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1 September 2005

Volume 41, Number 5
Clinical Infectious Diseases 2005;41:583–590
© 2005 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2005/4105-0001$15.00
DOI: 10.1086/432475
MAJOR ARTICLE

Pulmonary Manifestations in Children with Invasive Community‐Acquired Staphylococcus aureus Infection

Blanca E. Gonzalez,1,3

Kristina G. Hulten,1,3

Megan K. Dishop,1,2,3

Linda B. Lamberth,3

Wendy A. Hammerman,1,3

Edward O. Mason, Jr.,1,3 and

Sheldon L. Kaplan1,3

Departments of 1Pediatrics and 2Pathology, Baylor College of Medicine, and 3Texas Children’s Hospital, Houston, Texas

Background.Primary pneumonia and metastatic pulmonary infection have become more common in patients with invasive community‐acquired Staphylococcus aureus disease at Texas Children’s Hospital (TCH; Houston).

Methods.In this study, we sought to describe pulmonary involvement in children with community‐acquired S. aureus invasive infection and to determine whether the presence of genes encoding Panton‐Valentine leukocidin (PVL) (luk‐S‐PV and luk‐F‐PV) and collagen adhesin (cna) is correlated with pulmonary manifestations. Patients with invasive staphylococcal infections admitted to TCH between 1 August 2001 and 30 June 2004 were studied. Chest imaging and postmortem examination reports were reviewed. Isolates were tested for the presence of genes encoding PVL and collagen adhesin by PCR.

Results.A total of 47 of 70 patients with community‐acquired methicillin‐resistant S. aureus (MRSA) infection had abnormal pulmonary imaging findings, compared with 12 of 43 patients with community‐acquired methicillin‐susceptible S. aureus (MSSA) infection ( ). Pneumonia and/or empyema, in addition to septic emboli, were the most common findings. Metastatic pulmonary disease occurred more frequently among patients with osteomyelitis. Severe necrotizing pneumonia was present in 3 children coinfected with influenza and parainfluenza virus. The presence of genes encoding PVL was investigated in 67 MRSA and 36 MSSA isolates. Abnormal chest imaging findings were observed for 51 of 80 patients with PVL‐positive isolates, compared with 2 of 23 patients with PVL‐negative isolates ( ). Only 2 isolates (both of which were MSSA) from patients with abnormal chest radiograph findings carried cna. PVL remained independently associated with abnormal chest imaging findings in patients with secondary pneumonia in a multivariate analysis ( .

Conclusions.Pulmonary involvement is commonly observed in patients with invasive community‐acquired S. aureus infections. Community‐acquired MRSA may cause primary community‐acquired pneumonia, as well as metastatic pulmonary disease. The presence of genes encoding PVL is highly associated with pulmonary involvement by S. aureus.

Received 9 February 2005; accepted 18 April 2005; electronically published 29 July 2005.

  • (See the editorial commentary by Etienne on pages 591–3)

Reprints or correspondence: Dr. Sheldon L. Kaplan, Texas Children’s Hospital, Mail Code 3‐2371, 6621 Fannin St., Houston, TX 77030 ().

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