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Title : 30 year-old male w/ fever with chill for 3 weeks
Date : June 1, 2010
Contributed by

Jeong-a Lee, MD
Konyang University Hospital, Korea

Patient History
Age/Sex 30-year-old man
Chief complaint Fever with chill for 3weeks
Present illness

The patient had no other symptom except fever, mild cough and sputum, so he had been taking just a remedy for cold when he came to Konyang university hospital.

Past medical history

hypertension for 5 months, no acupuncture history Family History : Father and mother - hypertension (+) Social history : He is an insurance salesman. He is not a IV drug abuser. Soju 1-2 bottle/ 1 month 6-pack year smoker

Physical examination

Initial vital sign: BT 38횂횂횂¢횂횂횂娃 BP 130/80 mmHg PR 80bpm RR 20 breaths per minute No abnormal physical finding

Initial laboratory findings

WBC 14,000 (segmented neutrophil 80%) Hb 11,3g/dl Platelet 325¥횂횂횂¨횂횂횂£103/µl BUN/Cr 17.6/1.02 mg/dl CRP 7.4 Urine analysis : blood++

Radiologic findings

 
Question - ID Case of the Week ( June 1, 2010 )
What would be the etiologic agents of this infection?
 
Correct Answer

Staphylococcus lugdunensis

 
Review

Staphylococus lugdunensis (Clin Microbiol Rev. 2008;21:111-33 )

l       Coagulase negative staphylococcus

l       A skin commensal and an infrequent pathogen compared to S. aureus and S. epidermidis, but clinically, infections caused by this organism resemble those caused by S. aureus rather than those caused by other coagulase-negative staphylococci


l       Clinical disease

  1.       Cardiovascular infection : infective endocarditis, myocarditis
  2.       Skin and soft tissue infection
  3.       Blood stream infection
  4.       Toxic shock syndrome
  5.       Acute oral infection
  6.       Urinary tract infection
  7.       Bone and joint infection
  8.       Central nervous system infection
  9.       Peritonitis
  10.       Ocular infection

l        Infective endocarditis caused by S. lugdunensis

 - S. lugdunensis has a propensity to cause native valve endocarditis with a fulminant and highly destructive clinical course that is quite remarkable for a coagulase-negative species, which are otherwise more frequently the etiologic agents of prosthetic valve endocarditis

- Mortality rate : 50-70% => significantly higher than S. aureus (14.5%) and S. epidermidis (20%)

- Surgical treatment : 70% => significantly higher than S. aureua (37%)

l      Antimicrobial susceptibility

- S. lugdunensis, unlike most CNS, has remained remarkably susceptible to a wide array of antimicrobial agents.

- Frequency of ¥â-lactamase : 15-24%

- Frequency of mecA : only two case report

 


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