311, harbored SCCmec type IV and genes for Panton-Valentine leukocidin and Enterotoxin A. The pulsed-field gel electrophoresis pattern was distinct from North American classic CA-MRSA clones. However, the sequence type and the spa type revealed that the clone belong to the same clonal complex isolated in Argentina. This is the first CA-MRSA infection reported in that region, with significant epidemiologic and clinical implications. © 2013 Elsevier Inc.
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CA-MRSA, Panton-Valentine Leukocidin, SCCmec type IV, Systemic infection, alpha hemolysin, bacterial enzyme, cefepime, chloramphenicol, ciprofloxacin, clindamycin, cotrimoxazole, dalfopristin plus quinupristin, deoxyribonuclease, enterotoxin, enterotoxin a, erythromycin, gentamicin, imipenem, levofloxacin, linezolid, Panton Valentine leukocidin, phospholipase, triacylglycerol lipase, unclassified drug, vancomycin, abscess, adolescent, allele, appendicitis, artificial ventilation, bacterial gene, bacterial growth, bacterial virulence, bacterium culture, bacterium isolation, blood culture, Brazil, case report, cellulitis, communicable disease, computer assisted tomography, differential diagnosis, disease severity, drug response, drug sensitivity, drug substitution, drug withdrawal, enzyme synthesis, fever, gene cassette, gene identification, hip pain, human, jaundice, lung infiltrate, male, mecA gene, methicillin resistant Staphylococcus aureus, methicillin resistant Staphylococcus aureus infection, minimum inhibitory concentration, molecular cloning, neutrophil count, nonhuman, orchitis, pneumonia, priority journal, pulsed field gel electrophoresis, remission, respiratory failure, sepsis, soccer, sport injury, systemic disease, tachypnea, thrombocyte count, thrombocytopenia, tracheal aspiration procedure
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Diagnostic Microbiology and Infectious Disease, v. 76, n. 3, p. 372-374, 2013.