Methicillin-resistant staphylococcus aureus (MRSA) osteomyelitis of the mandible: a case report in pediatric patient

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Aim. Methicillin-resistant Staphylococcus aureus (MRSA)is usually considered a nosocomial pathogen, but more andmore it is procured in the community: in fact, communityassociated MRSA (CA-MRSA) infection has been observedin many patient groups and healthy children. Mostly, CAMRSAinfection has been associated not only with skin andsuperficial soft tissue lesions, but also with invasive infiltration,requiring aggressive treatment with a specific antibiotictherapy and often hospitalization.We present a case of acute osteomyelitis - with severeprogression - caused by community associated MRSA (CAMRSA)in an healthy young patient who had no risk factors.Case presentation. In October 2014, a 10 year-old boywas hospitalized for pain and swelling of anterior mandibleassociated with persistent fever (39°C) and the staphylococcalgingival odontogenic cellulite was diagnosed. He wasimmediately treated with antibiotic (intravenous amoxicillin/clavulanic acid and orally clarithromycin for 15 days) andanti-inflammatory therapy (ibuprofen).In December 2014, the patient came to our observationand his parents reported spontaneous teeth exfoliation. Clinicalexamination revealed the absence of two central mandibularincisor (3.1 and 4.1) and corresponding necrotic boneexposure. We proceeded to request some findings: normallevel of erythrocyte sedimentation rate (ESR) of 2 mm/hand a C-reactive protein (CRP) measuring 0,02 mg/dl wereshowed. Furthermore, bone biopsy was performed andnecrotic bone lesions was confirmed: no Langerhans cellswere recognized in the biopsy, so excluding suspected diagnosisof Langerhans cell histocytosis. Patient was instructedfor correct oral hygiene and local antiseptic therapies (chlorhexidine0.2% mouth rinses and 0.5% chlorhexidine geltopical applications twice daily for 1 week) were prescribed.Conclusion. Nowadays, CA-MRSA infection is a commonand serious problem in most developing countries. Cliniciansshould be also aware of possible severe communityassociated MRSA (CA-MRSA) infections in healthy peoplewithout previously recognized risk factors and who havenever been hospitalized before. The widespread use of antibioticscould have contributed to the high resistance rates ofcommunity associated MRSA (CA-MRSA). It is our opinionthat an early identification of bacteria is essential in order toprovide an early appropriate antibiotic treatment and minimizeprogression to osteomyelitis.
Lingua originaleEnglish
Numero di pagine1
Stato di pubblicazionePublished - 2015


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