Balamuthia Amebic Encephalitis

test; bioMérieux). DNA was extracted from cultures grown on agar plates and amplified following a previously described protocol (1). The following oligonucleotide primer sequences were used: luk-PV1, 5′-ATCATTAGGTAAAATGTCTGGACATGATCCA-3′; luk-PV2, 5′-GCATCAAGTGTAT T G G ATA G C A A A A G C 3 ′ . Polymerase chain reaction products were sequenced commercially and submitted to GenBank (accession no. AY508231). This case is the first in Singapore of community-acquired pneumonia caused by S. aureus in which an attempt was made to detect PantonValentine leukocidin genes. Given that the patient had not traveled, she likely acquired the lethal strain of Panton-Valentine leukocidin–positive S. aureus locally. This idea is further supported by a recent study which reported that the Panton-Valentine leukocidin gene is found worldwide, albeit in community-acquired strains of methicillin-resistant S. aureus (3). The incidence of severe community-acquired pneumonia attributable to Panton-Valentine leukocidin–positive S. aureus is unknown in many parts of the world. With one exception (4), cases of Panton-Valentine leukocidin–positive S. aureus causing community-acquired pneumonia have been reported sporadically only from European countries and the United States (1,2,5–8). These results may be attributable to the lack of recognition rather than to the rarity of the condition. A previous report showed that 7.6% of cases of severe communityacquired pneumonia in patients requiring ventilatory support in Singapore were caused by S. aureus (9), and a large proportion of these would fit the clinical syndrome described by Gillet et al. (2). Given the ease of transmitting the infection to close contacts (7,10), with the real possibility of a consequent outbreak (10), Panton-Valentine leukocidin testing should be conducted on S. aureus strains isolated from all patients with community-acquired necrotizing pneumonia and furunculosis for infection control purposes. Implementing standard hospital methicillin-resistant S. aureus measures resulted in control of the outbreak described by Boubaker et al. (10). This measure seems especially relevant given the dismal prognosis offered by conventional therapy in which the death rate of patients with necrotizing pneumonia may reach 75% (2). Further research on the epidemiology, optimal therapy, and prevention of this infection is needed.