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Roshkovan L, Thompson JC, Chatterjee N, Galperin-Aizenberg M, Katz SI. A 53-Year-Old Man Presents to the ED With Shortness of Breath, Cough, and Fever. Chest 2021; 159:e107-e113. [PMID: 33563452 PMCID: PMC8436147 DOI: 10.1016/j.chest.2020.09.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
A 53-year-old man presented to the ED at a time of low severe acute respiratory syndrome coronavirus 2, also known as coronavirus disease 2019 (COVID-19), prevalence and reported 2 weeks of progressive shortness of breath, dry cough, headache, myalgias, diarrhea, and recurrent low-grade fevers to 39°C for 1 week with several days of recorded peripheral capillary oxygen saturation of 80% to 90% (room air) on home pulse oximeter. Five days earlier, he had visited an urgent care center where a routine respiratory viral panel was reportedly negative. A COVID-19 reverse transcriptase polymerase chain reaction test result was pending at the time of ED visit. He reported a past medical history of gastroesophageal reflux disease that was treated with famotidine. Travel history included an out-of-state trip 3 weeks earlier, but no recent international travel.
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Affiliation(s)
- Leonid Roshkovan
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Jeffrey C Thompson
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Neil Chatterjee
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Maya Galperin-Aizenberg
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Sharyn I Katz
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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2
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Shi Y, Shi X, Liang J, Luo J, Ba J, Chen J, Wu B. Aggravated MRSA pneumonia secondary to influenza A virus infection is derived from decreased expression of IL-1β. J Med Virol 2020; 92:3047-3056. [PMID: 32697385 PMCID: PMC7692898 DOI: 10.1002/jmv.26329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 07/15/2020] [Indexed: 12/29/2022]
Abstract
Secondary methicillin-resistant Staphylococcus aureus (MRSA) infection is a cause of severe pneumonia with high mortality during influenza A virus (IAV) pandemics. Alveolar macrophages (AMs) mount cellular defenses against IAV and MRSA infection, which occurs via the nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome. However, the activity and function of the NLRP3 inflammasome in MRSA pneumonia secondary to IAV infection remain unclear. To clarify this, we studied MRSA infection secondary to IAV both in vitro and in mouse model. The expression of the NLRP3 inflammasome was evaluated by quantitative reverse transcription polymerase chain reaction, immunofluorescence, Western blot, and enzyme-linked immunosorbent assay. The lung pathology and the rate of weight change were observed. We found that IAV infection for 1 week activated NLRP3 inflammasome. The enhanced expression of NLRP3, caspase-1, and cleaved caspase-1 was associated with MRSA infection secondary to IAV, but the expression of interleukin (IL)-1β decreased in superinfection with MRSA both in vitro and in vivo. The aggravated inflammatory pathology in MRSA pneumonia secondary to IAV infection was associated with decreased expression of IL-1β. And increased weight loss in MRSA pneumonia secondary to IAV infection was related to decreased concentration of IL-1β in serum. It infers that superinfection with MRSA reduces expression of IL-1β someway, and decreased expression of IL-1β impairs the host immunity and leads to aggravated pneumonia. These results contributed to our understanding of the detailed activity of the NLRP3 inflammasome, IL-1β, and their relationship with aggravation of MRSA pneumonia secondary to IAV infection. Immunotherapy targeting the IL-1β signaling pathway could be possible therapeutic strategy for secondary MRSA pneumonia.
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Affiliation(s)
- Yunfeng Shi
- Medical Intensive Care Unit, Department of Respiratory and Critical Care MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineInstitute of Respiratory Diseases of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xiaohan Shi
- Medical Intensive Care Unit, Department of Respiratory and Critical Care MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineInstitute of Respiratory Diseases of Sun Yat‐Sen UniversityGuangzhouChina
| | - Jingjing Liang
- Department of EmergencyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Jinmei Luo
- Medical Intensive Care Unit, Department of Respiratory and Critical Care MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineInstitute of Respiratory Diseases of Sun Yat‐Sen UniversityGuangzhouChina
| | - Junhui Ba
- Medical Intensive Care Unit, Department of Respiratory and Critical Care MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineInstitute of Respiratory Diseases of Sun Yat‐Sen UniversityGuangzhouChina
| | - Jianning Chen
- Department of PathologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Benquan Wu
- Medical Intensive Care Unit, Department of Respiratory and Critical Care MedicineThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
- Department of Respiratory and Critical Care MedicineInstitute of Respiratory Diseases of Sun Yat‐Sen UniversityGuangzhouChina
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Duployez C, Le Guern R, Tinez C, Lejeune AL, Robriquet L, Six S, Loïez C, Wallet F. Panton-Valentine Leukocidin-Secreting Staphylococcus aureus Pneumonia Complicating COVID-19. Emerg Infect Dis 2020; 26:1939-1941. [PMID: 32298228 PMCID: PMC7392470 DOI: 10.3201/eid2608.201413] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Necrotizing pneumonia induced by Panton-Valentine leukocidin–secreting Staphylococcus aureus is a rare but life-threatening infection that has been described in patients after they had influenza. We report a fatal case of this superinfection in a young adult who had coronavirus disease.
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Warren-Gash C, Blackburn R, Whitaker H, McMenamin J, Hayward AC. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: a self-controlled case series analysis of national linked datasets from Scotland. Eur Respir J 2018; 51:1701794. [PMID: 29563170 PMCID: PMC5898931 DOI: 10.1183/13993003.01794-2017] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 02/13/2018] [Indexed: 11/05/2022]
Abstract
While acute respiratory tract infections can trigger cardiovascular events, the differential effect of specific organisms is unknown. This is important to guide vaccine policy.Using national infection surveillance data linked to the Scottish Morbidity Record, we identified adults with a first myocardial infarction or stroke from January 1, 2004 to December 31, 2014 and a record of laboratory-confirmed respiratory infection during this period. Using self-controlled case series analysis, we generated age- and season-adjusted incidence ratios (IRs) for myocardial infarction (n=1227) or stroke (n=762) after infections compared with baseline time.We found substantially increased myocardial infarction rates in the week after Streptococcus pneumoniae and influenza virus infection: adjusted IRs for days 1-3 were 5.98 (95% CI 2.47-14.4) and 9.80 (95% CI 2.37-40.5), respectively. Rates of stroke after infection were similarly high and remained elevated to 28 days: day 1-3 adjusted IRs 12.3 (95% CI 5.48-27.7) and 7.82 (95% CI 1.07-56.9) for S. pneumoniae and influenza virus, respectively. Although other respiratory viruses were associated with raised point estimates for both outcomes, only the day 4-7 estimate for stroke reached statistical significance.We showed a marked cardiovascular triggering effect of S. pneumoniae and influenza virus, which highlights the need for adequate pneumococcal and influenza vaccine uptake. Further research is needed into vascular effects of noninfluenza respiratory viruses.
