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1 January 2005

Volume 40, Number 1
Clinical Infectious Diseases 2005;40:100–107
© 2004 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4001-0015$15.00
DOI: 10.1086/427148
MAJOR ARTICLE

Severe Community‐Onset Pneumonia in Healthy Adults Caused by Methicillin‐Resistant Staphylococcus aureus Carrying the Panton‐Valentine Leukocidin Genes

John S. Francis,1

Meg C. Doherty,1

Uri Lopatin,4

Cecilia P. Johnston,1

Gita Sinha,1

Tracy Ross,3

Mian Cai,3

Nadia N. Hansel,2

Trish Perl,1

John R. Ticehurst,3

Karen Carroll,1,3

David L. Thomas,1

Eric Nuermberger,1 and

John G. Bartlett1

Divisions of 1Infectious Diseases and 2Pulmonary and Critical Care Medicine, Department of Medicine, and 3Division of Medical Microbiology, Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, and 4National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

Background.Recent worldwide reports of community‐onset skin abscesses, outbreaks of furunculosis, and severe pneumonia associated with methicillin‐resistant Staphylococcus aureus (MRSA) carrying Panton‐Valentine leukocidin (PVL) genes and the staphylococcal cassette chromosome mec (SCCmec) type IV indicate that MRSA infections are evolving into a community‐related problem. The majority of cases reported to date involve skin and soft‐tissue infections, with severe pneumonia representing a relatively rare phenomenon. During a 2‐month period in the winter of 2003–2004, four healthy adults presented to 1 of 2 Baltimore hospitals with severe necrotizing MRSA pneumonia in the absence of typical risk factors for MRSA infection.

Methods.Patients’ MRSA isolates were characterized by strain typing with use of pulsed‐field gel electrophoresis and SCCmec typing with use of a multiplex polymerase chain reaction (PCR) assay and detection of PVL genes by PCR.

Results.All 4 patients’ MRSA isolates carried the PVL genes and the SCCmec type IV element and belonged to the USA300 pulsed‐field type. These 3 findings are among the typical characteristics of community‐onset MRSA strains. In addition, 2 of our patients had concomitant influenza A diagnosed, which likely contributed to the severity of their presentation.

Conclusions.To our knowledge, these patients represent the first reported North American adults with severe community‐onset MRSA pneumonia caused by strains carrying the PVL genes.

Received 10 August 2004; accepted 28 October 2004; electronically published 7 December 2004.

Reprints or correspondence: Dr. John Francis, Dept. of Medicine, Div. of Infectious Diseases, Johns Hopkins University, 1830 E. Monument St., Ste. 401, Baltimore, MD 21205 ().

