Panton-Valentine Leukocidin–positive Staphylococcus aureus, Singapore

Trichinella papuae and Trichinella zimbab-wensis induce infection in experimentally infected varans, caimans, pythons and turtles. Trichinellosis: recommendations on methods for the control of Trichinella in domestic and wild animals intended for human consumption. La Rosa G. PCR-derived methods for the identification of Trichinella parasites from animal and human samples. The identification and characterization of a break within the large subunit ribosomal RNA of Trichinella spiralis: comparison of gap sequences within the genus. To the Editor: Necrotizing community acquired pneumonia attributable to Panton-Valentine leukocidin– producing strains of Staphylococcus aureus has been described as a distinct clinical syndrome with a high death rate in young, immunocom-petent patients (1,2). This letter details the first reported case of necrotizing pneumonia caused by Panton-Valentine leukocidin-positive S. aureus in a southeastern Asian country , Singapore. An 18-year-old girl of Chinese eth-nicity with a 4-day history of fever, cough, hemoptysis, and dyspnea sought treatment at Singapore General Hospital in October 2003. This episode had immediately followed an influenza-like prodromal illness for which a general practitioner had prescribed oral erythromycin ethinylsuccinate and medications for symptomatic relief. Her medical history showed an intrauterine Toxoplasma gondii infection that had resulted in developmental delay and slight mental retardation. She had never traveled outside Singapore. On admission, the patient's temperature was 38.4°C, blood pressure was 130/70 mm Hg, and her pulse rate was 108 per min. Bibasal crackles were heard on auscultation of her lung fields, and her respiratory rate was 30 per min despite the use of supplemental oxygen. The results of physical examination were otherwise unre-markable. Initial chest x-ray showed airspace shadowing of the right upper and middle lobes of the lung, as well as blunting of the right costophrenic angle. Blood tests gave the following results: leukocyte count 7.42 x 10 9 /L, neutrophil count 6.53 x 10 9 /L, platelet count 287 x 10 9 /L, hemoglobin level 8.6 g/dL, prothrombin time 15.3 s, and activated partial thromboplastin time 28.7 s. She was experiencing acute renal failure with a serum crea-tinine level of 783 µmol/L. Liver biochemistry was abnormal with the following values: alkaline phosphatase 513 U/L, alanine aminotransferase 38 U/L, and aspartate aminotransferase 65 U/L. Serum bilirubin level was within the normal range. The patient was prescribed intravenous ceftriaxone and azithromycin, and hemodialysis was initiated. Within 6 hours of hospitalization, the patient became hypotensive and hypoxemic and required inotropic support and mechanical ventilation. Intravenous ceftazidime and high-dose …