Community-associated Methicillin-Resistant Staphylococcus aureus (ca-MRSA) as a Pandemic Pathogen: Risk Factors and Implications for Healthcare

Abstract

Background A diversity of risk factors for ca-MRSA manifestations has been described so far. Up to date toxic contact dermatitis induced by plants has not been identified as one.

Patients and Methods After intense skin contact with poison ivy in the US a 24-year-old Afro-American showed pronounced bullous contact dermatitis on the back of the neck and subsequently massive ca-MRSA furunculitis with proof of Panton-Valentine-leucocidin (PVL). After travelling to Germany, his German girlfriend developed a subacute ca-MRSA, PVL-positive superinfection of a mosquito bite at her lower leg. Both infections required surgical intervention.

Results While the male patient displayed contact dermatitis by poison ivy, the female patient demonstrated two risk factors for ca-MRSA: contact with a ca-MRSA positive person and a predisposing skin lesion. Both cases underpin the role of ca-MRSA transmission and the potential severeness of wound infections in young and immunocompetent persons, just to be resolved by invasive intervention.

Conclusions Marked and recalcitrant skin or soft tissue infections in otherwise healthy young patients require instant microbiological analysis and surgical intervention flanked by adequate antibiotic therapy. Contact dermatitis induced by plant toxins should be taken into consideration as possible risk factor for the acquisition of ca-MRSA.

Zusammenfassung

Hintergrund Für die Manifestation von ca-MRSA-Infektionen ist eine Vielzahl von Risikofaktoren beschrieben. Die durch Pflanzen ausgelöste toxische Kontaktdermatitis gehörte jedoch bislang nicht dazu.

Patienten und Methodik Nach intensivem Hautkontakt mit Poison Ivy in den USA entwickelte ein 24-jähriger Afro-Amerikaner eine ausgeprägte bullöse Kontaktdermatitis im Bereich des Nackens, später in Deutschland bildete sich eine ca-MRSA-assoziierte, Panton-Valentine-Leukozidin (PVL)-positive Furunkulitis aus. Seine deutsche Freundin wies im Bereich des Unterschenkels nach Insektenstich eine subakute Entzündung mit ca-MRSA und positivem PVL-Nachweis auf. Beide Infektionen bedurften chirurgischer Intervention.

Ergebnisse Während der männliche Patient primär lediglich eine durch Poison Ivy hervorgerufene Kontaktdermatitis zeigte, wies die weibliche Patientin zwei Risikofaktoren für ca-MRSA auf: Kontakt mit einer ca-MRSA-positiven Person sowie eine prädisponierende Hautverletzung. Beide Fälle zeigen die Bedeutung von ca-MRSA-Übertragung sowie den potenziell schweren Verlauf solcher Wundinfektionen, der auch bei jungen und immunkompetenten Personen nicht ohne invasive Intervention beherrschbar ist.

Schlussfolgerungen Ausgeprägte und schwer zu behandelnde Haut- und Weichgewebsinfektionen bei ansonsten gesunden jungen Patienten bedürfen umgehender mikrobiologischer Analyse und chirurgischer Intervention flankiert durch zielgerichtete Antibiotikatherapie. Durch Pflanzen ausgelöste toxische Kontaktdermatitis sollte als möglicher zusätzlicher Risikofaktor für ca-MRSA in Betracht gezogen werden.

Schlüsselwörter

ca-MRSA - Risikofaktor - Follikulitis - Poison Ivy - Übertragung - beeinträchtigte Hautbarriere

Keywords

ca-MRSA - risk factor - folliculitis - poison ivy - transmission - compromised skin barrier

Publication History

Article published online:
29 November 2022

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