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Affiliation(s)
- Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Institute of Health Informatics, University College London, London, UK
| | - Ruth Blackburn
- Institute of Health Informatics, University College London, London, UK
| | - Heather Whitaker
- School of Mathematics and Statistics, Open University, Milton Keynes, UK
| | - Jim McMenamin
- Health Protection Scotland, NHS National Services Scotland, Glasgow, UK
| | - Andrew C. Hayward
- Institute of Health Informatics, University College London, London, UK
- Institute of Epidemiology and Healthcare, University College London, London, UK
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Tavakoli Tabazavareh S, Seitz A, Jernigan P, Sehl C, Keitsch S, Lang S, Kahl BC, Edwards M, Grassmé H, Gulbins E, Becker KA. Lack of Sphingosine Causes Susceptibility to Pulmonary Staphylococcus Aureus Infections in Cystic Fibrosis. Cell Physiol Biochem 2016; 38:2094-102. [PMID: 27184795 DOI: 10.1159/000445567] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Pulmonary Staphylococcus aureus (S. aureus) infections occur early in a high percentage of cystic fibrosis (CF) patients and it is believed that these infections facilitate further colonization of CF lungs with Pseudomonas aeruginosa (P. aeruginosa). Previous studies demonstrated a marked reduction of sphingosine in tracheal and bronchial epithelial cells in CF compared to wild type mice, while ceramide is massively increased in CF mice. METHODS We investigated the effect of C18-sphingosine and C16-ceramide on S. aureus in vitro. Based on our results we performed pulmonary infections with S. aureus and tested the influence of sphingosine inhalation. RESULTS In vitro incubation of S. aureus with C18-sphingosine rapidly killed S. aureus, while C16-ceramide did not affect bacterial survival, but abrogated the effect of C18-sphingosine when applied together. The in vivo infection experiments revealed a high susceptibility of CF mice to pulmonary infection with S. aureus. Inhalation of C18-sphingosine rescued CF mice from pulmonary infections with different clinical S. aureus isolates, including a methicillin-resistant S. aureus (MRSA) strain. CONCLUSIONS Our data indicate that the imbalance between ceramide and sphingosine in the CF respiratory tract prevents killing of S. aureus and causes the high susceptibility of CF mice to pulmonary S. aureus infections.
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Tibebu M. Severe hospital acquired pneumonia and septicemia due TO methicillin resistant Staphylococcus lugdunensis in a newborn in Northwestern Ethiopia. Ethiop Med J 2014; 52:99-101. [PMID: 25588292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Staphylococcus lugdunensis can cause virulent infections in immunosuppressed individuals. This report describes the first known case of hospital acquired pneumonia and septicemia due to methicillin-resistant Staphylococcus lugdunensis in a newborn at Felege Hiwot Referral Hospital, North Western Ethiopia. The strain was simultaneously resistant to trimethoprim-sulfamethoxazole, tetracycline (30 ug), chloramphenicol (30 ug), gentamycin (10ug) and ciprofloxacin (5ug) but sensitive to erythromycin (15ug) and clindamycin (10ug).
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Affiliation(s)
- Martha Tibebu
- Department of Microbiology, Immunology and Parasitology, Bahir Dar University, Ethiopia
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7
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Bowles D, Perrin K. A retrospective case series of 44 patients with community-acquired Staphylococcus aureus pneumonia. N Z Med J 2014; 127:74-83. [PMID: 24732254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM Staphylococcus aureus (S. aureus) community-acquired pneumonia (CAP) is a potentially devastating and life-threatening infection. Early detection and appropriate treatment is important to prevent morbidity and death. The aim of this case series was to investigate the patient demographics, clinical features, antibiotic treatment and complications of cases of community-acquired S. aureus pneumonia occurring in the Wellington region. METHOD The case records of patients with radiographically confirmed community-acquired pneumonia and laboratory evidence to support S. aureus as the causative organism admitted to Wellington Regional Hospital over a 5-year period (2007-2012) were retrospectively reviewed. RESULTS A total of 48 presentations in 44 patients met the inclusion criteria. The majority of patients (63.6%) had underlying comorbidities. Although the mean CURB65 score was only one and fever was uncommon, 30% of patients were admitted to ICU and 16% died in hospital. Significant infective complications occurred in 48% with new lung cavitation in 20%. CONCLUSION This series of patients with staphylococcal pneumonia confirms the significant morbidity and mortality of the infection. A low CURB65 score and lack of objective fever should not detract from the possibility of S. aureus. The presence of bacteraemia in patients with S. aureus pneumonia needs to be regarded as a potentially deleterious finding that may necessitate a change in treatment.
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Affiliation(s)
- Darren Bowles
- Department of Internal Medicine, Wellington Regional Hospital, Riddiford Street, Newtown, Wellington 6021, New Zealand.
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8
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Iroh Tam PY, Koopmeiners JS. Trends in pneumonia hospitalizations in Hennepin County, Minnesota, 1999-2010. Mayo Clin Proc 2013; 88:1181-2. [PMID: 24079690 DOI: 10.1016/j.mayocp.2013.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Revised: 08/15/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
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9
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Athale J, Ulrich A, MacGarvey NC, Bartz RR, Welty-Wolf KE, Suliman HB, Piantadosi CA. Nrf2 promotes alveolar mitochondrial biogenesis and resolution of lung injury in Staphylococcus aureus pneumonia in mice. Free Radic Biol Med 2012; 53:1584-94. [PMID: 22940620 PMCID: PMC3729022 DOI: 10.1016/j.freeradbiomed.2012.08.009] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 07/18/2012] [Accepted: 08/06/2012] [Indexed: 12/17/2022]
Abstract
Acute lung injury (ALI) initiates protective responses involving genes downstream of the Nrf2 (Nfe2l2) transcription factor, including heme oxygenase-1 (HO-1), which stimulates mitochondrial biogenesis and related anti-inflammatory processes. We examined mitochondrial biogenesis during Staphylococcus aureus pneumonia in mice and the effect of Nrf2 deficiency on lung mitochondrial biogenesis and resolution of lung inflammation. S. aureus pneumonia established by nasal insufflation of live bacteria was studied in mitochondrial reporter (mt-COX8-GFP) mice, wild-type (WT) mice, and Nrf2⁻/⁻ mice. Bronchoalveolar lavage, wet/dry ratios, real-time RT-PCR and Western analysis, immunohistochemistry, and fluorescence microscopy were performed on the lung at 0, 6, 24, and 48 h. The mice survived S. aureus inoculations at 5×10⁸ CFU despite diffuse lung inflammation and edema, but the Nrf2⁻/⁻ lung showed increased ALI. In mt-COX8-GFP mice, mitochondrial fluorescence was enhanced in bronchial and alveolar type II (AT2) epithelial cells. WT mice displayed rapid HO-1 upregulation and lower proinflammatory TNF-α, IL-1β, and CCL2 and, especially in AT2 cells, higher anti-inflammatory IL-10 and suppressor of cytokine signaling-3 than Nrf2⁻/⁻ mice. In the alveolar region, WT but not Nrf2⁻/⁻ mice showed strongly induced nuclear respiratory factor-1, PGC-1α, mitochondrial transcription factor-A, SOD2, Bnip3, mtDNA copy number, and citrate synthase. These findings indicate that S. aureus pneumonia induces Nrf2-dependent mitochondrial biogenesis in the alveolar region, mainly in AT2 cells. Absence of Nrf2 suppresses the alveolar transcriptional network for mitochondrial biogenesis and anti-inflammation, which worsens ALI. The findings link redox activation of mitochondrial biogenesis to ALI resolution.
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Affiliation(s)
- Janhavi Athale
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
| | - Allison Ulrich
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | | | - Raquel R. Bartz
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Anesthesiology, Durham VA Medical Center, Durham, NC 27710, USA
| | - Karen E. Welty-Wolf
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Durham VA Medical Center, Durham, NC 27710, USA
| | - Hagir B. Suliman
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
| | - Claude A. Piantadosi
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA
- Department of Anesthesiology, Duke University Medical Center, Durham, NC 27710, USA
- Department of Medicine, Durham VA Medical Center, Durham, NC 27710, USA
- Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA
- Corresponding author at: Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. Fax: +1 919 684 6002. .
