Korean J Leg Med.  2018 Nov;42(4):153-158. 10.7580/kjlm.2018.42.4.153.

Unexpected Death by Sepsis of Staphylococcus aureus with Infective Endocarditis and Paravertebral Abscess in a Fisherman during Sailing out for Fish: An Autopsy Case

• Kim YS
• Hwang IK
• Moon S
• Park JH
• Lee YS

• KMID: 2427562
• DOI: http://doi.org/10.7580/kjlm.2018.42.4.153

Abstract

Staphylococcus aureus is an important cause of human infections, and it is also a commensal that colonizes the nose, axillae, vagina, throat, or skin surfaces. S. aureus has increasingly been recognized as a cause of severe invasive illness, and individuals colonized with this pathogen are subsequently at increased risk of its infections. S. aureus infection is a major cause of skin, soft tissue, respiratory, bone, joint, and endovascular disorders, and staphylococcal bacteremia may cause abscess, endocarditis, pneumonia, metastatic infection, foreign body infection, or sepsis. The authors describe a case of a fisherman who died of sepsis on a fishing boat during sailing out for fish. The autopsy shows paravertebral abscess, pus in the pericardial sac, infective endocarditis with vegetation on the aortic valve cusp, myocarditis, pneumonia and nephritis with bacterial colonization, and also liver cirrhosis and multiple gastric ulcerations.

Keyword

Staphylococcus aureus; Sepsis; Endocarditis; Paravertebral abscess; Autopsy

MeSH Terms

Abscess*
Aortic Valve
Autopsy*
Axilla
Bacteremia
Colon
Endocarditis*
Foreign Bodies
Humans
Joints
Liver Cirrhosis
Myocarditis
Nephritis
Nose
Pharynx
Pneumonia
Sepsis*
Ships
Skin
Staphylococcus aureus*
Staphylococcus*
Stomach Ulcer
Suppuration
Vagina

Figure

• 

  Fig. 1 Reddening of the lumbo-sacral region and linear scar on the thoraco-lumbar area.

• 

  Fig. 2 Dissection of the back showed abscess formation, subcutaneous hemorrhage, and inserted medical device.

• 

  Fig. 3 Purulent fluid in the pericardial sac with erythematous change in the pericardium.

• 

  Fig. 4 On dissection of the heart, bacterial vegetation was noted on the aortic valve cusp (arrow).

• 

  Fig. 5 Microscopic examination of the aortic valve cusp revealed inflammatory infiltrates, necrotic debris, and bacterial colonization (H&E stain, ×100).

Reference

1. Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998; 339:520–532.

2. Noble WC, Valkenburg HA, Wolters CH. Carriage of Staphylococcus aureus in random samples of a normal population. J Hyg (Lond). 1967; 65:567–573.

3. Wenzel RP, Perl TM. The significance of nasal carriage of Staphylococcus aureus and the incidence of postoperative wound infection. J Hosp Infect. 1995; 31:13–24.

4. Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA. 2005; 293:3012–3021.

5. Roder BL, Wandall DA, Frimodt-Moller N, et al. Clinical features of Staphylococcus aureus endocarditis: a 10-year experience in Denmark. Arch Intern Med. 1999; 159:462–469.

6. Chambers HF, Korzeniowski OM, Sande MA. Staphylococcus aureus endocarditis: clinical manifestations in addicts and nonaddicts. Medicine (Baltimore). 1983; 62:170–177.

7. Bone RC. Gram-positive organisms and sepsis. Arch Intern Med. 1994; 154:26–34.

8. Libman H, Arbeit RD. Complications associated with Staphylococcus aureus bacteremia. Arch Intern Med. 1984; 144:541–545.

9. Zimmerli W, Waldvogel FA, Vaudaux P, et al. Pathogenesis of foreign body infection: description and characteristics of an animal model. J Infect Dis. 1982; 146:487–497.

10. Zimmerli W, Lew PD, Waldvogel FA. Pathogenesis of foreign body infection: evidence for a local granulocyte defect. J Clin Invest. 1984; 73:1191–1200.

11. Elek SD, Conen PE. The virulence of Staphylococcus pyogenes for man: a study of the problems of wound infection. Br J Exp Pathol. 1957; 38:573–586.

12. Adem PV, Montgomery CP, Husain AN, et al. Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children. N Engl J Med. 2005; 353:1245–1251.

13. Lee JM, Hwang JH, Yi DY, et al. Aggressively progressed MRSA sepsis accompanied by endophthalmitis and endocarditis in preterm infant. Korean J Perinatol. 2015; 26:369–372.

14. Melzer M, Eykyn SJ, Gransden WR, et al. Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S. aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis. 2003; 37:1453–1460.

15. Williams RE. Healthy carriage of Staphylococcus aureus: its prevalence and importance. Bacteriol Rev. 1963; 27:56–71.

16. Kluytmans J, van Belkum A, Verbrugh H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev. 1997; 10:505–520.

17. Sherertz RJ, Bassetti S, Bassetti-Wyss B. “Cloud” health-care workers. Emerg Infect Dis. 2001; 7:241–244.

18. Sattler CA, Correa AG. Coagulase-positive staphylococcal infections (Staphylococcus aureus). In : Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, editors. Textbook of pediatric infectious diseases. Vol. 1. 5th ed. Philadelphia, PA: Saunders;2004. p. 1099–1129.

19. Gonzalez BE, Hulten KG, Dishop MK, et al. Pulmonary manifestations in children with invasive community-acquired Staphylococcus aureus infection. Clin Infect Dis. 2005; 41:583–590.

20. Sandre RM, Shafran SD. Infective endocarditis: review of 135 cases over 9 years. Clin Infect Dis. 1996; 22:276–286.

21. Sanabria TJ, Alpert JS, Goldberg R, et al. Increasing frequency of staphylococcal infective endocarditis: experience at a university hospital, 1981 through 1988. Arch Intern Med. 1990; 150:1305–1309.

22. Decker MD, Lybarger JA, Vaughn WK, et al. An outbreak of staphylococcal skin infections among river rafting guides. Am J Epidemiol. 1986; 124:969–976.

23. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev. 2010; 23:616–687.