Epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus strain USA300 in Japan
Division of Medicine, Japan Self Defense Forces Hospital Yokosuka, Kanagawa, Japan.Journal of Infection and Chemotherapy (Impact Factor: 1.49). 04/2010; 16(5):345-9. DOI: 10.1007/s10156-010-0060-x
We report a case of epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strain USA300 in a previously healthy 25-year-old American woman who lived in Japan for more than 1 year. She started to complain of severe headache that continued for about 10 days after improvement of subcutaneous abscesses caused by MRSA. Computed tomography (CT) and magnetic resonance imaging (MRI) showed epidural abscess. As epidural abscess was not improved by treatment with vancomycin and ceftriaxone, craniotomy and drainage were performed, and the severe headache disappeared. Characteristics of the MRSA strain isolated from the abscess were identical to those of strain USA300; multilocus sequence typing sequence type 8, staphylococcal cassette chromosome mec type IVa, Panton-Valentine leukocidin positive, arginine catabolic mobile element positive, and pulsed-field gel electrophoresis type USA300. This may be the first report of epidural abscess caused by USA300 strain in Japan. Because CA-MRSA strains, including USA300, have begun to spread in Japan, epidural abscess should be taken into account in the diagnosis of previously healthy patients with persistent headache accompanied by skin lesions.
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ABSTRACT: We believe that bacterial-infection-associated glomerulonephritis (GN), so-called methicillin-resistant Staphylococcus aureus (MRSA)-GN, was exterminated in Japan. The control of bacterial infection is the most important part of infection-associated GN. In 1990s Japan, hospital-associated MRSA (HA-MRSA) caused MRSA-GN outbreaks. On the other hand, MRSA-GN incidence has been quite limited since 2000. This epidemiological transition suggests that antibacterial therapies and health programs for HA-MRSA infection in Japan were effective against MRSA-GN. Moreover, it appears that staphylococcal superantigens act in the pathogenesis of GN. The change of superantigen production might have influenced to the disappearance of MRSA-GN. If HA-MRSA-producing superantigen outbreaks occur in developing countries, our experience in Japan can provide guiding principles for preventing and eradicating GN.Clinical and Experimental Nephrology 11/2010; 15(1):184-6. DOI:10.1007/s10157-010-0369-x · 2.02 Impact Factor
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