Cavitary Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Non-Immunocompromised Patient After an Endoscopy: A Case Report.

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia has well-defined characteristics. We present a case of cavitary pneumonia due to MRSA in a patient who had undergone a recent outpatient gastroscopic procedure. CASE REPORT A 32-year-old man presented at the Emergency Department with tonic-clonic seizures of 2 min durations. He had a history of seizures without current treatment or use of psychostimulant drugs. His personal history referred to hypothyroidism treated with levothyroxine, morbid type 3 obesity, gastritis with a gastric ulcer, penicillin allergies, and an ambulatory endoscopy with a biopsy (7 days ago) for erosive gastropathy. On the 3rd day of admission to the Intensive Care Unit (ICU), a bronchoscopy was performed, which showed a reddened mucosa with hemorrhagic points and a cavitary area in the right main bronchus. Multiple polymerase chain reaction and mass spectrometry analyses of samples of bronchioalveolar lavage from the bronchus revealed MRSA with a mechanism of resistance to the mecA gene (1×105 colony-forming unit/mL). The laboratory results for the cerebrospinal fluid were negative for bacterial growth. CONCLUSIONS This is a rare case of cavitary pneumonia due to MRSA of clinical and epidemiological characteristics, which is unusual after an outpatient endoscopic procedure.

Neumonía estafilocócica complicada en un paciente pediátrico: a propósito de un caso clínico / Stafilocócica pneumony complicated in a pediatric patient: on the purpose of a clinical case

La neumonía es definida por la Organización Mundial de Salud (OMS) como una infección respiratoria aguda que afecta a los alvéolos pulmonares, dificultando la respiración y absorción de oxígeno afectando a la población infantil. Por eso se propuso analizar la neumonía estafilocócica complicada con enfoque clínico, radiológico y tratamiento en el paciente pediátrico para establecer elementos que ayuden a la elaboración de protocolos de diagnóstico y tratamiento. Se realizó un estudio de tipo documental, observacional y analítico mediante la entrevista directa con el paciente y familiares y el análisis clínico de los signos y síntomas presentados por el paciente. Mediante la valoración clínico, radiológico y oportuno tratamiento en el paciente pediátrico con neumonía estafilocócica complicada, se logró establecer elementos que podrán ayudar a la elaboración de un protocolo de diagnóstico y tratamiento de dicha patología(AU)

Pneumonia is defined by the World Health Organization (WHO) as an acute respiratory infection that affects the pulmonary alveoli, making it difficult to breathe and absorb oxygen, affecting the child population. Therefore, it was proposed to analyze complicated staphylococcal pneumonia with a clinical, radiological and treatment approach in the pediatric patient to establish elements that help to develop diagnostic and treatment protocols. A documentary, observational and analytical study was conducted through a direct interview with the patient and family members and the clinical analysis of the signs and symptoms presented by the patient. By means of the clinical, radiological evaluation and timely treatment in the pediatric patient with complicated staphylococcal pneumonia, it was possible to establish elements that may help to elaborate a protocol for the diagnosis and treatment of said pathology(AU)

Success stories about severe pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus

We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.

Success stories about severe pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus.

We describe three cases of community-acquired necrotizing pneumonia which were caused by Panton-Valentine leucocidin-producing strains of Staphylococcus aureus (one of them methicillin sensitive). All cases were successfully treated without any sequelae for the patients due to the prompt initiation of adequate antimicrobial therapy. High suspicion toward this fatal pathogen was the key to the successful outcome of the patients.

[Clinical features and outcome of community-acquired methicillin-resistant Staphylococcus aureus pneumonia]. / Características clínicas y pronóstico de la neumonía adquirida en la comunidad causada por Staphylococcus aureus resistente a la meticilina.

INTRODUCTION: The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies. METHODS: Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012. RESULTS: We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%. CONCLUSION: CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases.

Neumonía Estafilocócica. Hospital Infantil General Milanés Tamayo, 2011 / Staphylococcic Pneumonia. General Milanés Tamayo Children´s Hospital, 2011

La neumonía estafilocócica guarda relación con la resistencia del huésped a las infecciones, y con la virulencia del microorganismo. El estafilococo es el agente de infección, que produce una amplia gama de enfermedades de gravedad extrema con riesgo para la vida. Presentamos un caso de una paciente con una neumonía por estafilococo, que su tórpida evolución la conduce a la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil General Milanés. Se concluye que la neumonía estafilocócica adquirida en la comunidad, se desarrolla con un cuadro grave, por lo que necesita de un diagnóstico precoz y oportuno(AU)

