A 9-year-old male with no history of chronic diseases, hospitalizations or recent use of antimicrobials.
She had healthy parents and a grandmother with a history of hospitalization in the two months prior to the consultation.
Their family group belonged to the gypsy ethnic group, with nomad habits and bedroom.
They had recently camped in the Araucanía Region together with their signs, uncles and grandparents.
She developed fever in the EU for two days up to 39°C in the axillary region and progressive pain in the right ankle that began after a contusion, with increased volume, local heat and functional impotence.
Symptoms were managed with nonsteroidal anti-inflammatory drugs.
She was admitted with a diagnosis of septic arthritis of the right ankle.
The patient was febrile, with a complete blood count with leukocytosis of 25,300/mm3 and a CRP of 171 mg/L. Surgical removal was performed and cloxacillin 160 mg/kg/day was started.
Loss of consciousness, fever, malaise
The surgical wound gave way to purulent material requiring a new surgical silhouette.
At 48 h, two hemocultives, joint fluid and bone tissue positive for MRSA were reported.
Antibacterial therapy was switched to clindamycin 30 mg/kg/day iv and contact isolation measures were implemented according to institutional regulations.
Distant foci were ruled out by bone scintigraphy, chest X-ray and echocardiography.
She required several surgical debridement during hospitalization, progressing slowly with decreased inflammatory parameters and functional recovery until completing six weeks of effective antimicrobial treatment.
The isolated strain was confirmed as MRSA with absence of PV-L marker.
Molecular characterization corresponded to the genetic subtype CL-SAU-COM-SMA020 (PFGE) and sequence ST8 by MLST.
A nasal carriage study was conducted with the family.
Topical mupirocin was indicated for eradication in all S. aureus carriers.
