Panton-Valentine leukocidin (PVL) is associated with staphylococcal skin and pulmonary infections. Community dissemination of PVL-producing Staphylococcus aureus strains constitutes a public health concern. Family transmission and spread of community-acquired leukocidin-positive methicillin-susceptible S. aureus ST152 isolates associated with severe clinical symptoms are herein described. Remarkably, ST152 isolates usually are methicillin resistant.
CASE REPORTFrom July 2003 to December 2004, nine patients, members of a family and their relatives, had 20 episodes of skin infections, including abscesses in different body areas, bursitis, cellulitis, folliculitis, and furuncles. There was not any predisposed factor for soft tissue infection in the studied sample.Twenty-three cultures were performed at the Microbiology Department of the hospital, and three different Staphylococcus aureus strains were recovered from different clinical samples from patients (Table 1). Treatment measurements for methicillin-resistant S. aureus (MRSA) infections in hospitals were immediately implemented (13). Two of these three strains were isolated on repeated occasions, while the third one was isolated only once. The three strains had the same antibiotic resistance profile; they were resistant to penicillin (penicillinresistant S. aureus [PRSA]) and susceptible to clindamycin, ciprofloxacin, erythromycin, gentamicin, mupirocin, oxacillin, trimethoprim-sulfamethoxazole, rifampin, teicoplanin, and vancomycin. Molecular characterization of these PRSA strains signaled a remarkable association of community-acquired (CA) leukocidin-positive methicillin-susceptible S. aureus (MSSA) ST152 isolates with familial furunculosis.The nine patients were treated with systemic and topical antibiotherapy. Systemic antibiosis was used but the antibiotic and the treatment schedule changed depending on the patients' lesions. In cases of abscesses, 7 days of treatment with oral amoxicillin-clavulanic or cloxacillin was undergone. In cases of folliculitis, cellulitis, or bursitis, 3 days of intravenous (i.v.) amoxicillin-clavulanic, cloxacillin, or erythromycin treatment was administered. Some of them also needed surgical incisions and drainage. After the patients had been provided with information and teaching, all members of the family and relatives who were infected by Ն1 PRSA strain were prescribed with nasal mupirocin treatment twice a day and chlorhexidine showers once a day for 5 days. Moreover, the simultaneous use of alcohol-based hand rubs for the same people, plus all their relatives, was implemented. These measures were repeated each time that a member of this studied population became infected by PRSA. After application of these measures, there was satisfactory outcome of the episodes. Nevertheless, 1 year after the burst was thought to be solved, a new case of skin infection was detected in one son, who presented furuncle in the nape, infected by a Panton-Valentine leukocidin (PVL)-positive PRSA strain. He received antimicrobial therapy descr...