Pneumonia and Bacteremia Due to Community-Acquired Staphylococcus aureus in a Healthy Adult Carrying the Panton-Valentine Leukocidin Gene-A Case Report

有PVL毒素之社區型methicillin抗藥性金黃色葡萄球菌在健康成年人引起的肺炎與菌血症病例報告

郭家維(Chia-Wei Kuo) ； 郭書辰(Shu-Chen Kuo) ； 許正園(Jeng-Yuan Hsu) ； 傅彬貴(Pin-Kuei Fu)

《胸腔醫學》 30卷4期 (2015/08) Pp. 217-223

摘要

社區型抗藥性金黃色葡萄球菌（CA-MRSA）感染所致的社區型肺炎與院內感染型肺炎最大的不同處在於，前者多半感染於過去健康狀態良好的宿主，而且金黃色葡萄球菌上帶有Panton-Valentine leukocidin（PVL）的毒素。被帶有PVL毒素的抗藥性金黃色葡萄球菌感染的社區型肺炎，常見的表現為高燒、敗血症及呼吸衰竭，因此有較高的死亡率。本病例報告在闡述一位台灣健康年輕男性得到抗藥性金黃色葡萄球菌導致的社區型肺炎和菌血症，經檢查分析發現此CA-MRSA菌株為staphylococcal cassettechromosome mec (Sccmec) type V菌株並帶有PVL基因，且在影像學方面表現出多葉性肺炎而後進展成pneumatoceles。在經過完整的抗生素包括vancomycin及clindamycin治療後，患者的症狀以及影像學上的病灶便消失。

關鍵字

社區型抗藥性金黃色葡萄球菌 ； 肺炎

並列摘要

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) differs from nosocomial MRSA in that the former often carries genes for virulence factors such as Panton-Valentine leukocidin (PVL), which produce toxins and cause infections in previously healthy individuals. Pneumonia caused by CA-MRSA that harbors the PVL toxin gene is often characterized by high fever, sepsis, respiratory failure, and high mortality. We report a young adult who suffered from CA-MRSA-associated pneumonia and bacteremia. The CAMRSA isolate was a staphylococcal cassette chromosome mec (SCCmec) type V strain and carried the PVL gene. The young man presented with high fever and multi-lobar pneumonia, and subsequently developed pneumatoceles. All symptoms and pneumonic consolidations resolved after completion of the treatment course.

並列關鍵字

community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) ； Panton- Valentine leukocidin (PVL) ； pneumonia ； pneumatocele