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10
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de Carvalho Ferreira D, Cisne Frota AC, Cavalcante FS, Abad ED, Netto Dos Santos KR. Necrotizing fasciitis secondary to community pneumonia by Panton-Valentine leukocidin-positive methicillin-resistant Staphylococcus aureus. Am J Respir Crit Care Med 2012; 186:202-3. [PMID: 22798422 DOI: 10.1164/ajrccm.186.2.202] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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11
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Paleiron N, Tromeur C, Noel-Savina E, Quéré G, Descourt R. [Pneumocystis and Staphylococcus aureus pulmonary co-infection after chemotherapy for lung cancer]. Med Mal Infect 2011; 41:497-9. [PMID: 21459528 DOI: 10.1016/j.medmal.2011.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Revised: 12/28/2010] [Accepted: 02/14/2011] [Indexed: 11/19/2022]
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12
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Igarashi A, Tokairin Y, Hirono O, Kato T, Kubota I. [Two cases of mixed infection following 2009 H1N1 influenza pneumonia]. Nihon Kokyuki Gakkai Zasshi 2011; 49:226-231. [PMID: 21485158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Case 1 was a 73-year-old woman admitted to our hospital due to bilateral pneumonia with respiratory failure. Real-time reverse transcription polymerase chain reaction (RRT-PCR) analysis confirmed 2009 H1N1 influenza infection. Streptococcus pneumoniae was confirmed from sputum culture and a urine antigen test on admission. She was treated with antiviral drugs and antibiotics, and improved gradually. Case 2 was a 66-year-old woman admitted to our hospital due to suspected acute exacerbation of interstitial pneumonitis. RRT-PCR analysis confirmed 2009 H1N1 influenza infection, and methicillin-resistant Staphylococcus aureus was cultured from her sputum. Mixed pneumonia due to influenza virus, bacteria and fungus was suspected. Although she was treated with medicines for these pathogens, she died from respiratory failure. An autopsy confirmed primary viral pneumonia, Pseudomonas aeruginosa pneumonia and invasive pulmonary aspergillosis. Not only viral pneumonia, but also mixed infections due to bacteria or fungus, might influence the prognosis of 2009 H1N1 influenza infection. These cases indicate the importance of early identification of complicating pathogens and treatment in 2009 H1N1 influenza infection.
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Affiliation(s)
- Akira Igarashi
- Department of Internal Medicine, Yamagata Prefectural Shinjo Hospital
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13
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Thukral A, Tiwari DN, Tripathi K. Pneumatocele in an adult. J Assoc Physicians India 2011; 59:186-187. [PMID: 21751636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of 25-year-old male who presented with high grade fever with cough and expectoration. Chest examination revealed amphoric breath sounds on the right interscapular region. Chest X ray revealed multiple air fluid levels with collapse lung at places. Staph pneumonia with pneumatoceles is common in children but uncommon to in adult population.
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Affiliation(s)
- A Thukral
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi
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14
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Adjetey A, Edwards R. Necrotising pneumonia and pandemic influenza. N Z Med J 2010; 123:128-133. [PMID: 21358792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A case of PVL-positive Staphylococcus aureus pneumonia in a 32-year-old female is described. This is one of the first reports of this particular organism causing pneumonia in New Zealand, although the organism has been identified before. With the likelihood of increased numbers of cases of this life-threatening infection in the future in connection with pandemic influenza, an approach to the management of patients with PVL-positive necrotising pneumonia is discussed.
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15
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Schlaudecker JD. A refractory case of community-acquired pneumonia. J Fam Pract 2009; 58:573-575. [PMID: 19891934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Jeffrey D Schlaudecker
- Inpatient Family Medicine Service, The Christ Hospital/University of Cincinnati Family Medicine Residency, Cincinnati, OH 45219, USA.
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16
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Hong SM, Chen YC, Hsueh S, Jenq CC, Fang JT, Yang CW, Tian YC. Adult-onset perinuclear antineutrophil cytoplasmic antibody-positive Henoch-Schönlein purpura in diabetic nephropathy. J Nephrol 2009; 22:164-170. [PMID: 19229833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Adult-onset Henoch-Schönlein purpura (HSP) is a rare systemic vasculitis characterized by a leukocytoclastic vasculitis of small vessels with the deposition of IgA immune complexes involving skin, gastrointestinal tract, joints and kidneys. Antineutrophil cytoplasmic antibody (ANCA) detected by indirect immunofluorescence assay is commonly found in other vasculitic disorders but rarely discovered in HSP patients. ANCA with perinuclear pattern has hardly ever reported in HSP patients. The diagnostic importance of ANCA still remains controversial. In addition, the simultaneous presence of diabetic nephropathy and HSP is uncommon. We present a case of an adult patient with diabetic nephropathy and superimposed HSP, which resulted in acute renal failure. Perinuclear-pattern ANCA was detected in the acute phase of HSP but disappeared when the disease resolved. Further, we have reviewed ANCA-positive HSP in this article.
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Affiliation(s)
- Shyh-Ming Hong
- Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
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Sarwar UN, Hamadeh R. Presence of hypogammaglobulinemia in a patient with Fanconi anemia: a case report. J Investig Allergol Clin Immunol 2009; 19:335-336. [PMID: 19639741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Affiliation(s)
- U N Sarwar
- Department of Internal Medicine, NYU School of Medicine, New York, USA.
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18
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Maseda E, Ruiz A, Ramasco F, Quecedo L. [Diagnosis: pneumatocele as a complication of ventilator-associated pneumonia due to Staphylococcus aureus]. Rev Esp Anestesiol Reanim 2008; 55:524. [PMID: 18982797 DOI: 10.1016/s0034-9356(08)70646-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- E Maseda
- Unidad de Cuidados Críticos Quirúrgicos, Servicio de Anestesiología, Reanimación y Clínica del Dolor, Hospital Universitario de la Princesa, Madrid.
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Larue A, Loos-Ayav C, Jay N, Commun N, Rabaud C, Bollaert PE. [Impact on morbidity and costs of methicillin-resistant Staphylococcus aureus nosocomial pneumonia in intensive care patients]. Presse Med 2008; 38:25-33. [PMID: 18771897 DOI: 10.1016/j.lpm.2008.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2007] [Revised: 05/24/2008] [Accepted: 06/04/2008] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Prevention of methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections in the intensive care units (ICU) has been recommended for several years. However, the workload and the costs of these programs are to be weighed against the benefit obtained in terms of reduction of morbidity and costs induced by the infection. The purpose of this study was to evaluate the cost and the current morbidity of the infection with MRSA in the ICU. METHODS In a retrospective case-control study carried out in 2004, all patients of the 6 intensive care units of a teaching hospital having developed a MRSA nosocomial infection were included. They were paired with controls on the following criteria: department, Simplified Acute Physiology Score II (SAPSII), age (+/- 5 years), type of surgery (for the surgical intensive care units). The duration of hospitalization of the paired control had to be at least equal to the time from admission to infection of the infected patient. The costs were evaluated using the following parameters: scores omega 1, 2 and 3, duration of artificial ventilation, hemodialysis, length of ICU stay, radiological procedures, surgical procedures, total antibiotic cost and other expensive drugs. RESULTS Twenty-one patients with MRSA infection were included. All had nosocomial pneumonia. The 21 paired patients were similar with regard to both initial criteria and sex. Hospital mortality was not different between the 2 groups (cases=8; controls=6; p=0.41), as well as median duration of hospital stay (cases=41 days; controls=43 days; p=0.9). The duration of mechanical ventilation, number of hemodialysis or hemofiltration sessions, number of radiological procedures were similar in both groups. The total omega score was not significantly different between cases (median 435; IQR: 218-579) and controls (median 281, IQR: 231-419; p=0.55). The median duration of isolation was 12 days for cases and 0 day for controls (p=0.0007). The pharmaceutical expenditure was significantly higher in cases (median: 1414euro; IQR: 795-4349), by comparison with the controls (median: 877euro, IQR: 687-2496) (p=0.049). CONCLUSION In the ICU having set up a policy intended to reduce the risk of MRSA nosocomial infections, MRSA pneumonia does not seem to involve major additional morbidity, as compared to a control population matched for similar severity of illness. It increases modestly the use of the medical resources.
