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 Disease:

The term “staph infection” covers all infections caused by bacteria of the genus Staphyloccocus. Some gram positive, facultatively anaerobic cocci in this genus (e.g., S. epidermidis) normally live on the skin without causing problems. S. aureus also lives harmlessly on 10 percent of the human population. However, S. aureus can cause fatal disease and is the major cause of NOSOCOMIAL INFECTION and becoming important as a COMMUNITY-ACQUIRED INFECTION. Of grave concern, is the S. aureus’ increasing resistance to most antibiotics, especially methicillin (METHICILLIN-RESISTANT S. AUREUS; MRSA) and a last resort antibiotic vancomycin (VANCOMYCIN-RESISTANT S. AUREUS; VRSA). Without effective antibiotics to fight this pathogen, few options, short of surgery are available to the S. aureus-infected patient.

During the 2006-07 influenza season, between December 2006 and January 2007, 10 cases of community-acquired pneumonia (CAP) were reported to state health agencies in Louisiana and Georgia. Ten was a higher number than expected for a two-month period, especially since six of these patients died. Described here are three CAP cases.

Louisiana Case 1. On December 6, 2007, a previously healthy 10-year-old boy became ill with fever, cough, sore throat, and earache, and was treated with acetaminophen at home. The next day, his symptoms worsened and he was taken to a local emergency department (ED) in respiratory distress with a fever of 104 °F (40°C).

A chest X ray revealed bilobar pneumonia. The patient was transferred to another hospital and admitted to the pediatric intensive care unit (PICU), where he required endotracheal intubation and mechanical ventilation. He was treated initially on December 7 with intravenous antibiotics. On December 8, a nasopharyngeal secretion assay was positive for influenza. A sputum culture obtained the same day grew gram-positive cocci; blood cultures were negative.The patient had a low white blood cell count and worsening low blood pressure and inadequate tissue oxygen. He died on December 9, 42 hours after admission to the PICU. The cause of death was reported as bilateral penumonia.

Louisiana Case 2. On December 26, 2007, a 14-year old boy exhibited influenza-like illness symptoms when taken to a local ED, where he was treated with clarithromycin and penicillin for atypical penumonial and sore throat. A rapid test for Streptococcus pyogenes was negative.

The following day, the patient was taken to his primary-care provider with worsening symptoms and was prescribed an antiviral drug for suspected influenza. On December 28,the youth returned to the ED in respiratory distress and was noted to have bloody, frothy sputum; a fever of  40°C; and inadequate tissue oxygen.In the ED, the patient was intubated, placed on mechanical ventilation, and administered antibiotics.

A chest X ray revealed diffuse bilateral fluids and an immunological assay on nasopharyngeal secretions was positive for influenza; a blood culture grew gram-positive cocci. The patient died on December 28, 6 hours after arrival in the ED. The case of death was recorded as pneumonia.

Lung examination at autopsy indicated the presence of gram-positive cocci in the lung and the lung tissues examined did not indicate evidence of influenza. An antibiotic sensitivity assay from a tonsil swab and lung specimen indicated the bacterium was resistant to the antibiotic methicillin. The deceased’s medical history was unremarkable except for a culture-confirmed armpit abscess identified as caused by a gram-positive coccus that was diagnosed on October 9, 2006 and treated with antibiotics for 7 days.

Georgia case. On December 17, 2006, a previously healthy 8-year-old girl was taken to her primary-care provider after 3 days of fever, cough, and vomiting. She was treated with antibiotics and an aerosolized asthma drug.

Her condition worsened, and she was transported to a local ED, where she received additional antibiotics and asthma drugs. A high-resolution CT scan revealed right lobe pneumonia. She was transported to a referral hospital, where she was noted to have low blood pressure and inadequate tissue oxygen. She was intubated on arrival and placed on membrane oxygenation. During intubation, she had cardiac arrest and was resuscitated.

Also on December 17, viral and sputum cultures tested positive for influenza and gram-positive cocci; blood cultures were negative for cocci. After a long hospital course complicated by renal and hepatic failure and a heart abscess, the patient died on January 7, 2007, 25 days after onset of symptoms. Cause of death was listed as pneumonia.

-Dr. Pommerville-

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