Severe Community-Onset Pneumonia in Healthy Adults Caused by Methicillin-ResistantStaphylococcus aureusCarrying the Panton-Valentine Leukocidin Genes

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Background.Recent worldwide reports of community-onset skin abscesses, outbreaks of furunculosis, and severe pneumonia associated with methicillin-resistant Staphylococcus aureus (MRSA) carrying Panton-Valentine leukocidin (PVL) genes and the staphylococcal cassette chromosome mec (SCC mec) type IV indicate that MRSA infections are evolving into a community-related problem. The majority of cases reported to date involve skin and soft-tissue infections, with severe pneumonia representing a relatively rare phenomenon. During a 2-month period in the winter of 2003-2004, four healthy adults presented to 1 of 2 Baltimore hospitals with severe necrotizing MRSA pneumonia in the absence of typical risk factors for MRSA infection.Methods.Patients' MRSA isolates were characterized by strain typing with use of pulsed-field gel electrophoresis and SCC mec typing with use of a multiplex polymerase chain reaction (PCR) assay and detection of PVL genes by PCR.Results.All 4 patients' MRSA isolates carried the PVL genes and the SCC mec type IV element and belonged to the USA300 pulsed-field type. These 3 findings are among the typical characteristics of community-onset MRSA strains. In addition, 2 of our patients had concomitant influenza A diagnosed, which likely contributed to the severity of their presentation.Conclusions.To our knowledge, these patients represent the first reported North American adults with severe community-onset MRSA pneumonia caused by strains carrying the PVL genes.

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