Assuntos
COVID-19 , Pneumonia Estafilocócica , Pneumonia , Infecções Estafilocócicas , Humanos , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/tratamento farmacológico , SARS-CoV-2 , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureusRESUMO
A 66-year-old man was transferred to our hospital for pneumonia that was resistant to sulbactam/ampicillin and levofloxacin therapy. Chest computed tomography showed the rapidly progressive formation of multiple cavities. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated, and the patient was diagnosed with necrotizing pneumonia caused by community-acquired MRSA (CA-MRSA). The MRSA strain had type IV staphylococcus cassette chromosome mec and genes encoding Panton-Valentine leucocidin (PVL). CA-MRSA necrotizing pneumonia with the PVL gene is rare; only three cases have been previously reported in Japan. We administered anti-MRSA antibiotics and the patient achieved complete clinical and radiological improvement.
Assuntos
Toxinas Bacterianas/genética , Exotoxinas/genética , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/genética , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Estafilocócica/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Humanos , Masculino , Resistência a Meticilina , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/microbiologia , Radiografia , Tomografia Computadorizada por Raios XAssuntos
Pneumonia Necrosante/fisiopatologia , Pneumonia Necrosante/cirurgia , Pneumonia Estafilocócica/fisiopatologia , Pneumonia Estafilocócica/cirurgia , Stents , Traqueia/cirurgia , Feminino , Humanos , Lactente , Masculino , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Estafilocócica/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in cystic fibrosis (CF), with increasing incidence in recent years. We examined the association between bacterial colonization in the sputum (MRSA with or without pseudomonas (PA)) and computed tomography (CT) scores in CF patients. METHODS: MRSA patients were divided according to PA status based on at least three consecutive sputum cultures; controls were patients without MRSA (with or without PA), matched for gender and age at CT. Clinical data and CT scores were compared between groups. RESULTS: Of 33 patients with MRSA, 14 had no PA (MRSA + PA-) and 19 had also PA (MRSA + PA+). MRSA + PA- and MRSA + PA+ patients had CT scores similar to their controls PA+ (38.25 ± 20.18 vs. 32.22 ± 18.74, P = .4, and 41.88 ± 18.18 vs. 45.33 ± 11.5, P = .4, respectively). Although MRSA + PA- had worse CT scores than their matched PA- controls, their mean FEV1 values were similar. CONCLUSIONS: Colonization with MRSA in CF is associated with structural CT changes at least similar to those in PA. A cause and effect relationship cannot be established. The current findings call for a larger study assessing longitudinally the impact of MRSA acquisition and eradication protocols.
Assuntos
Antibacterianos/administração & dosagem , Fibrose Cística/diagnóstico por imagem , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Pneumonia Estafilocócica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Fatores Etários , Criança , Estudos Transversais , Fibrose Cística/complicações , Fibrose Cística/microbiologia , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/patogenicidade , Testes de Sensibilidade Microbiana , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/etiologia , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Resultado do Tratamento , Adulto JovemAssuntos
Artrite Infecciosa/tratamento farmacológico , Pneumonia Estafilocócica/tratamento farmacológico , Articulação Esternoclavicular , Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/microbiologia , Infecções Comunitárias Adquiridas/complicações , Farmacorresistência Bacteriana , Feminino , Humanos , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/microbiologia , Dor de Ombro/microbiologia , Infecções Estafilocócicas/diagnóstico por imagem , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/microbiologia , Tomografia Computadorizada por Raios XRESUMO
Almost all traumatic pulmonary pseudocysts (TPP), such as cavitary pulmonary lesions after blunt chest trauma, resolve spontaneously. On the contrary, secondary infection of a TPP should be considered in the presence of purulent sputum or hemosputum and a persistent cavity. We report a case of an infected TPP that was successfully treated by early surgical treatment. A 25-year-old man was transferred to our hospital with a TPP, shown by computed tomography (CT) as having a thick-walled large cavity, after the acute phase of blunt chest trauma. Purulent hemosputum suggested infection of the cavity. Serial CT scans of the chest revealed a persistent cavity. The thick-walled large cavity was diagnosed as a secondary infection of the TPP, that is, a potential lung abscess. We resected the cavity before a systemic inflammatory reaction occurred.
