Gonzalez Blanca E, Hulten Kristina G, Dishop Megan K, Lamberth Linda B, Hammerman Wendy A, Mason Edward O, Kaplan Sheldon L
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Clin Infect Dis. 2005 Sep 1;41(5):583-90. doi: 10.1086/432475. Epub 2005 Jul 29.
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).
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.
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 (P < .001). 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 (P < .001). 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 (P = .03).
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.
在德克萨斯儿童医院（TCH；休斯顿），原发性肺炎和转移性肺部感染在侵袭性社区获得性金黄色葡萄球菌病患者中变得更加常见。
在本研究中，我们试图描述社区获得性金黄色葡萄球菌侵袭性感染患儿的肺部受累情况，并确定编码杀白细胞素（PVL）（luk-S-PV和luk-F-PV）和胶原黏附素（cna）的基因的存在是否与肺部表现相关。对2001年8月1日至2004年6月30日期间入住TCH的侵袭性葡萄球菌感染患者进行了研究。回顾了胸部影像学和尸检报告。通过聚合酶链反应（PCR）检测分离株中编码PVL和胶原黏附素的基因的存在情况。
70例社区获得性耐甲氧西林金黄色葡萄球菌（MRSA）感染患者中有47例肺部影像学检查结果异常，而43例社区获得性甲氧西林敏感金黄色葡萄球菌（MSSA）感染患者中有12例（P <.001）。除脓毒性栓子外，肺炎和/或脓胸是最常见的表现。转移性肺部疾病在骨髓炎患者中更常见。3例同时感染流感和副流感病毒的儿童出现严重坏死性肺炎。在67株MRSA和36株MSSA分离株中研究了编码PVL的基因的存在情况。80例PVL阳性分离株患者中有51例胸部影像学检查结果异常，而23例PVL阴性分离株患者中有2例（P <.001）。胸部X线检查结果异常的患者中只有2株分离株（均为MSSA）携带cna。在多变量分析中，PVL仍然与继发性肺炎患者的胸部影像学检查结果异常独立相关（P =.03）。
在侵袭性社区获得性金黄色葡萄球菌感染患者中常见肺部受累。社区获得性MRSA可能导致原发性社区获得性肺炎以及转移性肺部疾病。编码PVL的基因的存在与金黄色葡萄球菌引起的肺部受累高度相关。