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Affiliation(s)
- Alexandrine Larue
- Service de médecine interne, Centre hospitalier Jean Monnet, F-88000 Epinal, France
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Lee YP, Hoi WH, Wong RCC. A case of myopericarditis in a patient with methicillin-resistant Staphylococcus aureus community-acquired pneumonia. Ann Acad Med Singap 2008; 37:243-2. [PMID: 18392307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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21
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Mu XD, Wang GF, Que CL. [H3N2 subtype of human influenza pneumonia with staphylococcal sepsis and staphylococcal pneumonia: report of one case]. Beijing Da Xue Xue Bao Yi Xue Ban 2007; 39:663-665. [PMID: 18087564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
To investigate the clinical characteristics, diagnosis and therapy of influenza pneumonia with staphylococcal infection. One patient in our hospital was diagnosed and the literatures on the subject were reviewed. The patient presented with high fever and dyspnea. Arterial gas analysis indicated type 1 respiratory failure. Chest X ray photographs showed bilateral infiltrations and bilateral encapsulated pleural effusions. Viral separation and culture of pharyngeal swab indicated H(3)N(2) subtype of human influenza virus. Blood, sputum and bronchoalveolar lavage fluid (BALF) cultures showed Staphylococcus aureus. Pleural effusion was complex parapneumonic pleural effusion. After the administration of anti-virus, anti-staphylococcal antibiotics and pleural cavity drainage, the patient was cured. The infection of staphylococcus aureus is a typical characteristic of influenza pneumonia, and anti-staphylococcal antibiotic therapy (with MRSA activity in MRSA endemic regions) should be initiated in hospitalized cases of influenza pneumonia. If complex parapneumonic pleural effusion or empyema complicated, we should perform pleural cavity drainage in time. The oral neuraminidase inhibitor (oseltamivir) could significantly improve prognosis.
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Affiliation(s)
- Xiang Dong Mu
- Department of Respiratory Medicine, Peking University First Hospital, Beijing 100034, China
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22
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Wang J, Yang LH, Wang M, Ye XX, Wen T, Gao J. [Methacillin resistant Staphylococcus aureus pneumonia complicated with septicemia, multiple aneurysms and arterial thrombosis: a case report and review of the literature]. Zhonghua Jie He He Hu Xi Za Zhi 2007; 30:844-847. [PMID: 18269846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To improve the understanding of the clinical manifestations of complications caused by methacillin resistant Staphylococcus aureus (MRSA) pneumonia. METHODS A case of MRSA pneumonia complicated by septicemia, multiple aneurysms and arterial thrombosis was reported, and the literature was reviewed. The pathogenesis of MRSA septicemia, aneurysm and arterial thrombosis was discussed. RESULTS A 66 year old male was admitted to this hospital because of fever, cough and sputum production for 1 month. The temperature on admission was 40 degrees C. Blood cultures for 2 times and sputum cultures all grew MRSA. The diagnosis of community acquired MRSA pneumonia and septicemia was made. The temperature returned normal after intravenous vancomycin therapy. But localized fever, pain and pulsating masses were noted, and ultrasonography and CT scanning revealed aneurysm formation in the external iliac arteries and the bilateral superior gluteal arteries, and arterial thrombi in the bilateral femoral arteries and deep femoral arteries. CONCLUSIONS MRSA pneumonia complicated with multiple aneurysm and arterial thrombosis is uncommon. Endothelial injury caused by arteritis may lead to blood coagulation, and vascular muscle injury can cause or aggravate arterial dilatation and aneurysm.
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Affiliation(s)
- Jun Wang
- Second Affiliated Hospital of Shandong University of Chinese Traditional Medicine, Jinan 250001, China
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23
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Jeffres MN, Isakow W, Doherty JA, Micek ST, Kollef MH. A retrospective analysis of possible renal toxicity associated with vancomycin in patients with health care-associated methicillin-resistant Staphylococcus aureus pneumonia. Clin Ther 2007; 29:1107-15. [PMID: 17692725 DOI: 10.1016/j.clinthera.2007.06.014] [Citation(s) in RCA: 243] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2007] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The goal of this investigation was to determine whether more aggressive vancomycin dosing is associated with greater risk for renal toxicity in patients with health care-associated pneumonia (HCAP) attributed to methicillin-resistant Staphylococcus aureus (MRSA). METHODS This was a retrospective, single-center, observational cohort study. The following information was obtained for all study patients from automated hospital, microbiology, and pharmacy databases: age, sex, weight, serial serum creatinine (SCr), age- and sex-adjusted creatinine clearance (CrCl) during receipt of vancomycin, vancomycin serum trough concentrations, duration of vancomycin therapy, and Acute Physiology and Chronic Health Evaluation II scores. Renal toxicity was defined as either a 0.5-mg/dL increase from baseline in SCr or a >or=50% increase in SCr based on serial SCr measurements. Data for patients who met the definition of renal toxicity were compared with data for those who did not. RESULTS Ninety-four patients (mean [SD]age, 59.0 [15.6] years; 59 [62.8%] men; 73 (77.7%) white; mean baseline CrCl, 70.3 [23.0] mL/min) were identified as having MRSA HCAP. Forty (42.6%) patients developed renal toxicity. Patients who developed renal toxicity were significantly more likely than patients who did not develop renal toxicity to have greater mean vancomycin serum trough concentrations (20.8 [9.9] g/mL vs 14.3 [6.7] g/mL, respectively; P < 0.001), vancomycin serum trough concentrations >or=15 g/mL (67.5% vs 40.7%; P = 0.01), and a prolonged duration (>or=14 days) of vancomycin treatment (45.0% vs 20.4%; P = 0.011). Logistic regression analysis identified a maximum vancomycin serum trough concentration of >or=15 g/mL as being independently associated with renal toxicity (adjusted odds ratio = 2.82; 95% CI, 1.02-7.74; P = 0.045). The overall mean change in CrCl for the study population was -13.5 (-16.0) mL/min (range, 0.0 to -62.6 mL/min). Patients with maximum measured vancomycin serum trough concentrations >or=15 g/mL (n = 49) had significantly greater absolute changes in CrCl compared with patients with maximum measured vancomycin serum trough concentrations <15 g/mL (n = 45) (-18.9 [-17.0] vs -7.6 [-12.5] mL/min, respectively; P < 0.001). CONCLUSIONS The results suggest that aggressive vancomycin dosing and prolonged vancomycin administration may be associated with greater risk for renal toxicity in patients with MRSA HCAP. However, this retrospective study cannot establish causation, and a prospective, randomized, double-blind trial is needed.
