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Nahyoung G. Lee, Daniel R. Lefebvre, Savannah Baril, Suzanne K. Freitag; Community Acquired Methicillin-Resistant Staphylococcus aureus periorbital abscesses are transmissible between members of the same household. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1465.
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To describe two cases of community-acquired, methicillin-resistant Staphylococcus aureus (CA-MRSA)-related preseptal cellulitis with abscess. Both patients reported exposure to family members in their homes with known MRSA abscesses.
Retrospective case series of two healthy male patients without prior history of infections or immune compromise who presented to the Massachusetts Eye and Ear Infirmary with eyelid abscesses and were diagnosed with CA-MRSA.
Both patients had eyelid lesions that were firm, erythematous, and fluctuant without initial resolution on systemic antibiotics. Patient #1 was a 54-year old administrator at a nursing home who is in frequent contact with patients. His wife runs an in-home daycare. Culture results of the left eyebrow abscess in Patient #1 revealed Methicillin-resistant Staphylococcus aureus that was sensitive to Clindamycin, Bactrim, Gentamicin, Tetracycline, Vancomycin, and Linezolid. After incision and drainage of the multiloculated abscess, the patient was treated with intravenous Vancomycin for 12 days with complete resolution of the infection. Upon further questioning, the patient revealed that he was living in a house with 9 family members, one of whom was his daughter who had a MRSA "boil" on an extremity just prior to his infection. Patient #2 was a 25-year old manager who lives at home with his nieces, nephews and brother-in-law who recently suffered a large, facial abscess that was positive for MRSA. The children also had a history of MRSA boils on their legs. Patient #2 underwent incision and drainage of his left lower eyelid abscess that was also MRSA sensitive to Clindamycin, Ciprofloxacin, Gentamicin, Levofloxacin, Linezolid, Bactrim, Tetracycline, and Vancomycin. The infection subsequently resolved on oral clindamycin for a total of 14 days.
In a recent study, MRSA transmission from an index patient to a member of the household has been shown to account for 50% of new MRSA infections. We report two cases of patients with severe MRSA infections in the periocular area, requiring surgical intervention, who have had direct exposure to the bacteria through members within their household. Neither of the patients was immunocompromised. It is possible that CA-MRSA is more virulent than once thought and that strict contact precautions within the household should be emphasized by the physician.
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