Community acquired methicillin resistant staphylococcus aureus pneumonia
Citation, DOI, disclosures and case data
At the time the case was submitted for publication Callum Smith had no recorded disclosures.View Callum Smith's current disclosures
Fevers, productive cough and hemoptysis on a background of recent intravenous drug use. There was no history of travel or exposure to tuberculosis.
Loading Stack -
0 images remaining
Right middle lobe consolidation with an associated cavitating lesion and air bronchogram. There is a small right sided pleural effusion. The remainder of the lung fields are unremarkable. There are no abnormalities of the mediastinal structures, bones or soft tissues.
1 case question available
A 30 year old man presented with 2 days of fevers, productive cough and hemoptysis on a background of recent intravenous drug use. Three induced sputum specimens were obtained. Methicillin resistant staphylococcus aureus (MRSA) was cultured in two of the three specimens. All three were negative for acid fast bacilli. The patient was treated with a course of intravenous vancomycin followed by oral trimethoprim/sulphamethoxazole.
Community acquired MRSA pneumonia most commonly occurs post influenza in young and previously healthy patients. It is associated with a high mortality and should be suspected in patients with a prodrome of flu like symptoms, hemoptysis, high fevers, multilobar infiltrates with cavitation on chest x-ray or a history of intravenous drug use. Although community acquired MRSA pneumonia is frequently bilateral, as in this case it can be unilateral.
MRSA pneumonias were previously predominantly nosocomial infections. However, since the 1990s MRSA has emerged as a community acquired pathogen. It most commonly causes skin and soft tissue infections. Community acquired MRSA pneumonia is uncommon and has an incidence between 100-1000 per 100000 and 75-85% of patients require admission to the intensive care unit 1-4.
Fortunately, this patient was successfully treated on the respiratory ward and did not require admission to the intensive care unit.
- 1. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clinical microbiology reviews. 23 (3): 616-87. doi:10.1128/CMR.00081-09 - Pubmed
- 2. A. Nakou, M. Woodhead, A. Torres. MRSA as a cause of community-acquired pneumonia. European Respiratory Journal. 34 (5): 1013. doi:10.1183/09031936.00120009 - Pubmed
- 3. Nguyen ET, Kanne JP, Hoang LM, Reynolds S, Dhingra V, Bryce E, Müller NL. Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: radiographic and computed tomography findings. Journal of thoracic imaging. 23 (1): 13-9. doi:10.1097/RTI.0b013e318149e698 - Pubmed
- 4. Rubinstein, Ethan, Kollef, Marin H., Nathwani, Dilip. Pneumonia Caused by Methicillin-Resistant Staphylococcus aureus. Clinical Infectious Diseases. 46 (Supplement_5): S378. doi:10.1086/533594
3 articles feature images from this case
21 public playlists include this case
- Neil viva 1 by Dr Neil J Glassford
- Pulmonary infections by Gunnar Andrésson
- 100 RX for R1 by Juan José Maya González
- Infectious chest by Kamy
- Xrays by Sarah Hodgson
- RAD6705 Exam 1 by Chris Borgerding
- Chest by Zachary Merritt
- Radiology final by Teal Clocksin
- CXR by Hoiwan Cheung
- Lungnasýkingar by Gunnar Bollason
- Favourite chest cases by Rohit Sharma ◉
- Chest X rays by Gamal Ghazala
- nezar chest by nezar shlaka
- infectious CXR by Christopher Zamani
- UCD Chest by Roisin MacDermott
- Resident teaching by Sai Navya Purchuri
- VALCHEV REVIEW by Georgi Nikolaev Valchev
- Chest 2 by N Seth
- chest x ray by Udithamala Priyanthi Ratnayake
- STUDENTS ! by Hysni Dida
- cardiothoracic infections by Nik M H Nik Hussin ◉