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Affiliation(s)
- Meghan N Jeffres
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA
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24
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Minneci PC, Deans KJ, Hansen B, Parent C, Romines C, Gonzales DA, Ying SX, Munson P, Suffredini AF, Feng J, Solomon MA, Banks SM, Kern SJ, Danner RL, Eichacker PQ, Natanson C, Solomon SB. A canine model of septic shock: balancing animal welfare and scientific relevance. Am J Physiol Heart Circ Physiol 2007; 293:H2487-500. [PMID: 17644570 DOI: 10.1152/ajpheart.00589.2007] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A shock canine pneumonia model that permitted relief of discomfort with the use of objective criteria was developed and validated. After intrabronchial Staphylococcus aureus challenge, mechanical ventilation, antibiotics, fluids, vasopressors, sedatives, and analgesics were titrated based on algorithms for 96 h. Increasing S. aureus (1 to 8 x 10(9) colony-forming units/kg) produced decreasing survival rates (P = 0.04). From 4 to 96 h, changes in arterial-alveolar oxygen gradients, mean pulmonary artery pressure, IL-1, serum sodium levels, mechanical ventilation, and vasopressor support were ordered based on survival time [acute nonsurvivors (< or =24 h until death, n = 8) > or = subacute nonsurvivors (>24 to 96 h until death, n = 8) > or = survivors (> or =96 h until death, n = 22) (all P < 0.05)]. In the first 12 h, increases in lactate and renal abnormalities were greatest in acute nonsurvivors (all P < 0.05). Compared with survivors, subacute nonsurvivors had greater rises in cytokines and liver enzymes and greater falls in platelets, white cell counts, pH, and urine output from 24 to 96 h (all P < 0.05). Importantly, these changes were not attributable to dosages of sedation, which decreased in nonsurvivors [survivors vs. nonsurvivors: 5.0 +/- 1.0 vs. 3.8 +/- 0.7 ml x h(-1) x (fentanyl/midazolam/ medetomidine)(-1); P = 0.02]. In this model, the pain control regimen did not mask changes in metabolic function and lung injury or the need for more hemodynamic and pulmonary support related to increasing severity of sepsis. The integration into this model of both specific and supportive titrated therapies routinely used in septic patients may provide a more realistic setting to evaluate therapies for sepsis.
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MESH Headings
- Analgesics/pharmacology
- Animal Welfare
- Animals
- Anti-Bacterial Agents/pharmacology
- Biomedical Research/methods
- Blood Chemical Analysis
- Blood Proteins/metabolism
- Cytokines/blood
- Disease Models, Animal
- Dogs
- Fluid Therapy
- Hematologic Tests
- Hypnotics and Sedatives/pharmacology
- Kidney Diseases/microbiology
- Kidney Function Tests
- Liver Diseases/microbiology
- Liver Function Tests
- Pneumonia, Staphylococcal/blood
- Pneumonia, Staphylococcal/complications
- Pneumonia, Staphylococcal/microbiology
- Pneumonia, Staphylococcal/physiopathology
- Pneumonia, Staphylococcal/therapy
- Reproducibility of Results
- Respiration, Artificial
- Severity of Illness Index
- Shock, Septic/blood
- Shock, Septic/complications
- Shock, Septic/microbiology
- Shock, Septic/physiopathology
- Shock, Septic/therapy
- Staphylococcus aureus
- Time Factors
- Vasoconstrictor Agents
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Affiliation(s)
- Peter C Minneci
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland 20892, USA
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25
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Onyeama CO, Okomo U, Garba D, Njai PC, Tapgun M, Corrah T. Staphylococcal purulent pericarditis in a malnourished Gambian child: A case report. Int J Cardiol 2007; 119:392-4. [PMID: 17070943 DOI: 10.1016/j.ijcard.2006.07.176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2006] [Revised: 07/23/2006] [Accepted: 07/29/2006] [Indexed: 11/30/2022]
Abstract
We report a case of purulent pericarditis caused by Staphylococcus aureus in a malnourished 17-month-old child. The clinical features, diagnosis especially the usefulness of non-invasive ultrasound as well as immunological and molecular biology studies, management and outcome of this life threatening condition are discussed.
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26
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Chetchotisakd P, Anunnatsiri S, Puapermpoonsiri S, Prariyachatgul C, Chumpol J. A rapidly fatal case of Panton-valentine leukocidin positive Staphylococcus aureus necrotizing pneumonia in an HIV-infected patient. Southeast Asian J Trop Med Public Health 2007; 38:690-4. [PMID: 17883008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
This article reports a rare case of necrotizing pneumonia caused by Panton-Valentine leukocidin (PVL) positive Staphylococcus aureus in an HIV-infected patient presenting with severe back pain and rash. The back pain progressed to excruciating abdominal pain which was misleading, resulting in an investigation on intraabdominal conditions. He developed massive hemoptysis and died within 2 days of the first clinical symptoms. Recognizing the emergence of PVL-producing S. aureus is important in both immunocompetent and immunocompromised patients. This organism was transmitted from his wife.
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Stroud MH, Okhuysen-Cawley R, Jaquiss R, Berlinski A, Fiser RT. Successful use of extracorporeal membrane oxygenation in severe necrotizing pneumonia caused by Staphylococcus aureus. Pediatr Crit Care Med 2007; 8:282-7. [PMID: 17417120 DOI: 10.1097/01.pcc.0000262795.11598.56] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To report the successful use of extracorporeal membrane oxygenation (ECMO) as rescue therapy for severe necrotizing pneumonia secondary to infection by the Staphylococcus aureus species. DESIGN Case series. SETTING Pediatric intensive care unit at a freestanding tertiary care children's hospital. PATIENTS Two pediatric patients with severe S. aureus-induced necrotizing pneumonia requiring rescue with ECMO. Both patients survived with good neurologic outcomes. One patient required the use of activated factor VII for severe bleeding while on ECMO, with no thrombotic effect on the ECMO circuit. CONCLUSION ECMO as rescue support should be considered in a timely fashion for refractory hypoxemic respiratory failure resulting from S. aureus pneumonia, including patients with necrotizing pneumonia. Use of ECMO support in such cases, coupled with aggressive measures aimed at minimizing bleeding, such as the use of activated factor VII, may result in excellent short- and long-term outcomes for such patients.
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Affiliation(s)
- Michael H Stroud
- Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR 72202, USA.
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28
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Dubrous P, Cuguillère A, Gendrot A, Koeck JL. [Panton-Valentine leukocidin-producing Staphylococcus aureus responsible for necrotizing pneumonia]. Ann Biol Clin (Paris) 2007; 65:277-81. [PMID: 17502300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 12/29/2006] [Indexed: 05/15/2023]
Abstract
Panton-Valentine leukocidin-producing (PVL) Staphylococcus aureus is responsible for a highly lethal necrotizing pneumonia, which occurs predominantly in young immunocompetent patients. Hemoptysis and leucopenia often occur but are not always present. Detection of PVL gene on S. aureus strains responsible for pneumonia should help us to a better understanding of this disease, to improve its treatment with antibiotics capable of lower the toxin production and to prevent its diffusion to others persons by detection and elimination of a nasal S. aureus carriage.
