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Fatal Fulminant Pneumonia Caused by Methicillin-Sensitive Staphylococcus aureus Negative for Major High-Virulence Factors Following Influenza B Virus Infection

Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)

Katsunori Masaki, Makoto Ishii, Masaki Anraku, Ho Namkoong, Ryo Miyakawa, Takeshi Nakajima, Koichi Fukunaga, Katsuhiko Naoki, Sadatomo Tasaka, Kenzo Soejima, Koichi Sayama, Kayoko Sugita, Satoshi Iwata, Longzhu Cui, Hideaki Hanaki, Naoki Hasegawa, Tomoko Betsuyaku

Japan Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

Am J Case Rep 2015; 16:454-458

DOI: 10.12659/AJCR.894022

Available online:

Published: 2015-07-14

BACKGROUND: Increasing evidence has indicated that Staphylococcus aureus pneumonia complicated with influenza virus infection is often fatal. In these cases, disease severity is typically determined by susceptibility to antimicrobial agents and the presence of high-virulence factors that are produced by Staphylococcus aureus, such as Panton-Valentine leukocidin (PVL).
CASE REPORT: We describe a rare case of fatal community-acquired pneumonia caused by methicillin-sensitive Staphylococcus aureus (MSSA), which did not secrete major high-virulence factors and coexisted with influenza type B infection. The 32-year-old previously healthy male patient presented with dyspnea, high fever, and cough. His roommate had been diagnosed with influenza B virus infection 3 days earlier. Gram-positive clusters of cocci were detected in the patient’s sputum; therefore, he was diagnosed with severe pneumonia and septic shock, and was admitted to the intensive care unit. Despite intensive antibiotic and antiviral treatment, he died of multiple organ failure 5 days after admission. His blood culture from the admission was positive for MSSA, and further analysis revealed that the strain was negative for major high-virulence factors, including PVL and enterotoxins, although influenza B virus RNA was detected by PCR.
CONCLUSIONS: Physicians should pay special attention to patients with pneumonia following influenza and Staphylococcus aureus infection, as it may be fatal, even if the Staphylococcus aureus strain is PVL-negative and sensitive to antimicrobial agents.

Keywords: Fatal Outcome, Adult, Influenza B virus - isolation & purification, Influenza, Human - virology, Methicillin Resistance, Pneumonia, Staphylococcal - microbiology, Staphylococcus aureus - isolation & purification, Virulence Factors