The synergistic interaction between Panton-Valentine leukocidin (PVL)-positive methicillin-susceptible Staphylococcus aureus (MSSA) and influenza virus can cause fulminant necrotizing pneumonia. We report a cluster of two cases involving epidemiologically linked construction workers illustrating this life-threatening synergy. After shared occupational exposure, one patient died of rapidly progressive pneumonia, while the other survived after prolonged intensive care. As conventional diagnostics failed, metagenomic next-generation sequencing (mNGS) of sputum and bronchoalveolar lavage fluid (BALF) identified co-infection with PVL-positive sequence type 22 (ST22) MSSA and influenza B virus (IBV) in case 2, guiding a successful shift to targeted therapy. This report demonstrates the extreme virulence of PVL-positive MSSA-influenza co-infection, highlights the diagnostic value of mNGS in severe treatment-refractory pneumonia, and emphasizes the need for effective respiratory protection in high-risk occupational environments.
Zheng et al. (Thu,) studied this question.