Case Reports
Vol. 6 (2025)
Rapid respiratory failure due to influenza A with superimposed methicillin-resistant Staphylococcus aureus pneumonia: a case report and review of diagnostic and therapeutic challenges
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 16 December 2025
69
Views
68
Downloads
Authors
Influenza is a viral respiratory infection affecting millions annually and can cause complications like superimposed Methicillin-Resistant Staphylococcus aureus (MRSA) pneumonia, which has high morbidity and mortality. This case describes a 50-year-old female with severe persistent asthma who had acute shortness of breath. Workup revealed influenza A with superimposed pneumonia on chest X-ray. She rapidly decompensated, requiring intubation and Intensive Care Unit (ICU) admission. Testing revealed MRSA-positive pneumonia. Despite early treatment with broad-spectrum antibiotics, including MRSA coverage, her course remained complicated by ICU admission and respiratory support. The Infectious Diseases Society of America guidelines emphasize treating influenza and recognizing bacterial coinfections but focus more on testing rather than prophylactic antibiotics. This case emphasizes the complexities of managing superimposed MRSA and the need to better understand its pathophysiology. Early antibiotic treatment, especially in high-risk individuals, may mitigate disease severity, reduce ICU admissions, and improve outcomes.
Downloads
Download data is not yet available.
Citations
1. Centers for Disease Control and Prevention. About estimated flu burden. Available from: https://www.cdc.gov/flu-burden/php/about/index.html
2. Karolyi M, Pawelka E, Daller S, et al. Is there a clinical difference between influenza A and B virus infections in hospitalized patients? Wien Klin Wochenschr 2019;131:362-8. DOI: https://doi.org/10.1007/s00508-019-1519-0
3. Wadhwani, K, Dammert, P. Utility of the methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA infection in patients with influenza and superimposed bacterial pneumonia. Chest 2024;166:A1139. DOI: https://doi.org/10.1016/j.chest.2024.06.747
4. Miron VD, Săndulescu O, Streinu-Cercel A, et al. Age, comorbidity burden and late presentation are significant predictors of hospitalization length and acute respiratory failure in patients with influenza. Sci Rep-UK 2024;14:15563. DOI: https://doi.org/10.1038/s41598-024-66550-8
5. Tenforde MW, Noah KP, O’Halloran AC, et al. Timing of influenza antiviral therapy and risk of death in adults hospitalized with influenza-associated pneumonia, influenza hospitalization surveillance network (FLUSURV-Net), 2012-2019. Clin Infect Dis 2024;80:461-8. DOI: https://doi.org/10.1093/cid/ciae427
6. Arranz-Herrero J, Presa J, Rius-Rocabert S, et al. Determinants of poor clinical outcome in patients with influenza pneumonia: A systematic review and meta-analysis. Int J Infect Dis 2023;131:173-9. DOI: https://doi.org/10.1016/j.ijid.2023.04.003
7. Hsu PC, Lin YT, Kao KC, et al. Risk factors for prolonged mechanical ventilation in critically ill patients with influenza-related acute respiratory distress syndrome. Respir Res 2024;25:9. DOI: https://doi.org/10.1186/s12931-023-02648-3
8. Centers for Disease Control and Prevention. Severe coinfection with seasonal influenza A (H3N2) virus and Staphylococcus aureus - Maryland, February–March 2012. Available from: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6116a4.htm
9. Timothy M, Uyeki HHB. Influenza. IDSA Home. Available from: https://www.idsociety.org/practice-guideline/influenza/#RecommendationsAbridged
10. Sur M. Oseltamivir. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539909/
11. Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care 2019;200:e45-7. DOI: https://doi.org/10.1164/rccm.201908-1581ST
12. Alwakeel M, Obeidat M, Nanah A, et al. Evaluating the diagnostic performance of nasal methicillin-resistant Staphylococcus aureus polymerase chain reaction in hospital-acquired pneumonia within the intensive care unit. A retrospective study. J Intensive Care Med 2025;40:54-9. DOI: https://doi.org/10.1177/08850666241264774
13. Palavecino EL. Rapid methods for detection of MRSA in clinical specimens. Methods Mol Biol 2020;2069:29-45. DOI: https://doi.org/10.1007/978-1-4939-9849-4_2
14. Gayen S, Dachert S, Lashari B, et al. Critical care management of severe asthma exacerbations. Jpn J Clin Med 2024;13:859. DOI: https://doi.org/10.3390/jcm13030859
15. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2024. Available from: www.ginasthma.org
16. Patterson, TF, Thompson, GR, Denning, DW, et al. Clinical practice guidelines for the diagnosis and management of Aspergillosis: 2016 update by IDSA. Clin Infect Dis 2016;63:1-60. DOI: https://doi.org/10.1093/cid/ciw326
17. Langouët-Astrié C, Oshima K, McMurtry SA, et al. The influenza-injured lung microenvironment promotes MRSA virulence, contributing to severe secondary bacterial pneumonia. Cell Rep 2022;41:111721. DOI: https://doi.org/10.1016/j.celrep.2022.111721
18. Fujimoto Y, Hasegawa S, Matsushige T, et al. Pulmonary inflammation and cytokine dynamics of bronchoalveolar lavage fluid from a mouse model of bronchial asthma during A(H1N1)pdm09 influenza infection. Sci Rep 2017;7:9128. DOI: https://doi.org/10.1038/s41598-017-08030-w
19. Jaiswal A, Dash D, Singh R. Intranasal curcumin and dexamethasone combination ameliorates inflammasome (NLRP3) activation in lipopolysachharide exposed asthma exacerbations. Toxicol Appl Pharmacol 2022;436:115861. DOI: https://doi.org/10.1016/j.taap.2021.115861
20. Randolph AG, Xu R, Novak T, et al. Vancomycin monotherapy may be insufficient to treat methicillin-resistant Staphylococcus aureus coinfection in children with influenza-related critical illness. Clin Infect Dis 2019;68:365-72. DOI: https://doi.org/10.1093/cid/ciy495
21. Chow EJ, Doyle JD, Uyeki TM. Influenza virus-related critical illness: prevention, diagnosis, treatment. Crit Care 2019;23:214. DOI: https://doi.org/10.1186/s13054-019-2491-9
22. Tong SYC, Lye DC, Yahav D, et al. Effect of vancomycin or daptomycin with vs without an antistaphylococcal β-lactam on mortality, bacteremia, relapse, or treatment failure in patients with MRSA bacteremia: a randomized clinical trial. JAMA 2020;323:527-37. DOI: https://doi.org/10.1001/jama.2020.0103
23. Shi Y, Shi X, Liang J, et al. Aggravated MRSA pneumonia secondary to influenza A virus infection is derived from decreased expression of il‐1β. J Med Virol 2020;92:3047-56. DOI: https://doi.org/10.1002/jmv.26329
24. Theofani E, Semitekolou M, Morianos I, et al. Targeting NLRP3 inflammasome activation in severe asthma. J Clin Med 2019;8:1615. DOI: https://doi.org/10.3390/jcm8101615
How to Cite
Rapid respiratory failure due to influenza A with superimposed methicillin-resistant Staphylococcus aureus pneumonia: a case report and review of diagnostic and therapeutic challenges. (2025). Infectious Diseases and Herbal Medicine, 6(1). https://doi.org/10.4081/idhm.2025.719
Copyright (c) 2025 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.