LETTERS Lethal Necrotizing bilateral pulmonary infi ltrates and References pleural effusion. S. aureus was iso- Pneumonia Caused 1. Wulf M, Voss A. MRSA in livestock an- lated by bronchoalveolar lavage fl uid imals—an epidemic waiting to happen? by an ST398 and blood culture, and staphylococ- Clin Microbiol Infect. 2008;14:519–21. Staphylococcus cal necrotizing pneumonia was diag- DOI: 10.1111/j.1469-0691.2008.01970.x nosed. Clinical features, including the 2. Smith TC, Male MJ, Harper AL, Kroeger aureus Strain JS, Tinkler GP, Moritz ED, et al. Methi- preceding infl uenza-like illness, were cillin-resistant Staphylococcus aureus To the Editor: Several recent highly consistent with those previ- (MRSA) strain ST398 is present in mid- studies have shown massive coloniza- ously reported (5). However, viral cul- western U.S. swine and swine workers. PLoS One. 2009;4:e4258. DOI: 10.1371/ tion of livestock (especially pigs) and tures and immunofl uorescence assays were negative for all common respira- journal.pone.0004258 livestock workers by methicillin-resis- 3. Fanoy E, Helmhout LC, van der Vaart WL, tant Staphylococcus aureus (MRSA) tory viruses, and, although the patient Weijdema K, van Santen-Verheuvel MG, in western Europe, Canada, and the had positive serologic test results for Thijsen SF, et al. An outbreak of non-type- able MRSA within a residential care facil- United States (1,2). Livestock MRSA infl uenza B virus, antibody titers were too low to affi rm infl uenza B infec- ity. Euro Surveill. 2009;14(1):pii=19080. isolates belong almost exclusively to 4. Chambers HF. Community-associated a single sequence type, ST398. Evi- tion. Severity factors were present (5), MRSA-resistance and virulence converge. dence of zoonotic and interhuman including leukopenia, airway bleed- N Engl J Med. 2005;352:1485–7. DOI: 10.1056/NEJMe058023 transmission of methicillin-resistant ing, and multiorgan failure. She died 6 days after symptom onset, with re- 5. Gillet Y, Vanhems P, Lina G, Bes M, and methicillin-susceptible variants Vandenesch F, Floret D, et al. Factors of this hitherto unusual sequence type fractory shock and respiratory failure predicting mortality in necrotizing com- was recently reported (1,3). S. aureus caused by bilateral pneumothorax. The munity-acquired pneumonia caused by Staphylococcus aureus containing Pan- ST398 infections in humans with S. aureus strain, which was suscep- tible to all tested antimicrobial agents ton-Valentine leukocidin. Clin Infect Dis. or without a history of contact with 2007;45:315–21. DOI: 10.1086/519263 livestock include bacteremia, endo- except macrolides, was agr1/ST398, carditis, ventilator-associated pneu- spa-type t571 and nontypeable by Address for correspondence: Jean-Philippe monia, and wound infections, none SmaI pulsed-fi eld gel electrophoresis, Rasigade, Centre de Référence des of which involve the expression of which showed its relatedness to live- Staphylocoques, Centre de Biologie Est, specifi c toxins. Indeed, ST398 isolates stock-associated strains. The origin of Groupement Hospitalier Est, 59 boulevard are negative for all major virulence the infection could not be determined. Pinel, Bron, 69677 France; email: jean-philippe. factors, with the exception of some The presence of the genes encoding [email protected] rare isolates that harbor the genes that PVL was confi rmed by PCR. encode the Panton-Valentine leukoci- Thus, the spread of S. aureus din (PVL) (1), a toxin that is usually ST398 among livestock is a matter Letters associated with community-acquired of increasing concern because strains Letters commenting on recent arti- MRSA (4). We report a case of lethal of this sequence type were able to ac- cles as well as letters reporting cas- necrotizing pneumonia caused by a quire PVL genes and cause necrotizing es, outbreaks, or original research PVL-positive methicillin-susceptible pneumonia in a young immunocom- are welcome. Letters commenting ST398 S. aureus isolate. petent patient. Transmission control on articles should contain no more A previously healthy 14-year-old and surveillance efforts are urgently than 300 words and 5 references; girl came to the emergency room with needed to prevent further spread of they are more likely to be pub- infl uenza-like illness, cough, fever, such strains. lished if submitted within 4 weeks and a 2-day history of severe abdomi- of the original article’s publication. Jean-Philippe Rasigade, nal pain. She was given intravenous Letters reporting cases, outbreaks, Frederic Laurent, Philippe antibacterial chemotherapy with ce- or original research should con- Hubert, François Vandenesch, fotaxime and amikacin. An explor- tain no more than 800 words and and Jerome Etienne atory laparotomy showed no signs of 10 references. They may have 1 Author affi liations: Hospices Civils de Lyon, abdominal disease. Immediately after Figure or Table and should not be Lyon, France (J.P. Rasigade, F. Laurent, J. surgery, acute respiratory distress syn- divided into sections. All letters Etienne, F. Vandenesch); and Assistance drome with hemodynamic instability should contain material not pre- Publique–Hôpitaux de Paris, Paris, France developed in the patient; mechanical viously published and include a (P. Hubert) ventilation and inotropic support were word count. required. A chest radiograph showed DOI: 10.3201/eid1608.100317 1330 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 16, No. 8, August 2010.