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Affiliation(s)
- P Dubrous
- Service de biologie, HIA Robert Picque, Bordeaux, France
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29
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Dalton HJ. Community-acquired methicillin-resistant Staphylococcus aureus: a new scourge so virulent even extracorporeal membrane oxygenation may not help? Pediatr Crit Care Med 2007; 8:294-6. [PMID: 17496516 DOI: 10.1097/01.pcc.0000262884.02605.84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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Selimović A, Mujicić E, Mesihović-Dinarević S, Saracević E, Hasanbegović E, Cerimagić Z, Mornjaković A. [Staphylococcus pneumonia--complications]. Med Arh 2007; 61:59-61. [PMID: 17582982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The paper presents the case of a 4-year-old child who was admitted with the diagnosis Dg: Pleuropneumonia lat. sin, while in the further course as a suspicion due to progressive flow as staphylococcus pneumonia. The illness is complex in terms of treatment. The diagnosis was set based on the history of illness, its clinical course, laboratory findings, radiology tests. The boy was hospitalized in January in current year with symptoms (coughing, vomiting and fever) that have been lingering for the past two days. The boy has been treated with a ternary antibiotic therapy (cephalosporin of third generation parenterally with aminoglycosides, plus anti-staphylococcus therapy). In laboratory findings Sedimentation rate increased 88/134 WBC 75 thousands. Radiologically extended pleuropneumonia on the left side. In sputum staphylococcus aureus was isolated. In the further course of hospitalization, due to the development of progressive form of staphylococcus pneumoniae with a fever of up to 39 degrees, pale aspect and dyspnoic patient with anemia and with complications in the form of cysts, ruptures and pneumothorax, with a thoracic drainage performed. In the further course, the cysts were gradually absorbed, while the thoracic drain was grafted. Clinically, the child was looking better. We continued the anti-staphylococcus therapy (stanicide), to which the child reacted well clinically and radiologically. Auscultatory breathing on the left side was audible. The last follow-up and the last rtg pulmo et cor 6 months after the outbreak of illness with a complete regression of the foregoing changes.
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Affiliation(s)
- Amina Selimović
- Pedijatrijska klinika, Klinicki centar Univerziteta u Sarajevu
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Abstract
Pleural empyema is a frequent complication of bacterial pneumonia in childhood but is rare in neonates. Various modalities of treatment from intravenous antibiotics, chest tube drainage, intrapleural fibrinolytic agent installation, video-assisted thoracostomy to surgical decortication have been suggested to treat different stages of empyema in children, but management of progressive empyema in neonates is still at the stage of antimicrobial therapy and tube thoracostomy. Here, we report a 1-month-old infant with staphylococcal pneumonia complicated with multiloculated empyema who was successfully treated with video-assisted thoracoscopic surgery (VATS) after 4 days of chest tube drainage and parenteral antibiotics. The patient's condition improved rapidly after the operation and the antimicrobial therapy was continued for 3 weeks. He was asymptomatic and thriving at follow-up 1 year later. Chest radiography at 1 month was free of any lesion. This case suggests that VATS can be a safe and effective treatment for neonatal empyema.
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Affiliation(s)
- Cheung Leung
- Division of Neonatology, Department of Pediatrics, Far Eastern Memorial Hospital, Panchiao, Taipei, Taiwan.
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32
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Wu ET, Chen JS. Management of Multiple Tension Pneumatoceles Refractory to Tube Thoracostomy Decompression. Ann Thorac Surg 2006; 81:1482-4. [PMID: 16564297 DOI: 10.1016/j.athoracsur.2005.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Revised: 04/29/2005] [Accepted: 05/09/2005] [Indexed: 11/23/2022]
Abstract
A 10-month-old boy had multiple tension pneumatoceles develop 4 weeks after pneumonia with parapneumonic empyema caused by methicillin-resistant Staphylococcus aureus. The pneumatoceles failed to completely respond to tube thoracostomy drainage, and sudden onset of cardiopulmonary collapse occurred after induction of anesthesia. He was rescued by multiple percutaneous venous catheter decompressions, followed by lobectomy. Our experience showed that surgery remains the definitive treatment for pediatric patients with multiple tension pneumatoceles. However, extra caution should be taken in the preoperative management of these patients, even in the presence of tube thoracostomy.
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Affiliation(s)
- En-Ting Wu
- Department of Pediatrics, National Taiwan University Hospital Taipei, Taiwan
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33
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Kai H, Shimizu Y, Hagiwara M, Yoh K, Hirayama K, Yamagata K, Ohba S, Nagata M, Koyama A. Post-MRSA infection glomerulonephritis with marked Staphylococcus aureus cell envelope antigen deposition in glomeruli. J Nephrol 2006; 19:215-9. [PMID: 16736424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A 48-year-old male developed massive proteinuria and renal dysfunction after pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) infection. Examination of a renal biopsy specimen by light microscopy showed severe mesangiocapillary proliferative glomerulonephritis with fibrocellular crescents. Immunofluorescence microscopy showed weak linear staining for immunoglobulin G (IgG), while both the peripheral and mesangial lesions stained for IgA and C3. Immunostaining for a possible antigen related to post-MRSA infection glomerulonephritis, using monoclonal antibody S1D6, revealed marked deposition of S.aureus cell envelope antigen in the glomeruli. Electron-dense deposits were observed in both the subendothelial and the mesangial areas. Focal subendothelial widening accompanied with monocytes or foam cell infiltration was also seen. The findings reflect a typical post-MRSA infection glomerulonephritis caused by S.aureus cell envelope antigen.
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Affiliation(s)
- Hirayasu Kai
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba City, Ibaraki, Japan
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Horton JW, Maass DL, White DJ. Hypertonic saline dextran after burn injury decreases inflammatory cytokine responses to subsequent pneumonia-related sepsis. Am J Physiol Heart Circ Physiol 2005; 290:H1642-50. [PMID: 16299261 PMCID: PMC1550345 DOI: 10.1152/ajpheart.00586.2005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The present study examined the hypothesis that hypertonic saline dextran (HSD), given after an initial insult, attenuates exaggerated inflammation that occurs with a second insult. Adult rats (n = 15 per group) were divided into groups 1 (sham burn), 2 [40% total body surface area burn + 4 ml/kg isotonic saline (IS) + 4 ml.kg(-1).% burn(-1) lactated Ringer solution (LR)], and 3 (burn + 4 ml/kg HSD + LR), all studied 24 h after burns. Groups 4 (sham burn), 5 (burn + IS + LR), and 6 (burns + HSD + LR) received intratracheal (IT) vehicle 7 days after burns; groups 7 (burn + IS + LR) and 8 (burn + HSD + LR) received IT Streptococcus pneumoniae (4 x 10(6) colony-forming units) 7 days after burn. Groups 4-8 were studied 8 days after burn and 24 h after IT septic challenge. When compared with sham burn, contractile defects occurred 24 h after burn in IS-treated but not HSD-treated burns. Cardiac inflammatory responses (pg/ml TNF-alpha) were evident with IS (170 +/- 10) but not HSD (45 +/- 5) treatment vs. sham treatment (80 +/- 15). Pneumonia-related sepsis 8 days after IS-treated burns (group 7) exacerbated TNF-alpha responses/contractile dysfunction vs. IS-treated burns in the absence of sepsis (P < 0.05). Sepsis that occurred after HSD-treated burns (group 8) had less myocyte TNF-alpha secretion/better contractile function than IS-treated burns given septic challenge (group 7, P < 0.05). We conclude that an initial burn injury exacerbates myocardial inflammation/dysfunction occurring with a second insult; giving HSD after the initial insult attenuates myocardial inflammation/dysfunction associated with a second hit, suggesting that HSD reduces postinjury risk for infectious complications.
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Affiliation(s)
- Jureta W Horton
- Dept. of Surgery, UT Southwestern Medical Center, Dallas, TX 75390-9160, USA.
