Tomita Yusuke, Kawano Osamu, Ichiyasu Hidenori, Fukushima Takakazu, Fukuda Kouichirou, Sugimoto Mineharu, Kohrogi Hirotsugu
Department of Respiratory Medicine, Kumamoto Saishunso National Hospital.
Nihon Kokyuki Gakkai Zasshi. 2008 May;46(5):395-403.
We present 2 cases with severe necrotizing pneumonia due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection. The patients were a 89-year-old man and a male student of 15 years of age. Chest X-rays and CT scans demonstrated multiple consolidations with cavitary lesions showing necrotizing pneumonia. MRSA strains were isolated from the sputum cultures on admission in these patients who did not have any established risk factors for MRSA infections such as history of hospitalization, surgery, hemodialysis, the presence of a permanent indwelling catheter or percutaneous medical device, and residence in a long-term care facility. These patients thus satisfied the international criteria for CA-MRSA presented by the Centers for Disease Control and Prevention (CDC). Unfortunately, the first case died of CA-MRSA pneumonia in spite of intensive treatments including anti-MRSA antibiotics. Unlike the severe CA-MRSA cases in western countries, Panton-Valentine leukocidin (PVL) genes were not detected in the present cases, suggesting that factors other than PVL had a significant effect on the severity of necrotizing pneumonia. To the best of our knowledge, this is the first report of severe necrotizing pneumonia caused by CA-MRSA in Japan.
我们报告了2例因社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）感染导致的严重坏死性肺炎病例。患者分别为一名89岁男性和一名15岁男学生。胸部X线和CT扫描显示多处实变并伴有空洞性病变，提示坏死性肺炎。在这些患者入院时的痰培养中分离出了MRSA菌株，他们没有任何已确定的MRSA感染危险因素，如住院史、手术史、血液透析史、长期留置导管或经皮医疗器械的存在以及居住在长期护理机构。因此，这些患者符合美国疾病控制与预防中心（CDC）提出的CA-MRSA国际标准。不幸的是，尽管进行了包括抗MRSA抗生素在内的强化治疗，第一例患者仍死于CA-MRSA肺炎。与西方国家的严重CA-MRSA病例不同，本病例中未检测到杀白细胞素（PVL）基因，这表明除PVL外的其他因素对坏死性肺炎的严重程度有显著影响。据我们所知，这是日本首例由CA-MRSA引起的严重坏死性肺炎报告。