The staphylococcic pneumonia keeps a close relation with the guest ressistance to the infections, and with the virulence of the microorganism. The staphylococcus is the agent of infection that produces a wide range of illnesses of extreme severity with risks for the life. We present a case of a patient with staphylococcus pneumonia, and its torpid evolution leads to the Pediatric Intensive Care Unit of General Milanés Children´s Hospital. It was concluded that the staphylococcic pneumonia acquired in the community, is developed with severe clinical manifestations, for which it needs a precocious and oportune diagnosis(EU)

Pneumonia estafilocócica: Aspectos clínicos e radiológicos / Staphylococcal pneumonia: clinical and radiologic aspects

Os autores que pela primeira vez descreveram a pneumonia estafilocócica como entidade clínica autônoma foram Chickering & Park, ao apresentarem, em 1919, uma série de 153 casos ocorridos em adultos, como complicação de epidemia de influenza (1). Dese então, a incidência de pneumonia estafilocócica vem aumentando, principalmente depois de iniciada a era dos antimicrobianos. Atualmente, a pneumonia estafilocócica é, dentre as pneumonias bacterianas, a de maior importância, não somente pela prevalência variável mas também pela gravidade de sua evolução

Tratamento cirúrgico de pneumonia necrosante: análise de quatro casos / Surgical treatment of necrotizing pneumonia: analysis of four cases

A pneumonia necrosante é uma patologia grave que surge como complicaçäo rara de pneumonia lobar. Quatro crianças na faixa etária entre dez e 28 meses foram hospitalizadas com pneumonia bacteriana aguda, evoluindo com toxemia, derrame pleural e insuficiência respiratória, respondendo insatisfatoriamente a antibioticoterapia e drenagem pleural. Todos os pacientes foram submetidos a tratamento cirúrgico para descorticaçäo pulmonar e ressecçäo de tecido pulmonar necrosado. Complicaçöes como fístulas broncopleurais ocorreram em dois pacientes, havendo óbito em um dos casos. Os autores concluem que a ressecçäo pulmonar de emergência é indicada quando a necrose pulmonar é diagnosticada em pacientes septicêmicos ou com fístula broncopleural de alto débito, visando a melhora do prognóstico dessas crianças, mesmo de que o índice de morbimortalidade nesses casos é alta

Neumonias adquiridas en la comunidad en pacientes de riesgo / Adquired neumonias in higs risk patients

Analizamos 101 casos de neumonia adquirida en la comunidad, en pacientes con patologia de riesgo atendidos en el CMQBB los ultimos 10 anos. Se deseaba conocer el aporte de los procedimientos de busqueda etiologica, correlacionar los patrones radiograficos pulmonares con los microbiologicos,analizar las patologias subyacentes y catalogar la evolucion del cuadro. Constatamos el agente etiologico en 76 pacientes, resultando positivas 40/60 muestras de espectoracion, 15/24 hemocultivos, 10/16 muestras de liquido pleural, 8/9 aspirados bronquiales, 4/4 aspirados broncofibroscopicos y 2/2 muestras quirurgicas. Se identifico mas frecuentemente el neumococo, los gram negativos y el estafilococo en 28, 23 y 15 pacientes respectivamente. La correlacion clinico-radiologica como hipotesis inicial de diagnostico histologico fue valida en 59 casos. De los 50 pacientes con neumopatias cronicas, 28 tenian EPOC, la insuficiencia respiratoria estuvo asociada en 35 pacientes. evolucionaron favorablemente 74 pacientes, 16 presentaron complicaciones, estableciendose insuficiencia respiratoria y cavitacion pulmonar en 8 casos cada una. Fallecieron 11 pacientes constatandose septicemia aislada o asociada en 7 de ellos. En conclusion, el diagnostico etiologico precoz, tratamiento especifico y la atencion eficaz de las patologias de riesgoasociadas determinan menor morbimortalidad por neumonia

Estudio evaluativo de las neumopatías supuradas en el servicio de pediatría del Hospital General Base Goyeneche 1974-1983 / Evaluative study in suppurated lung disease in the child health service of the Base General Hospital Goyeneche (1974-1983)

Se presentaron los datos correspondientes a 109 casos de Neumopatías Supuradas, recogidos en el Servicio de Pediatría del Hospital General Base Goyeneche, entre el 01 de junio de 1974 y 01 de junio de 1983. De 114 historias clínicas revisados minuciosamente se relacionaron 109 que reunían los criterios 2 mayores y como mínimo 1 criterio mayor y otro menor de Highman y Camphell. De estos fueron aceptados 86 historias con un criterio mayor y otro menor; 22 historias tuvieron 2 criterios mayores y una presentó 3 criterios mayores. Se valoran los síntomas, signos, hallazgos de laboratorio, bacteriológico y datos radiológicos referentes al momento del ingreso y evolución posterior, así como algunos datos anatomopatológicos. Finalmente, se analizó el tratamiento administrativo, la respuesta conseguida y las complicaciones más frecuentes y se compararon los resultados obtenidos con otros similares mostrados en la literatura