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36
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Matsui S, Baba K, Suzuki K, Yamaguchi E. [A case of nonclostridial gas gangrene of the leg complicated by severe pneumonia]. Kansenshogaku Zasshi 2005; 79:818-23. [PMID: 16296328 DOI: 10.11150/kansenshogakuzasshi1970.79.818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
A 73-year-old man admitted for febrile left leg pain with dyspnea, who had poorly controlled diabetes was found on admission to have severe hypoxia and chest X-ray showed infiltrates in the middle to lower left lung. X-rays of the left leg showed gas around the knee joint. These findings suggested severe pneumonia with gas gangrene, necessitating immediate debridement of the gas gangrene lesion and hyperbaric oxygenation. Antibiotics were also administered intravenously (panipenem/betamipron 0.5 g x 3/day, clindamycin 600 mg x 2/day, and erythromycin 500 mg x 3/day). We conducted fiberoptic bronchoscope daily because consolidation of the whole left lung developed with purulent sputum expectoration. Both pneumonia and gas gangrene gradually ameliorated avoiding amputation of theleg. Gas gangrene was cured without leaving sequelae such as motor dysfunction. Staphylococcus aureus was detected in both pus from the leg and sputum collected by bronchoscopy. Microorganisms showed the same pattern of sensitivity to antibiotics, suggesting a causal relationship between pneumonia and gas gangrene through the blood stream. Gas gangrene was considered the primary infection followed by pneumonia, since pain and swelling of the left leg preceded the airway symptoms. The present case illustrates in compromised hosts including diabetics, gas gangrene may develop taking an opportunity of airway infection, and that in some cases, early debridement of the lesion and optimal use of antibiotics may help cure this disease without aggressive surgery. Hyperbaric oxygenation may also be useful, although its validity must be investigated further.
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Affiliation(s)
- Seiko Matsui
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine
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37
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Abstract
The incidence of empyema complicating community-acquired pneumonia is increasing and causes significant childhood morbidity. Pneumococcal infection remains the most common isolated cause in developed countries, with Staphylococcus aureus the predominant pathogen in the developing world. Newer molecular techniques utilizing the polymerase chain reaction have led to an increase in identification of causative bacteria, previously not isolated by conventional culture techniques. This remains an important epidemiological tool, and may help in guiding correct antibiotic use in the future. There are many treatment options, however, and the care a child currently receives is dependent on local practice, which is largely determined by availability of medical personnel and their preferences. Although there are many reported case series comparing treatment options, only two randomized controlled studies exist to guide treatment in children. There is an urgent need for this to be addressed, particularly with the introduction of relatively new surgical techniques such as video-assisted thorascopic surgery.
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Affiliation(s)
- Adam Jaffé
- Portex Respiratory Medicine Group, Great Ormond Street Hospital for Children, National Health System Trust and Institute of Child Health, London, UK.
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38
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Abstract
Intractable hiccups in transplanted patients may be caused by various medical conditions including infections. We report a case of a 44-year-old man who suffered from intractable hiccups after cadaveric kidney transplantation. We identified 3 different hiccup periods with different causes: 1) steroid and anesthetics use, 2) severe ulcerose herpetic and mycotic esophagitis, and 3) pleuropneumonia caused by nosocomial methicillin-resistant Staphylococcus epidermidis and pulmonary abscess requiring thoracic surgery.
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Affiliation(s)
- J Rosenberger
- Transplantation Department, Faculty Hospital of L. Pasteur, Kosice, Slovak Republic.
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40
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Yanagihara K, Okada M, Fukuda Y, Imamura Y, Kaneko Y, Ohno H, Higashiyama Y, Miyazaki Y, Tsukamoto K, Hirakata Y, Tomono K, Kadota JI, Tashiro T, Murata I, Kohno S. Efficacy of Quinupristin-Dalfopristin against Methicillin-Resistant Staphylococcus aureus and Vancomycin-Insensitive S. aureus in a Model of Hematogenous Pulmonary Infection. Chemotherapy 2004; 50:260-4. [PMID: 15528893 DOI: 10.1159/000081948] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2003] [Accepted: 03/23/2004] [Indexed: 11/19/2022]
Abstract
BACKGROUND Quinupristin-dalfopristin (Q-D) is a mixture of quinupristin and dalfopristin, which are semisynthetic antibiotics of streptogramin groups B and A, respectively. METHODS We compared the effect of Q-D to that of vancomycin (VCM) in murine models of hematogenous pulmonary infections caused by methicillin-resistant Staphylococcus aureus (MRSA) and VCM-insensitive S. aureus (VISA). RESULTS Treatment with Q-D resulted in a significant decrease in the number of viable bacteria in the lungs of mice in an MRSA infection model [Q-D 100 mg/kg, Q-D 10 mg/kg, VCM and control (mean +/- SEM): 2.99 +/- 0.44, 6.38 +/- 0.32, 5.75 +/- 0.43 and 8.40 +/- 0.14 log10 CFU/lung, respectively]. Compared with VCM, high-dose Q-D significantly reduced the number of bacteria detected in the VISA hematogenous infection model [Q-D 100 mg/kg, Q-D 10 mg/kg, VCM and control (mean +/- SEM): 5.17 +/- 0.52, 7.03 +/- 0.11, 7.10 +/- 0.49 and 7.18 +/- 0.36 log10 CFU/lung, respectively]. Histopathological examination confirmed the effect of Q-D. CONCLUSION Our results suggest that Q-D is potent and effective in the treatment of MRSA and VISA hematogenous pulmonary infections.
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Affiliation(s)
- Katsunori Yanagihara
- Second Department of Internal Medicine, Nagasaki University Graduate School of Pharmaceutical Sciences, Nagasaki, Japan.
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Alexander G, Saldanha J, Ebrahim MK, Ghoneim I. Late secondary spontaneous pneumothorax occurring in a major burn patient with inhalation injury following MRSA pneumonia. Burns 2004; 30:488-90. [PMID: 15225918 DOI: 10.1016/j.burns.2004.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2004] [Indexed: 11/30/2022]
Affiliation(s)
- G Alexander
- Al-Babtain Center for Burns and Plastic Surgery, Ibn-Sina Hospital, Post Box No. 25427, Safat 13115, Kuwait.
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Bronchard R, Albaladejo P, Brezac G, Geffroy A, Seince PF, Morris W, Branger C, Marty J. Early onset pneumonia: risk factors and consequences in head trauma patients. Anesthesiology 2004; 100:234-9. [PMID: 14739794 DOI: 10.1097/00000542-200402000-00009] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Early onset pneumonia occurs frequently in head trauma patients, but the potential consequences and the risk factors of this event have been poorly studied. METHODS This prospective observational study was undertaken in the surgical intensive care unit of a university teaching hospital in Clichy, France. Head trauma patients requiring tracheal intubation for neurologic reasons and ventilation for at least 2 days were studied to assess the risk factors and the consequences of early onset pneumonia. RESULTS During a 2-yr period, 109 head trauma patients were studied. The authors found an incidence of early onset pneumonia of 41.3%. Staphylococcus aureus was the most common bacteria involved in early onset pneumonia. Patients with early onset pneumonia had a lower worst arterial oxygen tension:fraction of inspired oxygen ratio, more fever, more arterial hypotension, and more intracranial hypertension, factors known to worsen the neurologic prognosis of head trauma patients. Nasal carriage of S. aureus on admission (odds ratio, 5.1; 95% confidence interval, 1.9-14.0), aspiration before intubation (odds ratio, 5.5; 95% confidence interval, 1.9-16.4) and barbiturate use (odds ratio, 3.9; 95% confidence interval, 1.2-12.8) were found to be independent risk factors of early onset pneumonia. CONCLUSIONS The results suggest that early onset pneumonia leads to secondary injuries in head-injured patients. Nasal carriage of S. aureus, aspiration before intubation, and use of barbiturates are specific independent risk factors for early onset pneumonia and must be assessed to find and evaluate strategies to prevent early onset pneumonia.
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Affiliation(s)
- Régis Bronchard
- Department of Anesthesiology, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, University Xavier Bichat Paris 7, 100 Boulevard du Général Leclerc, 92118 Clichy Cedex, France.
