An outbreak of cutaneous abscesses caused by Panton-Valentine leukocidin-producing methicillin-susceptible Staphylococcus aureus among gold mine workers, South Africa, November 2017 to March 2018

Abstract

Background We aimed to describe an outbreak of cutaneous abscesses caused by Panton-Valentine leukocidin (PVL)-producing methicillin-susceptible Staphylococcus aureus (MSSA) among gold mine workers. Methods In February 2018, we retrospectively reviewed a random sample of 50 medical records from 243 cases and conducted face-to-face interviews using a structured questionnaire. Pus aspirates were sent to the National Institute for Communicable Diseases from prospectively-identified cases (November 2017–March 2018). Nasopharyngeal swabs were collected during a colonisation survey in February 2018. Staphylococcus aureus isolates were screened with a conventional PCR for lukS/F -PV. Pulsed-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness among the isolates. A sample of isolates were selected for whole genome sequencing (WGS). We conducted an assessment on biological risks associated with mining activities. Results From January 2017 to February 2018, 10% (350/3582) of mine workers sought care for cutaneous abscesses. Forty-seven medical files were available for review, 96% were male ( n = 45) with a mean age of 43 years (SD = 7). About 52% (24/46) were involved in stoping and 28% (13/47) worked on a particular level. We cultured S. aureus from 79% (30/38) of cases with a submitted specimen and 14% (12/83) from colonisation swabs. All isolates were susceptible to cloxacillin. Seventy-one percent of S. aureus isolates (30/42) were PVL-PCR-positive. Six PFGE clusters were identified, 57% (21/37) were closely related. WGS analysis found nine different sequence types. PFGE and WGS analysis showed more than one cluster of S. aureus infections involving closely related isolates. Test reports for feed and product water of the mine showed that total plate counts were above the limits of 1000 cfu/ml, coliform counts > 10 cfu/100 ml and presence of faecal coliforms. Best practices were poorly implemented as some mine workers washed protective clothing with untreated water and hung them for drying at the underground surface. Conclusions PVL-producing MSSA caused an outbreak of cutaneous abscesses among underground workers at a gold mining company. To our knowledge, no other outbreaks of PVL-producing S. aureus involving skin and soft tissue infections have been reported in mining facilities in South Africa. We recommend that worker awareness of infection prevention and control practices be strengthened.

Ward-specific clustering of methicillin-resistant Staphylococcus aureus spa-type t037 and t045 in two hospitals in South Africa: 2013 to 2017

“…adult and paediatric wards) were selected for PFGE. PFGE was done as previously described [27,28]. Cluster analysis was done in BioNumerics (GelCompar II Gel Electrophoresis Software, Version 7.6, Applied Math, UK).…”

From skin infection to invasive diseases: A descriptive review of Staphylococcus aureus, focusing on Panton-Valentine leucocidin and methicillin-resistant strains

“…In a recent retrospective study, Rochet et al (2020) have shown that the rate of patients visits for skin abscesses in the emergency department has increased significantly and that S. aureus was the pathogen involved in 73% of these infections (Rochet et al, 2020). Moreover, Ismail et al (2020) have described a large epidemic of skin abscesses among gold mine employers in South Africa. S. aureus PVL was responsible for this epidemic, due to cross-contamination resulting from poor hygiene practices.…”

Skin infections due to Panton-Valentine leukocidin (PVL)-producing S. aureus—Cost effectiveness of outpatient treatment

“…International travel is another risk factor. This has been described, for example, in travelers returning from Africa [ 6 ] or the Americas [ 7 ].…”