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Bradley A. Sharpe, Scott A. Flanders. (2006) Community-acquired pneumonia: A practical approach to management for the hospitalist. Journal of Hospital Medicine 1:3, 177-190
Online publication date: 1-Jun-2006.
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Timothy F. Jones, C. Buddy Creech, Paul Erwin, Susan G. Baird, Amy M. Woron, and William Schaffner. (2006) Family Outbreaks of Invasive Community‐Associated Methicillin‐Resistant Staphylococcus aureus Infection. Clinical Infectious Diseases 42:9, e76-e78
Online publication date: 1-May-2006.
Abstract-Full Text-PDF Version (66 kB)
P. C. Appelbaum. (2006) MRSA-the tip of the iceberg. Clinical Microbiology and Infection 12:s2, 3-10
Online publication date: 1-May-2006.
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Donald E Craven. (2006) What is healthcare-associated pneumonia, and how should it be treated?. Current Opinion in Infectious Diseases 19:2, 153???160
Online publication date: 1-May-2006.
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Marin H Kollef, Scott T Micek. (2006) Methicillin-resistant Staphylococcus aureus: a new community-acquired pathogen?. Current Opinion in Infectious Diseases 19:2, 161???168
Online publication date: 1-May-2006.
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E. E. Udo, N. Al-Sweih, B. Noronha. (2006) Characterisation of non-multiresistant methicillin-resistant Staphylococcus aureus (including EMRSA-15) in Kuwait Hospitals. Clinical Microbiology and Infection 12:3, 262-269
Online publication date: 1-Apr-2006.
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P. C. Appelbaum. (2006) The emergence of vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus. Clinical Microbiology and Infection 12:s1, 16-23
Online publication date: 1-Apr-2006.
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Ulrich Seybold, Ekaterina V. Kourbatova, James G. Johnson, Sue J. Halvosa, Yun F. Wang, Mark D. King, Susan M. Ray, and Henry M. Blumberg. (2006) Emergence of Community‐Associated Methicillin‐Resistant Staphylococcus aureus USA300 Genotype as a Major Cause of Health Care–Associated Blood Stream Infections. Clinical Infectious Diseases 42:5, 647-656
Online publication date: 1-Mar-2006.
Abstract-Full Text-PDF Version (799 kB)
Mark H. Wilcox. (2006) Tigecycline and the Need for a New Broad-Spectrum Antibiotic Class. Surgical Infections 7:1, 69-80
Online publication date: 1-Mar-2006.
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Scott T Micek, Timothy J Heuring, James M Hollands, Rina A Shah, Marin H Kollef. (2006) Optimizing Antibiotic Treatment for Ventilator-Associated Pneumonia. Pharmacotherapy 26:2, 204-213
Online publication date: 1-Mar-2006.
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Donald E. Craven and Daniel S. Shapiro. (2006) Editorial Commentary: Staphylococcus aureus: Times, They Are A‐Changin'. Clinical Infectious Diseases 42:2, 179-180
Online publication date: 15-Jan-2006.
Citation-Full Text-PDF Version (57 kB)
M. H. Kollef. (2006) Antibiotic management of ventilator-associated pneumonia due to antibiotic-resistant gram-positive bacterial infection. European Journal of Clinical Microbiology & Infectious Diseases 24:12, 794
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Susan I Gerber. (2006) Describing the methicillin-resistant <i>Staphylococcus aureus</i> epidemic: a public health challenge. Expert Review of Anti-infective Therapy 4:6, 905
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Tristan Ferry, Thomas Perpoint, François Vandenesch, Jerome Etienne. (2006) Virulence determinants in Staphylococcus aureus and their involvement in clinical syndromes. Current Infectious Disease Reports 7:6, 420-428
Online publication date: 1-Jan-2006.
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Michael W Ellis, James S Lewis. (2006) Treatment approaches for community-acquired methicillin-resistant Staphylococcus aureus infections. Current Opinion in Infectious Diseases 18:6, 496???501
Online publication date: 1-Jan-2006.
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Erik Torell, Daniel Molin, Eva Tano, Christian Ehrenborg, Cecilia Ryden. (2005) Community-acquired pneumonia and bacteraemia in a healthy young woman caused by methicillin-resistant Staphylococcus aureus (MRSA) carrying the genes encoding Panton-Valentine leukocidin (PVL). Scandinavian Journal of Infectious Diseases 37:11-12, 902-904
Online publication date: 1-Dec-2005.
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Ludmyla Gerasymchuk, Marcus Zervos, Christopher Carpenter. (2005) Community-onset MRSA Necrotizing Bronchopneumonia in a Patient With Diabetic Ketoacidosis. Infectious Diseases in Clinical Practice 13:6, 330-331
Online publication date: 1-Dec-2005.
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C. Alonso-Tarrés, M. L. Villegas, F. J. Gispert, M. C. Cortés-Lletget, A. Rovira Plarromaní, J. Etienne. (2005) Favorable outcome of pneumonia due to Panton–Valentine leukocidin-producing Staphylococcus aureus associated with hematogenous origin and absence of flu-like illness. European Journal of Clinical Microbiology & Infectious Diseases 24:11, 756-759
Online publication date: 1-Dec-2005.
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Doanh Lu, Paul Holtom. (2005) Community-acquired methicillin-resistant Staphylococcus aureus, a new player in sports medicine. Current Sports Medicine Reports 4:5, 265-270
Online publication date: 1-Oct-2005.
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Philip S. Barie. (2005) Another Scourge Upon the Populace: Community- Associated Methicillin-Resistant Staphylococcus aureus. Surgical Infections 6:3, 265-267
Online publication date: 1-Oct-2005.
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Blanca E. Gonzalez, Kristina G. Hulten, Megan K. Dishop, Linda B. Lamberth, Wendy A. Hammerman, Edward O. Mason, Jr., and Sheldon L. Kaplan. (2005) Pulmonary Manifestations in Children with Invasive Community‐Acquired Staphylococcus aureus Infection. Clinical Infectious Diseases 41:5, 583-590
Online publication date: 1-Sep-2005.
Abstract-Full Text-PDF Version (2176 kB)
Jerome Etienne. (2005) Editorial Commentary: Panton‐Valentine Leukocidin: A Marker of Severity for Staphylococcus aureus Infection?. Clinical Infectious Diseases 41:5, 591-593
Online publication date: 1-Sep-2005.
Citation-Full Text-PDF Version (60 kB)
Thomas M File. (2005) Community-associated methicillin-resistant Staphylococcus aureas: not only a cause of skin infections, also a new cause of pneumonia. Current Opinion in Internal Medicine 4:3, 229-230
Online publication date: 1-Jul-2005.
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Donald E Low, Tony Mazzulli, Tom Marrie. (2005) Progressive and nonresolving pneumonia. Current Opinion in Pulmonary Medicine 11:3, 247-252
Online publication date: 1-Jun-2005.
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