Bertreau E, Grard S, Baudry T, Freymond N
Service de pneumologie aiguë spécialisée et cancérologie thoracique, groupement hospitalier sud, hospices civils de Lyon, Pierre-Bénite, 69310 Lyon, France.
Service de pneumologie aiguë spécialisée et cancérologie thoracique, groupement hospitalier sud, hospices civils de Lyon, Pierre-Bénite, 69310 Lyon, France.
Rev Mal Respir. 2017 Nov;34(9):1007-1010. doi: 10.1016/j.rmr.2017.01.006. Epub 2017 Sep 19.
Some strains of Staphylococcus aureus produce a toxin known as Panton-Valentine leukocidin. These strains notably cause a necrotizing pneumonia which is associated with a high mortality.
A 70-year-old woman presented with sub-acute onset dyspnea, low-grade fever, and hemoptysis after a trip to Dubai and New Zealand. Computed tomography showed bilateral necrotizing pneumonia, suggesting the diagnosis of pneumonia caused by S. aureus producing Panton-Valentine toxin. It was confirmed by microbiological investigation. The rapid initiation of adequate antimicrobial therapy including an effective antitoxin was essential for successful treatment, without the need for ventilatory support.
Necrotizing pneumonia caused by S. aureus producing Panton-Valentine leukocidin usually occurs in young subjects without comorbidities. Typical symptoms are a combination of hypoxemia, high fever, hemoptysis, leukopenia, and a rapidly worsening condition. Panton-Valentine leukocidin should not be discarded if not all the symptoms are typical. Antibiotic therapy including an antitoxin drug such as linezolid or clindamycin should be initiated promptly.
某些金黄色葡萄球菌菌株会产生一种名为杀白细胞素的毒素。这些菌株尤其会引发坏死性肺炎，且死亡率很高。
一名70岁女性在前往迪拜和新西兰旅行后出现亚急性起病的呼吸困难、低热和咯血。计算机断层扫描显示双侧坏死性肺炎，提示由产生杀白细胞素的金黄色葡萄球菌引起的肺炎诊断。微生物学调查证实了这一诊断。迅速开始适当的抗菌治疗，包括有效的抗毒素，对于成功治疗至关重要，无需通气支持。
由产生杀白细胞素的金黄色葡萄球菌引起的坏死性肺炎通常发生在无合并症的年轻患者中。典型症状包括低氧血症、高热、咯血、白细胞减少和病情迅速恶化。如果并非所有症状都典型，也不应排除杀白细胞素的可能性。应立即开始包括抗毒素药物如利奈唑胺或克林霉素的抗生素治疗。
