Abstract
We report a case of cryptogenic brain abscess caused by infection due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a previously healthy, 2-year-old, girl child with a history of persistent headache and fever for several weeks. Headache acutely worsened the day before hospital admission with vomiting, right hemiparesis, and altered sensorium. Community-onset pyogenic brain abscess should be added to the growing list of life-threatening invasive infections caused by community-acquired S. aureus . Early diagnosis, prompt neurosurgical drainage, and appropriate medical therapy are important for management of such infections. In light of expanding community-acquired S. aureus epidemic and the life-threatening nature of the disease we recommend empirical use of vancomycin in all cases of community onset brain abscess.
Highlights
Staphylococcus aureus is among the most important pathogen because of both the diversity and the severity of infections it causes
Quick response code: We report a case of cryptogenic brain abscess caused by infection due to communityassociated methicillin-resistant Staphylococcus aureus (CA-Methicillin resistant S. aureus (MRSA)) in a previously healthy, 2-year-old, girl child with a history of persistent headache and fever for several weeks
The most common infections resulting from community-associated MRSA (CA-MRSA) involve skin and soft tissue, though cases of fatal, invasive infections have occurred in children [9] and only recently, CA-MRSA was found to cause central nervous system (CNS) infections
Summary
Staphylococcus aureus is among the most important pathogen because of both the diversity and the severity of infections it causes. Methicillin resistant S. aureus (MRSA) was first described in 1961[1] and since has become a significant pathogen in nosocomial infections. The aspirated specimen yielded a pure growth of MRSA, susceptible to tetracycline, clindamycin, gentamicin, cotrimoxazole, and vancomycin; and resistant to methicillin, erythromycin, ciprofloxacin, penicillin, and ampicillinsulbactam. Parenteral antibiotic therapy was continued for 3 weeks and was followed by 8 weeks course of teicoplanin (800 mg thrice/week) During this treatment, the patient remained afebrile and there were no signs of infection at a 6 month follow-up examination. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion method on Muller-Hinton agar (HiMedia Laboratories Pvt. Ltd, India) supplemented with 2% NaCl. Methicillin resistance was confirmed using PBP2a latex agglutination test (Oxoid Ltd, Hampshire, UK) and by polymerase chain reaction (PCR) assay targeting mecA gene. The results of the D-test were negative for inducible clindamycin resistance
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