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Volume 12, Number 6—June 2006

Research

Severe Community-acquired Pneumonia Due to Staphylococcus aureus, 2003–04 Influenza Season

Jeffrey C. Hageman*Comments to Author , Timothy M. Uyeki*, John S. Francis†, Daniel B. Jernigan*, J. Gary Wheeler‡, Carolyn B. Bridges*, Stephen J. Barenkamp§, Dawn M. Sievert¶, Arjun Srinivasan*, Meg C. Doherty†, Linda K. McDougal*, George E. Killgore*, Uri A. Lopatin#, Rebecca Coffman**, J. Kathryn MacDonald††, Sigrid K. McAllister*, Gregory E. Fosheim*, Jean B. Patel*, and L. Clifford McDonald*
Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Johns Hopkins Medical Institutions, Baltimore, Maryland, USA; ‡University of Arkansas for Medical Sciences College of Medicine, Little Rock, Arkansas, USA; §Saint Louis University School of Medicine, Saint Louis, Missouri, USA; ¶Michigan Department of Community Health, Lansing, Michigan, USA; #National Institutes of Health, Bethesda, Maryland, USA; **Oklahoma State Department of Health, Oklahoma City, Oklahoma, USA; ††Washington State Department of Health, Shoreline, Washington, USA

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Table 1

Demographic and clinical characteristics of cases of Staphylococcus aureus community-acquired pneumonia associated with influenzalike illness, influenza season 2003–04*

Characteristic No. (%), N = 17
Median age, y (range) 21 (3 mo–62 y)
Sex, male 8 (47)
Race
White 10 (59)
Black 7 (41)
Underlying disease† 5 (29)
MRSA risk factors‡ 4 (24)
Documented influenza vaccination 1 (6)
Evidence of influenza infection
Laboratory-confirmed 12 (71)§
Rapid antigen test 10 (59)
Paired serology 2 (12)
Fluorescent antibody staining 2 (12)
Clinical symptoms
Cough 14 (82)
Myalgias 9 (53)
Sore throat 6 (35)
Headache 6 (35)
Shortness of breath 5 (29)
Rigors 4 (24)
Clinical signs
Temperature >38°C 12/13 (92)
Hypotension (systolic blood pressure <90 mm Hg) 12/13 (93)
Normal or elevated leukocyte count† (>3,500/mm3) 12/16 (75)
Median leukocyte count (range) 16,500 mm3 (6,000–295,000)
Leukopenia (<3,500/mm3) 4/16 (25)
Thrombocytopenia (<150,000/mm3) 6/16 (38)
Radiologic documentation of pneumonia¶#
Lobar 3/16 (19)
Multiple lobe involvement 4/16 (25)
Diffuse/patchy infiltrates 6/16 (38)
Effusions/empyema 5/16 (31)
Cavitation/necrosis 4/16 (25)

*MRSA, methicillin-resistant S. aureus.
†One each of diabetes, multiple sclerosis, prune belly syndrome, cystic fibrosis, eczema.
‡Hospitalization, dialysis, surgery, or residence in a long-term care facility in the previous year; ever having an MRSA infection; and presence of percutaneous device or catheter at time of culture.
§One patient had influenza infection confirmed by all methods.
¶One patient died on arrival at the hospital. #Not mutually exclusive.

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