Enterovirus D68 and Panton-Valentine Leukocidin–Positive Staphylococcus Aureus Respiratory Coinfection with Fatal Outcome

A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of dissemina...

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Bibliographic Details
Published in:Pediatric and developmental pathology 2016-01, Vol.19 (1), p.80-85
Main Authors: Ravishankar, Sanjita, Chapin, Kimberle, Alexander-Scott, Nicole, Wills, Hale, Merritt, Christopher, Jacobson, Melanie, Kleris, Renee, Alhinai, Zaid, Sediva, Ivona, Muratore, Christopher, Mermel, Leonard, Mangray, Shamlal
Format: Article
Language:English
Subjects:
Autopsy
Bacterial Toxins - isolation & purification
Cause of Death
Child
Coinfection
Enterovirus D, Human - isolation & purification
Enterovirus Infections - diagnosis
Enterovirus Infections - therapy
Enterovirus Infections - virology
Exotoxins - isolation & purification
Fatal Outcome
Female
Humans
Leukocidins - isolation & purification
Methicillin-Resistant Staphylococcus aureus - isolation & purification
Predictive Value of Tests
Respiratory Tract Infections - diagnosis
Respiratory Tract Infections - microbiology
Respiratory Tract Infections - therapy
Respiratory Tract Infections - virology
Staphylococcal Infections - diagnosis
Staphylococcal Infections - microbiology
Staphylococcal Infections - therapy
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Summary:A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swabs and lung tissue submitted to the Centers for Disease Control and Prevention (CDC) were positive for Enterovirus D68 (EV-D68). Blood and lung cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were submitted to the CDC and were found to be positive for the toxin Panton-Valentine leukocidin. We describe a fatality related to invasive toxin-mediated MRSA associated with EV-D68 coinfection, along with the clinical, laboratory, and autopsy findings, which provided important clues, prompting further investigation at the CDC to arrive at the correct diagnosis.
ISSN:1093-5266
1615-5742
DOI:10.2350/15-06-1652-CR.1