The Challenge of Diagnosing and Treating Staphylococcus aureus Invasive Infections in a Resource-limited Sub-Saharan Africa Setting: A Case Report

J Trop Pediatr. 2015 Oct;61(5):397-402. doi: 10.1093/tropej/fmv045. Epub 2015 Jul 17.

Abstract

Background: Community-acquired methicillin-sensitive Staphylococcus aureus (CA-MSSA) is responsible for the majority of skin and soft-tissue infections. CA-MSSA can also cause life-threatening infections, possibly in relation to particular virulence factors, including Panton-Valentine leukocidin (PVL).

Methods: We describe a severe CA-MSSA necrotizing pneumonia complicated with multifocal osteomyelitis, pericardial effusion and endocarditis in a 6-year-old boy admitted to a Mozambican hospital. Staphylococcus aureus isolation and antibiotic susceptibility testing were performed by conventional microbiology. Additionally, microarray assay was used for molecular characterization.

Results: Blood culture confirmed the presence of S. aureus susceptible to most antimicrobial agents, including methicillin. Molecular characterization confirmed the presence of PVL, together with alpha and beta haemolysin genes.

Conclusions: To our knowledge, this is the first reported case of disseminated CA-MSSA disease with confirmed PVL exotoxin in sub-Saharan Africa. PVL-positive CA-MSSA should be considered in the differential diagnosis of community-acquired pneumonia, making laboratory testing a higher priority.

Keywords: Panton–Valentine leukocidin; Staphylococcus aureus; Sub-Saharan Africa; community-acquired infections; necrotizing pneumonia; virulence factors.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Toxins
  • Child
  • Community-Acquired Infections / drug therapy
  • Echocardiography
  • Exotoxins
  • Humans
  • Leukocidins
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • Osteomyelitis / microbiology*
  • Pericarditis
  • Staphylococcal Infections / diagnosis*
  • Staphylococcal Infections / drug therapy
  • Treatment Outcome
  • Virulence Factors

Substances

  • Anti-Bacterial Agents
  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin
  • Virulence Factors