Epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus strain USA300 in Japan.
ABSTRACT 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.
- Journal of Perianesthesia Nursing. 01/2011; 26(3):188-188.
- [Show abstract] [Hide abstract]
ABSTRACT: The ST8 methicillin-resistant Staphylococcus aureus (MRSA) with Staphylococcal cassette chromosome mec (SCCmec) type IVa, known as USA300, is a prevalent community-acquired MRSA (CA-MRSA) clone in the United States and has been spreading worldwide. The USA300 characteristically harbors Panton-Valentine Leukocidin (PVL) genes and the arginine catabolic mobile element (ACME, type I). Prevalence and molecular characteristics of PVL(+) and/or ACME(+) S. aureus were investigated in a university hospital located in northern Japan, for 1,366 S. aureus isolates, including 601 MRSA strains derived from clinical specimens collected from 2008 to 2010. The PVL gene was identified in three MRSA strains with SCCmec IV, which belonged to ST8, spa type t008, coagulase type III, and agr type I. Two PVL-positive MRSA strains had also type I ACME, and were isolated from skin abscess of outpatients who have not travelled abroad recently. One of these PVL(+)/ACME(+) strains carried tet(K), msrA, and aph(3')-IIIa, showing resistance to kanamycin, tetracycline, erythromycin, and ciprofloxacin, suggesting acquisition of more resistance than ST8 CA-MRSA reported in Japan previously. In contrast, another PVL(+)/ACME(+) strain and a PVL(+)/ACME(-) strain were susceptible to more antimicrobials and had less virulence factors than PVL(-)/ACME(+) MRSA strains. Besides the two PVL(+) MRSA strains, ACME (type-ΔII) was identified into seven MRSA strains with SCCmec II belonging to ST5, one of the three spa types (t002, t067, and t071), coagulase type II, and agr type II. These PVL(-)/ACME(+) MRSA strains showed multiple drug resistance and harbored various toxin genes as observed for ST5 PVL(-)/ACME(-) MRSA-II. The present study suggested the spread of ST8-MRSA-IV in northern Japan, and a potential significance of ACME-positive ST5-MRSA-II as an emerging MRSA clone in a hospital.Microbial drug resistance (Larchmont, N.Y.) 10/2012; · 1.99 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Panton-Valentine leukocidine (PVL) is a distinctive virulence factor of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), and arginine catabolic mobile element (ACME) is a staphylococcal genomic island which enhances fitness and ability of bacterial cells to colonize on skin and mucous membranes. The ACME is characteristically found in USA300 which is a predominant CA-MRSA clone (ST8) in the United States and spreading globally, and has also been detected in non-ST8 MRSA at low frequency. In Japan, spread of MRSA with PVL and/or ACME and their genetic traits have not yet been well characterised. In the present study, the prevalence and genetic diversity of PVL/ACME-positive MRSA were investigated for a total of 422 MRSA clinical isolates collected from outpatients in northern Japan for a period of one year. All the isolates were genotyped for the SCCmec and coagulase genes (coa), and screened for PVL and ACME genes.The PVL/ACME-positive isolates were further studied by genetic analysis, including single nucleotide polymorphisms (SNP) analysis based on PVL genes (lukS-PV-lukF-PV), ACME (arc and opp3 clusters), and sarU promoter region. Among all the isolates examined, PVL genes and ACME were detected in 8 isolates (SCCmec-II, 1;IV, 6;V, 1) and 20 isolates (SCCmec-II, 14;IV, 5;V, 1), respectively. Five isolates were found to have both PVL genes and ACME (type I), and were classified into ST8/spa-t008/agr-I/coa-IIIa, which was the same genetic traits as USA300. Fifteen PVL-/ACME+ isolates had type ΔII-ACME, belonging to either ST5 or ST764 [clonal complex (CC) 5], and spa-t001, t002, or t3557. All the ST8-PVL+/ACME-I+ MRSA had identical sequences of PVL genes (haplotype R) and ACME-arc/opp3 clusters to those of USA300 clone. In contrast, in the CC5-PVL-/ACME-ΔII+ MRSA, SNPs in arc cluster were detected in 11 sites (four haplotypes), with some different profiles of virulence/resistance factors. These results indicated single clonality of PVL+/ACME-I+ ST8-MRSA and heterogeneity of PVL-/ACME-ΔII+ CC5-MRSA, and suggested their potential spread in northern Japan.Journal of Medical Microbiology 08/2013; · 2.30 Impact Factor