Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging public health problem worldwide. Severe invasive infections have been described, mostly associated with the presence of Panton-Valentine leukocidin (PVL). In Portugal limited information exists regarding CA-MRSA infections. In this study we describe the case of a previously healthy 12-year-old female, sport athlete, who presented to the hospital with acetabulofemoral septic arthritis, myositis, fasciitis, acetabulum osteomyelitis, and pneumonia. The MRSA isolated from blood and synovial fluid was PVL negative and staphylococcal enterotoxin type P (SEP) and type L (SEL) positive, with a vancomycin MIC of 1.0 mg/L and resistant to clindamycin and ciprofloxacin. The patient was submitted to multiple surgical drainages and started on vancomycin, rifampicin, and gentamycin. Due to persistence of fever and no microbiological clearance, linezolid was started with improvement. This is one of the few reported cases of severe invasive infection caused by CA-MRSA in Portugal, which was successfully treated with linezolid. In spite of the severity of infection, the MRSA isolate did not produce PVL.
Highlights
Staphylococcus aureus is a common cause of disease in children
community-associated methicillin-resistant S. aureus (CA-MRSA) is becoming more prevalent in Europe and probably is an emergent pathogen in Portugal as well, limited information exists regarding CA-MRSA infections prevalence in the country
In a recent study from Portuguese children with mild skin and soft tissue infections attending a pediatric emergency department, Conceicao et al [21], observed that 10% of all S. aureus isolated were MRSA, but more recent studies indicate that this rate is higher (Tavares et al, unpublished)
Summary
Staphylococcus aureus is a common cause of disease in children. the overall prevalence of community-associated methicillin-resistant S. aureus (CA-MRSA) is variable, it is increasing worldwide, in the United States (reaching 70% in Texas) and Australia [1, 2]. In 2005, Gonzalez et al reported 14 adolescents presenting severe S. aureus sepsis [9]. These patients were considered unusual because of their illness severity, as well as the noticeable absence of underlying medical conditions or risk factors. In recent years several groups reported other invasive, severe, MRSA infections, such as multifocal osteomyelitis, pyomyositis, or necrotizing pneumonia [9,10,11]. Data on these invasive infections is scarce in Portugal. Our aim is to report an adolescent with a severe, lifethreatening infection by a multiresistant PVL negative MRSA acquired in the community whose treatment was difficult, but successful
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