Case Report: Fatal Necrotizing Pneumonia by Exfoliative Toxin etE2-Producing Staphylococcus aureus Belonging to MLST ST152 in The Netherlands
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We present a case of fatal necrotizing Staphylococcus aureus pneumonia with underlying influenza A (H3) infection. Next-generation-sequencing-based analysis revealed that the S. aureus isolate harbored the newly recognized exfoliative toxin etE2 gene. Molecular epidemiologic analysis showed that the isolate belonged to the MSSA ST152 lineage, harboring PVL genes and edinB co-located to etE2 as distinctive virulence factors. The etE2 gene is present in all isolates of this lineage co-located to the exotoxin gene edinB, both implicated in the destruction of tissue integrity. We alert as to the global emergence of this lineage causing serious infections in patients.