ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (5)
CA-MRSA skin infection in Child
Print Captions
Other Resources UpToDate PubMed

CA-MRSA skin infection in Child

Print Images (5)
Contributors: Loren G. Miller MD, MPH, Noah Craft MD, PhD
Other Resources UpToDate PubMed

Alerts and Notices

Synopsis

CA-MRSA skin infection : Erythema, Pustule, Painful skin lesion
Skin and soft tissue infections (SSTIs) including cellulitis, abscesses, impetigo (bullous and nonbullous), folliculitis, and furunculosis can all be caused by infection with Staphylococcus aureus, including methicillin-resistant S aureus, or MRSA.

MRSA was first identified in 1961, shortly after the introduction of methicillin. Since that time, MRSA has widely been recognized as an important agent of disease in hospitals, nursing homes, and other long-term care facilities. Beginning in the 1990s, however, outbreaks of MRSA were recognized among healthy children, athletes, prisoners, military recruits, and intravenous drug users in the community at large. Most of those with MRSA infections lacked "traditional" MRSA risk factors, such as exposure to the health care system.

MRSA is no longer primarily limited to hospital-acquired infection. Over the past 2 decades, the incidence of community-associated MRSA (CA-MRSA) has been increasing. In many parts of the United States, over 50% of community-associated S aureus isolates are MRSA. Hence, infections where S. aureus is suspected should be considered MRSA unless susceptibility studies demonstrate otherwise.

The most common manifestation of CA-MRSA infections are skin and subcutaneous infections. Many infections are attributed by patients to spider bites, although an exposure to a spider is typically not recalled by patients. They may occur in tattoos. MRSA skin infections occur in patients of all ages and among people with no traditional risk factors, or even recently described risk factors. Clearly, any person, regardless of background or exposures, can acquire a CA-MRSA infection.

Virtually all CA-MRSA isolates retain susceptibility to vancomycin, linezolid, daptomycin, and trimethoprim-sulfamethoxazole (TMP-SMX). Most isolates are susceptible to clindamycin and tetracyclines, although susceptibility can vary by geography. While CA-MRSA has a propensity for causing skin and soft tissue infections, it can also cause more severe and invasive disease syndromes including necrotizing pneumonia, empyema, necrotizing fasciitis, pyomyositis, septic thrombophlebitis with pulmonary embolization, osteomyelitis, and severe sepsis syndrome, among other manifestations. "Spider bite"-like skin infections and the more severe syndromes may be due in large part to a specific exotoxin present in many strains of CA-MRSA, Panton-Valentine leukocidin (PVL). PVL, a virulence factor that is lethal to neutrophils, has also been implicated in cases of invasive CA-MRSA infections such as necrotizing pneumonia.

Livestock-Associated MRSA (LA-MRSA)
Staphylococcus aureus may colonize or cause disease in animals (pigs, cattle, poultry, etc). The transmission of strains associated with animal infections resulting in colonization and/or disease in humans has been described in people in close contact (veterinarians, livestock fair attendees, etc) with a variety of species that harbor S aureus. Animals may also act as reservoirs of S aureus strains such as USA300, typical CA-MRSA in humans.

Codes

ICD10CM:
A49.02 – Methicillin resistant Staphylococcus aureus infection, unspecified site

SNOMEDCT:
423561003 – Community-acquired methicillin-resistant Staphylococcus aureus infection

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Updated:04/13/2018
Copyright © 2021 VisualDx®. All rights reserved.
CA-MRSA skin infection in Child
Captions Print   View all Images (5)
(with subscription)
CA-MRSA skin infection : Erythema, Pustule, Painful skin lesion
Clinical image of CA-MRSA skin infection
A close-up of a furuncle with an overlying erosion.

+3 More images of CA-MRSA skin infection with subscription

Copyright © 2021 VisualDx®. All rights reserved.