Severe Community-acquired Pneumonia Due to Staphylococcus aureus , 2003–04 Influenza Season
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During the 2003-04 influenza season, 17 cases of Staphylococcus aureus community-acquired pneumonia (CAP) were reported from 9 states; 15 (88%) were associated with methicillin-resistant S. aureus (MRSA).The median age of patients was 21 years; 5 (29%) had underlying diseases, and 4 (24%) had risk factors for MRSA.Twelve (71%) had laboratory evidence of influenza virus infection.All but 1 patient, who died on arrival, were hospitalized.Death occurred in 5 (4 with MRSA).S. aureus isolates were available from 13 (76%) patients (11 MRSA).Toxin genes were detected in all isolates; 11 (85%) had only genes for Panton-Valentine leukocidin.All isolates had communityassociated pulsed-field gel electrophoresis patterns; all MRSA isolates had the staphylococcal cassette chromosome mec type IVa.In communities with a high prevalence of MRSA, empiric therapy of severe CAP during periods of high influenza activity should include consideration for MRSA.S taphylococcus aureus is an infrequent cause of commu- nity-acquired pneumonia (CAP), accounting for ≈3% of cases in which a bacterial cause is identified, but it is a recognized cause of influenza-associated CAP (1-4).Methicillin-resistant S. aureus (MRSA) commonly causes nosocomial pneumonia, but relatively few cases of MRSA CAP have been reported (5,6).Recent reports have shown that MRSA is an emerging cause of skin and soft tissue disease among otherwise healthy persons who have little or no contact with healthcare settings (7,8).These community-associated strains of MRSA differ from healthcare-associated strains by having a characteristic methicillin-resistant gene cassette (staphylococcal cassette chromosome mec [SCCmec] type IV) that elicits certain toxins, notably Panton-Valentine leukocidin (PVL), resistance generally limited to the β-lactams and macrolides, and specific molecular typing patterns (8-10).During the 2003-04 influenza season, the Centers for Disease Control and Prevention (CDC) received reports of severe complications after influenza virus infection, including pneumonia caused by S. aureus and MRSA, among previously healthy children and adults.We report the demographic and clinical features of 17 patients with S. aureus and MRSA CAP associated with influenza or influenzalike illness (ILI) and describe the microbiologic characteristics of the S. aureus isolates. Methods Case Definition and Case FindingA case of S. aureus CAP associated with ILI (S. aureus CAP-ILI) was defined as pneumonia occurring during the 2003-04 influenza season in a person with either laboratory-confirmed influenza virus infection, clinician-determined ILI (e.g., fever plus sore throat or cough), or both during the 2003-04 influenza season from whom a speci- Severe Community-acquired Pneumonia Due to Staphylococcus aureus, 2003-04 Influenza Season
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In studies examining severe or fatal cases, the pathogenesis of influenza-associated S. aureus pneumonia seems to be distinct from that of typical community-acquired pneumonia.
“In studies examining severe or fatal cases, however, the pathogenesis of influenza-associated S. aureus pneumonia seems to be distinct from that of typical community-acquired pneumonia.”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [9]
Influenza-associated S. aureus pneumonia is characterized as fulminant, with short intervals between onset of illness and diagnosis of pneumonia (<7 days) and rapid (often within <24 h) progression to severe disease with multilobar involvement.
“The disease is characterized as fulminant, with short intervals between onset of illness and diagnosis of pneumonia (,7 days) and rapid (often within ,24 h) progression to severe disease with multilobar involvement [6,7,9,11,12].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [9]
The epidemiological characteristics of S. aureus pneumonia have changed during the past decade with the emergence of the USA300 and USA400 clones of methicillin-resistant S. aureus.
“The epidemiological characteristics of S. aureus pneumonia have changed during the past decade with the emergence of the USA300 and USA400 clones of methicillin-resistant S. aureus [9].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [9]
The recently emerged USA300 and USA400 clones act synergistically with influenza virus.
“the recently emerged USA300 and USA400 clones that have been linked to a surge in necrotizing pneumonia in patients with influenza [9-11, 15, 29-31] act synergistically with influenza virus.”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [9]
Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages, and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic.
“Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages [9,11,30,31], and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic [12,15].”
From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [9]
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References 36 · Cited by 379
- Authors
- Hageman, J. C., Uyeki, T. M., Francis, J. S., Jernigan, D. B., Wheeler, J. G., Bridges, C. B., Barenkamp, S. J., Sievert, D. M., Srinivasan, A., Doherty, M. C., McDougal, L. K., Killgore, G. E., Lopatin, U. A., Coffman, R., MacDonald, J. K., McAllister, S. K., Fosheim, G. E., Patel, J. B., & McDonald, L. C.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Johns Hopkins University (US)
- University of Arkansas for Medical Sciences (US)
- Saint Louis University (US)
- Michigan Department of Health and Human Services (US)
- National Institutes of Health (US)
- Oklahoma State Department of Health (US)
- Washington State Department of Health (US)
- Corresponding author
- Hageman, Jeffrey C.
- ORCID
- Venue
- Emerging infectious diseases
- Published
- 2006-06
- Volume
- 12
- Issue
- 6
- Pages
- 894-899
- ISSN
- 1080-6040 (ISSN-L)
- 1080-6059
- PMC
- PMC3373026
- OpenAlex
- W2132813534
- Cited by
- 379
- References
- 36
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 13 · 2021: 8 · 2020: 14 · 2019: 16 · 2018: 10 · 2017: 14 · 2016: 12 · 2015: 18 · 2014: 13 · 2013: 26 · 2012: 18
- FWCI
- 24.25
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Emerging infectious diseases (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Centers for Disease Control and Prevention
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
- Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Keywords
- community-acquired pneumonia, Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, influenza-associated pneumonia, Panton-Valentine leukocidin, toxin genes, empirical antibiotic therapy, community-acquired MRSA
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, DNA, Bacterial, Female, Genotype, Humans, Infant, Influenza, Human, Male, Microbial Sensitivity Tests, Middle Aged, Orthomyxoviridae, Staphylococcal Infections, Staphylococcus aureus, Methicillin Resistance, Electrophoresis, Gel, Pulsed-Field, Community-Acquired Infections, Pneumonia, Bacterial
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