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Published on: February 9, 2011
Skin Infections Due to Panton-Valentine Leukocidin-Producing S. Aureus
Rasmus Leistner1, Leif G Hanitsch, Renate Krüger
1Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Pediatric Pneumology, Immunology and Intensive Care, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg; Department of Infectious Diseases and Microbiology, University Medical Center Schleswig-Holstein, Lübeck; Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; European network on imported Staphylococcus aureus.
Insights
Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) causes recurring skin abscesses. Diagnosis involves S. aureus culture and PCR, with treatment including drainage and decolonization to prevent recurrence.
Area of Science:
- Dermatology
- Infectious Diseases
- Microbiology
Background:
- Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) strains are linked to recurrent skin abscesses in young individuals.
- Clinical presentation, diagnosis, and treatment of PVL-SA infections are not widely recognized.
Approach:
- A selective PubMed search focused on pertinent publications and international recommendations.
- Review of evidence, primarily from nonrandomized cohort studies and experimental analyses (Level IIb).
Key Points:
- PVL-SA causes leukocytolysis and dermatonecrosis via pore formation, with no specific predilection site.
- PVL-SA accounts for a significant percentage of S. aureus skin and soft tissue infections (61.3% in Germany).
- PVL-SA skin infections recur three times more frequently than those caused by PVL-negative S. aureus.
Conclusions:
- Diagnosis relies on S. aureus culture and PCR detection of the PVL gene from wound and nasal/pharyngeal swabs.
- Acute management involves abscess drainage and potentially antimicrobial therapy.
- Secondary prevention includes topical mupirocin and whole-body cleansing with chlorhexidine or octenidine.
Background:
Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) strains are frequently associated with large, recurring abscesses in otherwise healthy young individuals. The typical clinical presentation and the recommended diagnostic evaluation and treatment are not widely known.
Methods:
This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to international recommendations.
Results:
PVL-SA can cause leukocytolysis and dermatonecrosis through specific cell-wall pore formation. Unlike other types of pyoderma, such conditions caused by PVL-SA have no particular site of predilection. In Germany, the PVL gene can be detected in 61.3% (252/411) of skin and soft tissue infections with S. aureus. Skin and soft tissue infections with PVL-SA recur three times as frequently as those due to PVL-negative S. aureus. They are diagnosed by S. aureus culture from wound swabs and combined nasal/pharyngeal swabs, along with PCR for gene detection. The acute treatment of the skin abscesses consists of drainage, followed by antimicrobial therapy if needed. Important secondary preventive measures include topical cleansing with mupirocin nasal ointment and whole-body washing with chlorhexidine or octenidine. The limited evidence (level IIb) concerning PVL-SA is mainly derived from nonrandomized cohort studies and experimental analyses.
Conclusion:
PVL-SA skin infections are easily distinguished from other skin diseases with targeted history-taking and diagnostic evaluation.
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