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Published on: February 9, 2011
Panton-Valentine Leukocidin-Producing Staphylococcus aureus Infection: A Case Series
Beatriz Prista-Leão1,2, Isabel Abreu1,2, Raquel Duro1,2,3
1Department of Infectious Diseases, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
Abstract:
Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) is associated with relapsing multifocal skin and soft tissue infections (SSTI), necrotizing pneumonia (NP) and severe musculoskeletal infections. Epidemiology is underknown and underdiagnosis is likely. Recent travel abroad, case clustering and relapsing disease are often reported. We reviewed all cases of PVL-SA infection diagnosed at our center, and found 21 cases over a 43-month period. Most patients were adult males, had relevant travel history, reported recurrent disease and presented with SSTI. Etiologic diagnosis took up to five years; meanwhile, 42% of patients had antibiotic treatments. Draining procedures were required in 43% of patients and intensive care support in 19%. All patients recovered. Methicillin-resistance prevalence was 24%. Only 2/13 decolonized patients had posterior relapsing SSTI, both with likely infected contacts. PVL-SA infection's severity and impact are clear, even in small case series as ours. Physician awareness and active PVL-gene search are crucial for an adequate management.
Insights
Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) causes severe infections, often recurring. Early diagnosis and physician awareness are crucial for effective management of these challenging PVL-SA cases.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) is linked to severe skin, soft tissue, and respiratory infections.
- The epidemiology and diagnosis of PVL-SA infections are often underestimated, leading to delayed management.
- Recurrent disease, travel history, and case clustering are common features of PVL-SA infections.
Observation:
- A review of 21 PVL-SA cases over 43 months revealed predominantly adult males with travel history and recurrent skin and soft tissue infections (SSTI).
- Diagnostic delays averaged up to five years, during which patients received extensive antibiotic treatments.
- A significant proportion of patients required surgical draining procedures (43%) and intensive care support (19%).
Findings:
- Methicillin resistance was observed in 24% of PVL-SA isolates.
- Decolonization appeared effective in preventing recurrent SSTI, particularly when close contacts were not infected.
- Despite the severity, all patients in the series achieved recovery.
Implications:
- Increased physician awareness and active molecular testing for the PVL gene are essential for timely and accurate diagnosis.
- Understanding the risk factors and clinical presentation aids in managing PVL-SA infections more effectively.
- Further research into PVL-SA epidemiology and optimal treatment strategies is warranted.
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