Assuntos
Cistos/diagnóstico , Diagnóstico Diferencial , Pneumopatias/diagnóstico , Lesão Pulmonar/complicações , Pneumonia Estafilocócica/cirurgia , Adulto , Humanos , Masculino , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/microbiologiaRESUMO
Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article reports the case of a 52-year-old woman, immunocompetent healthcare professional presenting to Accident and Emergency with NP and Staphylococcus aureus septicaemia. The cavitating lesion was not identified on initial chest X-ray leading to a delay in antimicrobial optimisation. However, the patient went on to achieve a full symptomatic recovery in 1 month and complete radiological recovery at 2-year follow-up. Long-term prognosis for adult cases of NP currently remains undocumented. This case serves as the first piece of published evidence documenting full physiological and radiological recovery following appropriate treatment of NP in an immunocompetent adult patient.
Assuntos
Pneumonia Necrosante/diagnóstico , Pneumonia Estafilocócica/diagnóstico , Staphylococcus aureus/isolamento & purificação , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Imunocompetência , Pessoa de Meia-Idade , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Necrosante/tratamento farmacológico , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/tratamento farmacológico , Radiografia Torácica , Tomografia Computadorizada por Raios XAssuntos
Cistos/diagnóstico por imagem , Cistos/microbiologia , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/diagnóstico por imagem , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina , Pessoa de Meia-Idade , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Our objective was to illustrate the potential of metabolomics to identify novel biomarkers of illness severity in a child with fatal necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA). We present a case report with two control groups and a metabolomics analysis: an infant with fatal MRSA pneumonia, four children with influenza pneumonia (pneumonia control group), and seven healthy children with no known infections (healthy control group). Urine samples were collected from all children. Metabolites were identified and quantified using 1 H-nuclear magnetic resonance spectrometry. Normalized metabolite concentration data from children with influenza pneumonia and healthy controls were compared by using an unpaired Student t test. To identify differentiating metabolites of MRSA pneumonia, the fold change of each metabolite was calculated by dividing each urine metabolite concentration of the patient with fatal MRSA pneumonia by the median urine concentration values of the same metabolite of the patients with influenza pneumonia and healthy controls, respectively. MetScape (http://metscape.ncibi.org/), a bioinformatics tool, was used for data visualization and interpretation. Urine metabolite concentrations previously identified as associated with sepsis in children (e.g., 3-hydroxybutyrate, carnitine, and creatinine) were higher in the patient with fatal MRSA pneumonia compared with those of patients with influenza pneumonia and healthy controls. The concentrations of additional metabolites-acetone, acetoacetate, choline, fumarate, glucose, and 3-aminoisobutyrate-were more than 25-fold higher in the patient with MRSA pneumonia than those of patients with influenza pneumonia and healthy controls. These metabolic changes in the urine preceded the clinical severe sepsis phenotype, suggesting that detection of the extent of metabolic disruption can aid in the early identification of a sepsis phenotype in advance of the clinical diagnosis. These data also support the utility of metabolomics for the development of clinical assays to identify patients with pediatric pneumonia at high risk for deterioration.
Assuntos
Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Necrosante/urina , Pneumonia Estafilocócica/urina , Sepse/urina , Índice de Gravidade de Doença , Biomarcadores/urina , Criança , Evolução Fatal , Feminino , Humanos , Lactente , Espectroscopia de Ressonância Magnética/métodos , Masculino , Metabolômica/métodos , Pneumonia Necrosante/complicações , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/diagnóstico por imagem , Sepse/complicações , Sepse/diagnóstico por imagemRESUMO
OBJECTIVE: To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months. METHODS: Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge. RESULTS: Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries. CONCLUSION: PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months.
