Staphylococcus Aureus

Saturday, September 27, 2014

6:33 PM

Introduction
Staphylococcus
aureus is part of
the normal skin
flora. It can
cause a variety
of diseases.

History of Present Illness

1. Endocarditis
Patients are commonly intravenous drug users who
present with fever and chest pain.
2. Food poisoning
Patients can present with nausea, vomiting, diarrhea
and abdominal pain after eating food contaminated
with Staphylococcus aureus. Commonly implicated
foods include eclairs, custards, and mayonnaise.
3. Osteomyelitis
Patients can present with fever, chills, sweats and
bone pain.
4. Pneumonia
Patients can present with fever, shortness of
breath commonly after recovering from an infection
with influenza.
5. Skin infections (Carbuncle, furuncle or boil)
Patients can present with red, tender boils on any part
of their body.
6. Toxic-Shock Syndrome (TSS)
Patients are typically females who are using tampons
who present with hypotension, fever, vomiting,
diarrhea, myalgia, erythroderma (diffuse
reddening of the skin due to vasodilation) and
diarrhea.
Physical Exam
Skin infections
Patients can demonstrate erythematous, raised pustules
with underlying induration. They may express purulent
material.

Chronic Osteomyelitis with fibrosis of the

marrow space. There can be bone destruction
with remodeling.

Seen in Endocarditis

Management Plan
Skin Infections
1. Patients with skin infections due to Methicillin
resistant Staphylococcus aureus can be treated with oral clindamycin
(Cleocin) or trimethoprim-sulfamethoxazole (Bactrim). If the patient
has fevers and a large abscess, it may need incision and drainage.
2. Patients can be given mupirocin (Bactroban) to place in their nares
twice daily for five days as this may decrease their carriage rate. It can
be recommended to patients to take a bleach baths for five days for 15
minutes by adding 1/4 cup bleach to a tub of bath water as well.

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Posteroanterior chest
radiograph of a 15-year-old
with staphylococcal
endocarditis and multiple
septic emboli, revealing
borderline cardiomegaly,
multiple nodular infiltrates,
and bilateral pleural effusions.

Discussion
Staphylococcus aureus forms several different toxins which
are responsible for its disease presentation. The organism
can activate macrophages and T-lymphocytes in
conditions such as toxic shock syndrome.
The organism has a defensive protein bound to its
peptidoglycan wall that binds the Fc portion of IgG.
A highly heat stable exotoxin which is formed prior to ingestion
is responsible for causing symptoms related to food poisoning.

Diagram depicting antibiotic resistance through alteration of the

antibiotic's target site, modeled after MRSA's resistance to penicillin.
Beta-lactam antibiotics permanently inactivate PBP enzymes which
are essential for bacterial life, by permanently binding to their active
sites. Some forms of MRSA, however, express a PBP that will not
allow the antibiotic into their active site.

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Labs and Diagnostics

Staphylococcus aureus is a gram positive, catalase positive, coagulase
positive cocci found in clusters.
It is identified in the laboratory through the clumping of latex beads
coated with antibody, typically IgG which binds protein A on
staphylococcus, and fibrinogen. Staphylococci also contain
fibrinogen receptors.

Methicillin-resistant Staphylococcus aureus (MRSA)

MRSA can be detected most commonly in the nares of individuals,
especially health care workers who are carriers of the organism.
MRSA is more virulent due to an alteration in its penicillin binding protein
structure and the ability to produce beta-lactamase which renders it
resistant to penicillins and cephalosporins and their beta-lactam rings.
Osteomyelitis
The gold standard for diagnosis will be a bone culture. X-rays of the bone can
show tissue swelling, bony destruction and periosteal reaction.