Huson M A M, Kalkman R, Remppis J, Beyeme J O, Kraef C, Schaumburg F, Alabi A S, Grobusch M P
Division of Internal Medicine, Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, Room F4-220, 1105 AZ, Amsterdam, The Netherlands.
Infection. 2014 Jun;42(3):451-7. doi: 10.1007/s15010-014-0589-1. Epub 2014 Jan 25.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection are increasingly being reported worldwide and are associated with severe illness. The vast majority of MRSA infections are skin and soft tissue infections, while invasive disease remains rare. In Western countries, the epidemiology of MRSA is well documented, but from Central Africa, reports on MRSA are very limited.
Case presentation and review of the literature. The clinical features, epidemiology, and characteristics of MRSA in Central Africa, as well as the treatment options, are discussed. We present a case of severe invasive CA-MRSA infection with pneumonia, pericarditis, and bacteremia in a previously healthy young woman in Gabon. Several virulence factors, like Panton-Valentine leukocidin and type I arginine catabolic mobile element, may play a role in the ability of CA-MRSA to cause severe invasive infections. Based on studies from Gabon and Cameroon (no reports were available from other countries), we find that the prevalence of MRSA is relatively low in this region. Treatment depends primarily on local prevalence and resistance profile of MRSA combined with clinical characteristics.
Severe invasive infection with CA-MRSA is a rare disease presentation in Central Africa, where this pathogen is still relatively uncommon. However, cases of MRSA may be complicated by the human immunodeficiency virus (HIV) and tuberculosis epidemics, and also the limited availability of effective antibiotics.
社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）定植和感染在全球范围内的报道日益增多，且与严重疾病相关。绝大多数MRSA感染为皮肤和软组织感染，而侵袭性疾病仍然罕见。在西方国家，MRSA的流行病学已有充分记录，但来自中非的MRSA报道非常有限。
病例报告及文献综述。讨论了中非地区MRSA的临床特征、流行病学、特点以及治疗选择。我们报告了一例加蓬一名既往健康的年轻女性发生的严重侵袭性CA-MRSA感染，伴有肺炎、心包炎和菌血症。几种毒力因子，如杀白细胞素和I型精氨酸分解代谢移动元件，可能在CA-MRSA引起严重侵袭性感染的能力中发挥作用。根据加蓬和喀麦隆的研究（其他国家无相关报告），我们发现该地区MRSA的患病率相对较低。治疗主要取决于MRSA的当地患病率和耐药情况以及临床特征。
在中非，严重侵袭性CA-MRSA感染是一种罕见的疾病表现，该病原体在当地仍然相对不常见。然而，MRSA病例可能因人类免疫缺陷病毒（HIV）和结核病流行以及有效抗生素供应有限而变得复杂。
