Fatal community-acquired pneumonia due to Staphylococcus aureus carrying Panton–Valentine leukocidin genes after a stay in Africa

Excerpt

Sir, Staphylococcus aureus is an infrequent cause of community-acquired pneumonia (CAP), accounting for 3–5% of cases. Panton–Valentine leukocidin (PVL) has leukotoxic properties and produces tissue necrosis. PVL-positive strains are associated with highly lethal necrotising pneumonia [1]. We report a fatal case with very rapid clinical course caused by methicillin-susceptible S. aureus after a trip to Africa. A 47-year-old French woman presented to the emergency department with an acute onset of fever, cough, dyspnoea and chest pain. The patient had been well up to 36 h before presentation, when she experienced cough and chills during her return flight to France after a 2-week vacation in Senegal. On the initial examination, the temperature was 40 °C, the heart rate 93 beats/min, the blood pressure 130/80 mmHg and oxygen saturation was 96% in room air. Many pustules were noted on the arms. A chest radiograph was not conclusive (Fig. 1a). Blood and urine were obtained for culture, and the patient was placed on amoxicillin. Over the next few hours, her condition began to deteriorate, with increasing dyspnoea and oxygen requirements. She was transferred to ICU in acute respiratory distress with severe shock. She required intensive management, including intravenous fluids, intubation and ventilation, and vasopressors. An emergency bronchoscopy was undertaken after intubation to clear the airway of large amounts of reddish bronchial secretions, requiring repeated suction and compromising mechanical ventilation. The patient received ceftriaxone and ofloxacin. There was profound hypoxemia with PaO₂/FiO₂ of 124. Repeated chest radiographs revealed extensive bilateral infiltrates (Fig. 1c, d). The patient's condition continued to deteriorate with refractory hypoxia and hypotension despite maximal treatment. She died 8 h after her admission to ICU (21 h after admission to hospital) from hypoxic cardiac arrest. The protected endotracheal specimens grew S. aureus susceptible to methicillin and positive for PVL; blood and urine cultures were negative. Autopsy revealed extensive diffuse bilateral necrotising bronchopneumonia with microabscesses.

…