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Affiliation(s)
- Munirih N Tahzib
- Department of Allergy and Immunology, Schneider Children's Hospital of Long Island Jewish Medical Center, Long Island Campus of the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA.
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Boussaud V, Parrot A, Mayaud C, Wislez M, Antoine M, Picard C, Delisle F, Etienne J, Cadranel J. Life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus. Intensive Care Med 2003; 29:1840-3. [PMID: 12904849 PMCID: PMC7095030 DOI: 10.1007/s00134-003-1918-5] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2003] [Accepted: 06/25/2003] [Indexed: 12/03/2022]
Abstract
Three new consecutive cases of life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus are presented, focusing on the particular clinical presentation of this new entity. Between December 1999 and March 2001, three adults aged from 23 to 67 years were admitted to our respiratory intensive care unit for massive hemoptysis and septic shock associated with community-acquired Staphylococcus aureus pneumonia. Isolates were sent to the Centre National de Référence des Toxémies Staphylococciques in Lyon, France, where they were found to secrete Panton-Valentive leukocidin. The clinical course was similar in the three patients, with massive hemoptysis and septic shock necessitating mechanical ventilation. Two patients died rapidly; necropsy showed pulmonary vascular necrosis in one of them. The third patient recovered after appropriate antibiotic therapy. Leukocidin/neutrophil interactions in the pulmonary vasculature may cause severe hemoptysis in patients with community-acquired Staphylococcus aureus pneumonia secreting Panton-Valentine leukocidin. Adult patients with massive hemoptysis and suspected community-acquired pneumonia should receive antibiotic regimens covering Staphylococcus aureus.
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Affiliation(s)
- Véronique Boussaud
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Antoine Parrot
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Charles Mayaud
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Marie Wislez
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Martine Antoine
- Service d'Anatomie-pathologique, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Clément Picard
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Françoise Delisle
- Service de Bactériologie, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
| | - Jérome Etienne
- Centre National de Références des Toxémies Staphylococciques, INSERM E0230, IFR 62, Faculté de Médecine, Université Claude Bernard Lyon I, 7 rue Guillaume Paradin, 69372 Lyon cedex 08, France
| | - Jacques Cadranel
- Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France
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Bielawski J, Olszewska-Konarska M, Sygnatowicz J. [The treatment of acute hematogenous osteomyelitis in children and young adults]. Chir Narzadow Ruchu Ortop Pol 2002; 67:61-7. [PMID: 12087677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
On the basis of own experiences and literature from last three years authors presented the role of surgical treatment in children above two years and young people, suffering from acute haematogenous osteomyelitis. Conservative treatment should be limited to these cases, where we can see a quick recovery, reducing of the pain and decreasing of the level of CRP and ESR. The presence of subperiosteal abscessus, positive bacteriological culture from blood and other complications (i.e. staphylococcal pneumonia), are the absolute indications to decompression of the medullary cavity, and local application of antibiotics.
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Affiliation(s)
- Janusz Bielawski
- Oddział Chirurgii Urazowej i Ortopedii, Szpital im. Jana Jonstona w Lubinie
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Abstract
A 71-year-old man with acrodermatitis continua of Hallopeau was treated successfully with a combination of oral propylthiouracil and methotrexate. After 14 weeks, he developed acute pancytopenia, an uncommon idiosyncratic side-effect of propylthiouracil, and presented with a life-threatening methicillin-resistant Staphylococcus aureus pneumonia. This illustrates the potential value and associated risks of propylthiouracil in the management of this difficult condition.
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Affiliation(s)
- M M Chowdhury
- Department of Dermatology, Box 100, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, UK
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Abstract
This is a case report of Lemierre's syndrome in a 17-year-old male patient. Lemierre's disease consists of suppurative thrombophlebitis of the internal jugular vein (SIJVT) in the presence of oropharyngeal infection and can be complicated by septic pulmonary embolism. Other causes of SIJVT include deep neck infections and central venous catheterization. The disease usually results from Gram-negative anaerobic organisms such as Fusobacterium necrophorum.
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Scheinbart EA. Integrating allopathic and alternative therapies in the treatment of a patient with multiple myeloma and vancomycin-resistant Staphylococcus aureus pneumonia. Altern Ther Health Med 2001; 7:160, 158-9. [PMID: 11347281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
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Tsai YG, Wang CC, Chu DM, Tsai MC, Chu ML. Primary staphylococcal infection and toxic shock syndrome diagnosed by polymerase chain reaction. J Formos Med Assoc 2000; 99:942-4. [PMID: 11155749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Primary staphylococcal pneumonia complicated with toxic shock syndrome (TSS) is relatively uncommon in children. Staphylococcus aureus exotoxins are thought to function as superantigens, and seem to promote disease manifestations. The identification of staphylococcal toxin genes by polymerase chain reaction (PCR) offers a specific and rapid diagnostic method for TSS. We describe a 7-year-old child with TSS resulting from staphylococcal pneumonia. S. aureus enterotoxins A and B were detected in the sputum of this patient by PCR.
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Affiliation(s)
- Y G Tsai
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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50
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Fujiki M, Shinbori T, Suga M, Miyakawa H, Mizobe T, Ando M. Bacterial superantigen staphylococcal enterotoxin B induces interstitial pneumonia in SCID mice reconstituted with peripheral blood mononuclear cells from collagen vascular disease patients. Clin Immunol 2000; 96:38-43. [PMID: 10873426 DOI: 10.1006/clim.2000.4872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
To investigate whether superantigens induce interstitial pneumonia associated with collagen vascular disease (CVD), staphylococcal enterotoxin B (SEB) was intratracheally administered to SCID mice reconstituted with peripheral blood mononuclear cells (PBMCs) from CVD patients that suffered lung complications. Although a slight accumulation of inflammatory cells into the perivascular area was seen in the lungs of SCID mice injected with PBMCs from CVD patients or healthy donors, SEB administration significantly increased the severity of inflammation in the lungs of SCID mice that received CVD patient PBMCs. Furthermore, human leukocytes were detected by immunohistochemistry in the lungs of SCID mice that received SEB after reconstitution with PBMCs from CVD patients but not in other groups of SCID mice. CD45RO(+) memory T cells comprised the majority of infiltrating human leukocytes. These results suggest the possibility that external superantigens may induce the development of interstitial pneumonia in patients that have a genetic background predisposition to autoimmune disease.
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MESH Headings
- Adoptive Transfer
- Adult
- Aged
- Animals
- Antibodies, Antinuclear/blood
- Antibodies, Antinuclear/immunology
- Collagen Diseases/blood
- Collagen Diseases/immunology
- Disease Models, Animal
- Enterotoxins/immunology
- Female
- Humans
- Immunoglobulin G/blood
- Immunoglobulin G/immunology
- Leukocytes, Mononuclear/cytology
- Leukocytes, Mononuclear/immunology
- Lung/immunology
- Lung/pathology
- Lung Diseases, Interstitial/blood
- Lung Diseases, Interstitial/complications
- Lung Diseases, Interstitial/immunology
- Lung Diseases, Interstitial/pathology
- Male
- Mice
- Mice, SCID
- Middle Aged
- Pneumonia, Staphylococcal/blood
- Pneumonia, Staphylococcal/complications
- Pneumonia, Staphylococcal/immunology
- Pneumonia, Staphylococcal/pathology
- Staphylococcus aureus/immunology
- Superantigens/immunology
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Affiliation(s)
- M Fujiki
- First Department of Internal Medicine, Kumamoto University School of Medicine, 1-1-1 Honjo, Kumamoto, 860-0811, Japan
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