Abstract
Necrotising fasciitis caused by Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as a new entity. Although it is recognised worldwide, there have been no reported cases to date in Malaysia. We report a case of necrotising fasciitis of the left lower limb in an otherwise healthy 20-year-old man. He presented with septic shock and despite the paucity of clinical signs in the limb, the infection was aggressive. Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from the deep fascia of the leg. Panton-Valentine leucocidin gene (PVL), which is a stable genetic marker for CA-MRSA strain, was positive in this case. This case of community acquired MRSA necrotising fasciitis is of concern and may herald the emergence of this resistant organism in Malaysia. Vigilant surveillance and microbiological monitoring is needed to follow this CAMRSA trend.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is typically thought to be a nosocomial pathogen and its incidence has increased markedly in the past few decades
Cultures were resistant to methicillin, erythromycin and ciprofloxacin, and sensitive to trimethoprimsulphamethoxazole, rifampicin, fucidic acid, gentamicin, vancomycin and clindamycin
According to the CDC, Community-acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) is MRSA that had been isolated from patients who have no history of 1) positive culture for MRSA from any site obtained more than 48 hours after admission to a hospital; 2) prior MRSA infection or colonization; 3) hospitalisation, surgery, residency in a longterm care facility, haemodialysis, or peritoneal dialysis within the past year; or 4) current indwelling percutaneous devices or catheters 2
Summary
A 20-year-old man presented to the hospital with fever and a 5-day history of pain in the left leg. The patient denied any recent injury to his left knee and reported no previous history of respiratory or genitourinary infections nor previous hospitalisations. He consulted a general practitioner and sought alternative medicine treatment, his condition did not improve. He developed fever with chills and rigour on day four, and when his fever and leg pain did not improve on day five, he sought medical treatment. The left knee was held flexed at 30° and the patient could only flex his knee up to 110°
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