Yonsei Med J.  2009 Feb;50(1):152-155. 10.3349/ymj.2009.50.1.152.

A Case of Primary Infective Endocarditis Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in a Healthy Individual and Colonization in the Family

• Lee SY
• Kim JY
• Kim JH
• Kim SY
• Park C
• Park YS
• Seo YH
• Cho YK

• KMID: 1782982
• DOI: http://doi.org/10.3349/ymj.2009.50.1.152

Abstract

Primary community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) endocarditis has rarely been reported in healthy individuals without risk factors, such as skin and soft tissue infections, and intravenous drug abuse. We describe a case of infective endocarditis by CA-MRSA (ST72-PVL negative-SCCmec IVA) in previously healthy individuals with no underlying medical condition and CA-MRSA colonization in the family.

Keyword

Endocarditis; colonization in family; community-associated methicillin-resistant Staphylococcus aureus

MeSH Terms

Adult
Community-Acquired Infections/microbiology/transmission
Endocarditis/*microbiology
Family
Female
Humans
*Methicillin Resistance
Staphylococcal Infections/*diagnosis/drug therapy/*transmission
Staphylococcus aureus/*drug effects

Figure

• 

  Fig. 1 Transthoracic echocardiography shows vegetations (arrows) on both mitral leaflets; (A) Diastole. (B) Systole. LA, left atrium; LV, left ventricle; Ao, aorta.

• 

  Fig. 2 Molecular profiling (A) Pulsed-field gel electrophoresis analysis shows clonal relationship between 4 community-associated methicillin-resistant Staphylococcus aureus isolates. M, Marker; B1, Blood isolate of the patient; N1, Nasal isolate of the patient; N2, Nasal isolate of the patient's father; N3, Nasal isolate of the patient's brother-in-law; C, Control. (B) All 4 community-associated methicillin-resistant Staphylococcus aureus isolates were Panton-Valentine leukocidin (PVL)-negative SCCmec IVA clone. M, Marker; B1, Blood isolate of the patient; N1, Nasal isolate of the patient; N2, Nasal isolate of the patient's father; N3, Nasal isolate of the patient's brother-in-law; PII, SCCmec II positive sample; PIII, SCCmec III positive sample; PIV, SCCmec IV positive sample.

Reference

1. Crum NF. The emergence of severe, community-acquired methicillin-resistant Staphylococcus aureus infections. Scand J Infect Dis. 2005. 37:651–656.

2. Zetola N, Francis JS, Nuermberger EL, Bishai WR. Community-acquired meticillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis. 2005. 5:275–286.

3. Bahrain M, Vasiliades M, Wolff M, Younus F. Five cases of bacterial endocarditis after furunculosis and the ongoing saga of community-acquired methicillin-resistant Staphylococcus aureus infections. Scand J Infect Dis. 2006. 38:702–707.

4. Tsigrelis C, Armstrong MD, Vlahakis NE, Batsis JA, Baddour LM. Infective endocarditis due to community-associated methicillin-resistant Staphylococcus aureus in injection drug users may be associated with Panton-Valentine leukocidin-negative strains. Scand J Infect Dis. 2007. 39:299–302.

5. Fowler VG Jr, Miro JM, Hoen B, Cabell CH, Abrutyn E, Rubinstein E, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005. 293:3012–3021.

6. Oliveira DC, de Lencastre H. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002. 46:2155–2161.

7. Millar BC, Prendergast BD, Moore JE. Community-associated MRSA (CA-MRSA): an emerging pathogen in infective endocarditis. J Antimicrob Chemother. 2008. 61:1–7.

8. Ako J, Ikari Y, Hatori M, Hara K, Ouchi Y. Changing spectrum of infective endocarditis: review of 194 episodes over 20 years. Circ J. 2003. 67:3–7.

9. Lin JC, Wu JS, Chang FY. Community-acquired methicillin-resistant Staphylococcus aureus endocarditis with septic embolism of popliteal artery: a case report. J Microbiol Immunol Infect. 2000. 33:57–59.

10. Kim SY, Kim JY, Lee HS, Park C, Park YS, Seo YH, et al. A case of acute pyelonephritis caused by community acquired methicillin-resistant Staphylococcus aureus. Infect Chemother. 2007. 39:100–103.

11. Kim ES, Song JS, Lee HJ, Choe PG, Park KH, Cho JH, et al. A survey of community-associated methicillin-resistant Staphylococcus aureus in Korea. J Antimicrob Chemother. 2007. 60:1108–1114.

12. Park C, Lee DG, Kim SW, Choi SM, Park SH, Chun HS, et al. Predominance of community-associated methicillin-resistant Staphylococcus aureus strains carrying staphylococcal chromosome cassette mec type IVA in South Korea. J Clin Microbiol. 2007. 45:4021–4026.

13. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001. 344:11–16.

14. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004. 364:703–705.