Assuntos
Toxinas Bacterianas/análise , Exotoxinas/análise , Oxigenação por Membrana Extracorpórea , Leucocidinas/análise , Pneumonia Necrosante/terapia , Pneumonia Estafilocócica/terapia , Staphylococcus aureus/química , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Feminino , Seguimentos , Hemorragia/induzido quimicamente , Hemorragia/etiologia , Hemorragia/prevenção & controle , Humanos , Pulmão/diagnóstico por imagem , Pneumopatias/induzido quimicamente , Pneumopatias/etiologia , Pneumopatias/prevenção & controle , Staphylococcus aureus Resistente à Meticilina/química , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Necrosante/complicações , Pneumonia Necrosante/diagnóstico por imagem , Pneumonia Necrosante/microbiologia , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/microbiologia , Indução de Remissão , Testes de Função Respiratória , Estudos Retrospectivos , Terapia de Salvação , Staphylococcus aureus/isolamento & purificação , Tomografia Computadorizada por Raios X , Vasoconstritores/uso terapêuticoAssuntos
Pneumonia em Organização Criptogênica/diagnóstico por imagem , Cistos/diagnóstico por imagem , Pneumonia Estafilocócica/diagnóstico por imagem , Idoso , Broncoscopia , Pneumonia em Organização Criptogênica/complicações , Cistos/complicações , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Estafilocócica/complicações , Radiografia TorácicaAssuntos
Tamponamento Cardíaco/microbiologia , Pneumonia Estafilocócica/complicações , Pneumopericárdio/microbiologia , Tamponamento Cardíaco/diagnóstico por imagem , Evolução Fatal , Feminino , Humanos , Lactente , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumopericárdio/diagnóstico por imagem , RadiografiaAssuntos
Diagnóstico Diferencial , Prótese de Quadril/efeitos adversos , Pneumonia Estafilocócica/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Estafilocócicas/diagnóstico por imagem , Tuberculose Miliar/diagnóstico por imagem , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Terapia Combinada , Remoção de Dispositivo , Quimioterapia Combinada , Dispneia/etiologia , Fraturas do Colo Femoral/cirurgia , Humanos , Masculino , Ofloxacino/administração & dosagem , Ofloxacino/uso terapêutico , Pneumonia Estafilocócica/diagnóstico , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Rifampina/administração & dosagem , Rifampina/uso terapêutico , Tomografia Computadorizada por Raios XRESUMO
A previously healthy 60-year-old male presented with fever, general pain and a C-reactive protein (CRP) of 160 mg/L. He was prescribed doxycycline. In the emergency room three days later, he was intubated and had a saturation of 70% on 100% oxygen. The chest X-ray showed bilateral lobar pneumonia. Streptococcus pneumonia was later verified. As a Jehovah's Witness, he had refused blood transfusions, but accepted albumin. Two days after admission, veno-venous extracorporeal membrane oxygenation (V-V ECMO) was started and the patient was then transported on ECMO to Stockholm. After two days, echocardiography showed right cardiac failure and the patient had to be converted to veno-arterial ECMO (VV-A ECMO) by cannulation of the left femoral artery. The haemoglobin decreased from 10.0 to 6.0 g/dL. Iron, folic acid, and erythropoietin were administered to stimulate erythropoesis. Romiplostim, to stimulate the production of platelets, was also started immediately. Blood samples were reduced to a minimum. The ECMO circuit was changed twice, using saline for priming, and the blood in the old circuit was then given back to the patient. The haemoglobin concentration varied between 4.5 and 6.0 g/dL during the ECMO treatment and the platelets between 80 and 140 x10(9)/L. After 44 days on ECMO, the patient was weaned off ECMO with 50% oxygen and nitric oxide (NO) at 20ppm in the ventilator. Four days after decannulation, he was transferred to a nearby intensive care unit. Long-term ECMO treatment without transfusion of blood products is possible. Being a Jehovah's Witness should not automatically be a contraindication for ECMO.
Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Testemunhas de Jeová , Pneumonia Estafilocócica/terapia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Estafilocócica/complicações , Pneumonia Estafilocócica/diagnóstico por imagem , Radiografia , Fatores de TempoAssuntos
Toxinas Bacterianas/análise , Infecções Comunitárias Adquiridas/microbiologia , Exotoxinas/análise , Leucocidinas/análise , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Pneumonia Estafilocócica/microbiologia , Infecções Estafilocócicas/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Toxinas Bacterianas/genética , Cloxacilina/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Exotoxinas/genética , Dermatoses do Pé/tratamento farmacológico , Dermatoses do Pé/microbiologia , Perfilação da Expressão Gênica , Genes Bacterianos , Dermatoses da Mão/tratamento farmacológico , Dermatoses da Mão/microbiologia , Humanos , Imunocompetência , Leucocidinas/genética , Masculino , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/metabolismo , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/tratamento farmacológico , Radiografia , Infecções Estafilocócicas/tratamento farmacológico , Vasculite/microbiologiaRESUMO
OBJECTIVES: The purpose of this study was to compare the clinical and thin-section CT findings in patients with meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-susceptible S. aureus (MSSA). METHODS: We retrospectively identified 201 patients with acute MRSA pneumonia and 164 patients with acute MSSA pneumonia who had undergone chest thin-section CT examinations between January 2004 and March 2009. Patients with concurrent infectious disease were excluded from our study. Consequently, our study group comprised 68 patients with MRSA pneumonia (37 male, 31 female) and 83 patients with MSSA pneumonia (32 male, 51 female). Clinical findings in the patients were assessed. Parenchymal abnormalities, lymph node enlargement and pleural effusion were assessed. RESULTS: Underlying diseases such as cardiovascular were significantly more frequent in the patients with MRSA pneumonia than in those with MSSA pneumonia. CT findings of centrilobular nodules, centrilobular nodules with a tree-in-bud pattern, and bronchial wall thickening were significantly more frequent in the patients with MSSA pneumonia than those with MRSA pneumonia (p = 0.038, p = 0.007 and p = 0.039, respectively). In the group with MRSA, parenchymal abnormalities were observed to be mainly peripherally distributed and the frequency was significantly higher than in the MSSA group (p = 0.028). Pleural effusion was significantly more frequent in the patients with MRSA pneumonia than those with MSSA pneumonia (p = 0.002). CONCLUSIONS: Findings from the evaluation of thin-section CT manifestations of pneumonia may be useful to distinguish between patients with acute MRSA pneumonia and those with MSSA pneumonia.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/tratamento farmacológico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Feminino , Humanos , Masculino , Meticilina/farmacologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacos , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
Necrotizing Staphylococcus aureus Panton-Valentine leukocidin (SA-PLV+) accounts for less than 1% of community-acquired lung diseases in children and young adults. Neonatal cases are exceptional. We report the observations of two newborn female twins, who were not breastfed, presenting a necrotizing lung disease due to the same strain of SA-PVL+ despite nasal decolonization measures taken. These two cases are informative and bring to light (1) the possibility of severe SA-PVL+ lung infections in young infants and (2) their strictly intrafamilial mode of transmission for which eradication measures were ineffective.
Assuntos
Toxinas Bacterianas/metabolismo , Exotoxinas/metabolismo , Leucocidinas/metabolismo , Pneumonia Estafilocócica/microbiologia , Pneumonia Estafilocócica/transmissão , Staphylococcus aureus/metabolismo , Adulto , Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/prevenção & controle , Família , Feminino , Humanos , Recém-Nascido , Testes de Sensibilidade Microbiana , Necrose , Pneumonia Estafilocócica/diagnóstico por imagem , Pneumonia Estafilocócica/tratamento farmacológico , Pneumonia Estafilocócica/patologia , Radiografia , Staphylococcus aureus/patogenicidade , Resultado do Tratamento , Gêmeos MonozigóticosRESUMO
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.