Successful treatment of panton-valentine leukocidin-expressing staphylococcus aureus-Associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation

Noritomo Fujisaki, Azusa Takahashi, Takahiro Arima, Tomoya Mizushima, Katsuki Ikeda, Hiroyuki Kakuchi, Atsunori Nakao, Joji Kotani, Koji Sakaida

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and lung necrosis. Managing respiratory failure and acute respiratory distress syndrome secondary to PVL-expressing Staphylococcus aureus pneumonia and its associated lung necrosis with mechanical ventilation is challenging. We report a patient with lifethreatening PVL-expressing S. aureus-Associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO). Case Report: We examined the case of a woman who presented to our Emergency Department with septic shock due to PVL-expressing S. aureus-Associated pneumonia. A 27-yearold Filipino woman was transferred to our hospital due to severe dyspnea, hemosputum, and high-grade fever. She had a medical history of osteosarcoma of the leg and hyperthyroidism. On arrival, her vital signs indicated septic shock, with a white blood cell count of 3.5×103/μl. Because a Gram stain of her sputum indicated SA, therapy with antibiotics, including meropenem and vancomycin, was started. Hypoxemia necessitated intubation and ventilation. Because the patient's PaO2/FiO2 remained less than 60 mmHg and her blood pressure was unstable despite aggressive conventional management, venoarterial ECMO was administered approximately 11 h after her arrival. The ECMO circuit was changed to veno-venous ECMO on day 7 and the patient was successfully weaned off ECMO after 12 days of treatment. She was discharged from the hospital 104 days after admission. Conclusion: This case demonstrates that early induction of ECMO support can be a reasonable therapeutic option for PVL-S. aureus-Associated pneumonia. This patient's successful outcome might be attributable to early establishment of ECMO to prevent ventilation-induced lung injury.

Original languageEnglish
Pages (from-to)961-966
Number of pages6
JournalIn Vivo
Volume28
Issue number5
Publication statusPublished - Sep 1 2014
Externally publishedYes

Fingerprint

Staphylococcal Pneumonia
Extracorporeal Membrane Oxygenation
Oxygenation
Human Influenza
Membranes
meropenem
Septic Shock
Therapeutics
Ventilation
Necrosis
Lung
Vital Signs
Adult Respiratory Distress Syndrome
Blood pressure
Cytotoxins
Lung Injury
Osteosarcoma
Hyperthyroidism
Vancomycin
Panton-Valentine leukocidin

Keywords

  • Influenza
  • Leukocyte destruction
  • Lung necrosis
  • Membrane oxygenation
  • Panton-Valentine leukocidin
  • Pneumonia
  • PVL
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Pharmacology
  • Medicine(all)

Cite this

Successful treatment of panton-valentine leukocidin-expressing staphylococcus aureus-Associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation. / Fujisaki, Noritomo; Takahashi, Azusa; Arima, Takahiro; Mizushima, Tomoya; Ikeda, Katsuki; Kakuchi, Hiroyuki; Nakao, Atsunori; Kotani, Joji; Sakaida, Koji.

In: In Vivo, Vol. 28, No. 5, 01.09.2014, p. 961-966.

Research output: Contribution to journalArticle

Fujisaki, Noritomo ; Takahashi, Azusa ; Arima, Takahiro ; Mizushima, Tomoya ; Ikeda, Katsuki ; Kakuchi, Hiroyuki ; Nakao, Atsunori ; Kotani, Joji ; Sakaida, Koji. / Successful treatment of panton-valentine leukocidin-expressing staphylococcus aureus-Associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation. In: In Vivo. 2014 ; Vol. 28, No. 5. pp. 961-966.
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AU - Takahashi, Azusa

AU - Arima, Takahiro

AU - Mizushima, Tomoya

AU - Ikeda, Katsuki

AU - Kakuchi, Hiroyuki

AU - Nakao, Atsunori

AU - Kotani, Joji

AU - Sakaida, Koji

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N2 - Background: Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and lung necrosis. Managing respiratory failure and acute respiratory distress syndrome secondary to PVL-expressing Staphylococcus aureus pneumonia and its associated lung necrosis with mechanical ventilation is challenging. We report a patient with lifethreatening PVL-expressing S. aureus-Associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO). Case Report: We examined the case of a woman who presented to our Emergency Department with septic shock due to PVL-expressing S. aureus-Associated pneumonia. A 27-yearold Filipino woman was transferred to our hospital due to severe dyspnea, hemosputum, and high-grade fever. She had a medical history of osteosarcoma of the leg and hyperthyroidism. On arrival, her vital signs indicated septic shock, with a white blood cell count of 3.5×103/μl. Because a Gram stain of her sputum indicated SA, therapy with antibiotics, including meropenem and vancomycin, was started. Hypoxemia necessitated intubation and ventilation. Because the patient's PaO2/FiO2 remained less than 60 mmHg and her blood pressure was unstable despite aggressive conventional management, venoarterial ECMO was administered approximately 11 h after her arrival. The ECMO circuit was changed to veno-venous ECMO on day 7 and the patient was successfully weaned off ECMO after 12 days of treatment. She was discharged from the hospital 104 days after admission. Conclusion: This case demonstrates that early induction of ECMO support can be a reasonable therapeutic option for PVL-S. aureus-Associated pneumonia. This patient's successful outcome might be attributable to early establishment of ECMO to prevent ventilation-induced lung injury.

AB - Background: Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and lung necrosis. Managing respiratory failure and acute respiratory distress syndrome secondary to PVL-expressing Staphylococcus aureus pneumonia and its associated lung necrosis with mechanical ventilation is challenging. We report a patient with lifethreatening PVL-expressing S. aureus-Associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO). Case Report: We examined the case of a woman who presented to our Emergency Department with septic shock due to PVL-expressing S. aureus-Associated pneumonia. A 27-yearold Filipino woman was transferred to our hospital due to severe dyspnea, hemosputum, and high-grade fever. She had a medical history of osteosarcoma of the leg and hyperthyroidism. On arrival, her vital signs indicated septic shock, with a white blood cell count of 3.5×103/μl. Because a Gram stain of her sputum indicated SA, therapy with antibiotics, including meropenem and vancomycin, was started. Hypoxemia necessitated intubation and ventilation. Because the patient's PaO2/FiO2 remained less than 60 mmHg and her blood pressure was unstable despite aggressive conventional management, venoarterial ECMO was administered approximately 11 h after her arrival. The ECMO circuit was changed to veno-venous ECMO on day 7 and the patient was successfully weaned off ECMO after 12 days of treatment. She was discharged from the hospital 104 days after admission. Conclusion: This case demonstrates that early induction of ECMO support can be a reasonable therapeutic option for PVL-S. aureus-Associated pneumonia. This patient's successful outcome might be attributable to early establishment of ECMO to prevent ventilation-induced lung injury.

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KW - Leukocyte destruction

KW - Lung necrosis

KW - Membrane oxygenation

KW - Panton-Valentine leukocidin

KW - Pneumonia

KW - PVL

KW - Staphylococcus aureus

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