Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis
Concurrent bacteraemia in patients with dengue fever is rarely reported. We report a case of a patient who initially presented with symptoms typical of dengue fever but later succumbed to septic shock caused by hypervirulent methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA). A...
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MDPI AG
2020-03-01
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| Series: | Pathogens |
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| Online Access: | https://www.mdpi.com/2076-0817/9/3/190 |
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| author | Soo Tein Ngoi Yee Wan Lee Wen Kiong Niek Foong Kee Kan Sazaly AbuBakar Sasheela Sri La Sri Ponnampalavanar Nuryana Idris Cindy Shuan Ju Teh |
| author_facet | Soo Tein Ngoi Yee Wan Lee Wen Kiong Niek Foong Kee Kan Sazaly AbuBakar Sasheela Sri La Sri Ponnampalavanar Nuryana Idris Cindy Shuan Ju Teh |
| author_sort | Soo Tein Ngoi |
| collection | DOAJ |
| description | Concurrent bacteraemia in patients with dengue fever is rarely reported. We report a case of a patient who initially presented with symptoms typical of dengue fever but later succumbed to septic shock caused by hypervirulent methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA). A 50-year-old female patient with hypertension and diabetes mellitus presented with typical symptoms of dengue fever. Upon investigation, the patient reported having prolonged fever for four days prior to hospitalization. Within 24 hours post-admission, the patient developed pneumonia and refractory shock, and ultimately succumbed to multiple-organs failure. Microbiological examination of the blood culture retrieved a pan susceptible MSSA strain. Genomic sequence analyses of the MSSA strain identified genes encoding staphylococcal superantigens (enterotoxin staphylococcal enterotoxin C 3 (SEC3) and enterotoxin-like staphylococcal enterotoxins-like toxin L (SElL)) that have been associated with toxic shock syndrome in human hosts. Genes encoding important toxins (Panton-Valentine leukocidins, alpha-haemolysin, protein A) involved in the development of staphylococcal pneumonia were also present in the MSSA genome. <i>Staphylococcus aureus</i> co-infections in dengue are uncommon but could be exceptionally fatal if caused by a toxin-producing strain. Clinicians should be aware of the risks and signs of sepsis in dengue fever, thus allowing early diagnosis and starting of antibiotic treatment in time to lower the mortality and morbidity rates. |
| first_indexed | 2024-12-10T07:14:37Z |
| format | Article |
| id | doaj.art-712278e7df7543feb5ead05d4365ed57 |
| institution | Directory Open Access Journal |
| issn | 2076-0817 |
| language | English |
| last_indexed | 2024-12-10T07:14:37Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pathogens |
| spelling | doaj.art-712278e7df7543feb5ead05d4365ed572022-12-22T01:57:59ZengMDPI AGPathogens2076-08172020-03-019319010.3390/pathogens9030190pathogens9030190Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes AnalysisSoo Tein Ngoi0Yee Wan Lee1Wen Kiong Niek2Foong Kee Kan3Sazaly AbuBakar4Sasheela Sri La Sri Ponnampalavanar5Nuryana Idris6Cindy Shuan Ju Teh7Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaDepartment of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaInfectious Disease Physician, Gleneagles Hospital Medini Johor, 79250 Iskandar Puteri Johor, MalaysiaDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaDepartment of Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaDepartment of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, MalaysiaConcurrent bacteraemia in patients with dengue fever is rarely reported. We report a case of a patient who initially presented with symptoms typical of dengue fever but later succumbed to septic shock caused by hypervirulent methicillin-susceptible <i>Staphylococcus aureus</i> (MSSA). A 50-year-old female patient with hypertension and diabetes mellitus presented with typical symptoms of dengue fever. Upon investigation, the patient reported having prolonged fever for four days prior to hospitalization. Within 24 hours post-admission, the patient developed pneumonia and refractory shock, and ultimately succumbed to multiple-organs failure. Microbiological examination of the blood culture retrieved a pan susceptible MSSA strain. Genomic sequence analyses of the MSSA strain identified genes encoding staphylococcal superantigens (enterotoxin staphylococcal enterotoxin C 3 (SEC3) and enterotoxin-like staphylococcal enterotoxins-like toxin L (SElL)) that have been associated with toxic shock syndrome in human hosts. Genes encoding important toxins (Panton-Valentine leukocidins, alpha-haemolysin, protein A) involved in the development of staphylococcal pneumonia were also present in the MSSA genome. <i>Staphylococcus aureus</i> co-infections in dengue are uncommon but could be exceptionally fatal if caused by a toxin-producing strain. Clinicians should be aware of the risks and signs of sepsis in dengue fever, thus allowing early diagnosis and starting of antibiotic treatment in time to lower the mortality and morbidity rates.https://www.mdpi.com/2076-0817/9/3/190bacteremiadengueinfectious diseasemssa<i>staphylococcus aureus</i> |
| spellingShingle | Soo Tein Ngoi Yee Wan Lee Wen Kiong Niek Foong Kee Kan Sazaly AbuBakar Sasheela Sri La Sri Ponnampalavanar Nuryana Idris Cindy Shuan Ju Teh Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis Pathogens bacteremia dengue infectious disease mssa <i>staphylococcus aureus</i> |
| title | Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis |
| title_full | Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis |
| title_fullStr | Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis |
| title_full_unstemmed | Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis |
| title_short | Atypical Presentation of Methicillin-Susceptible <i>Staphylococcus aureus</i> Infection in a Dengue-Positive Patient: A Case Report with Virulence Genes Analysis |
| title_sort | atypical presentation of methicillin susceptible i staphylococcus aureus i infection in a dengue positive patient a case report with virulence genes analysis |
| topic | bacteremia dengue infectious disease mssa <i>staphylococcus aureus</i> |
| url | https://www.mdpi.com/2076-0817/9/3/190 |
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