Paediatric musculoskeletal infections with Panton-Valentine leucocidin

Abstract

AIMS OF THE STUDY: Paediatric musculoskeletal infections by Panton-Valentine leucocidin (PVL)-producingStaphylococcus aureus constitute a rare, but highly critical event. They are characterised by a rapid course of marked inflammation, worsening under conservative therapy and a high rate of recurrence. This study aimed to illustrate the importance of paediatric PVL-producing S. aureus musculoskeletal infections in western Switzerland. METHODS: Case records, clinical parameters and biological assessments of children with musculoskeletal infections due to PVL-producing S. aureus who attended the University Hospitals of Lausanne and Geneva from 2008 to 2016 were studied retrospectively. RESULTS: Of the nine cases (seven male), four presented with haematogenous acute osteomyelitis, two with septic arthritis, and three with skin and soft tissue infections. Laboratory analysis revealed mean values for white blood cell count of 12,700/mm 3 , C-reactive protein (CRP) 171mg/ l, erythrocyte sedimentation rate (ESR) 62 mm/h and platelet count 241,000/mm 3 . Notably, fever and laboratory values were higher for osteoarticular infections. PVL was produced by methicillin-sensitive S. aureus (MSSA) in eight cases and by community-acquired methicillin-resistant S. aureus (CA-MRSA) in one case. PVL was identified in blood cultures (six cases), operative samples (seven cases) and an oral swab (one case). Treatment relied on surgical procedures, endorsed by two-agent antimicrobial therapy for up to 9 weeks. Complications included recurrent infections (five cases), pathological fracture (one case) and growth arrest (two cases), as well as an important psychological impact (one case). CONCLUSION:The results of this study highlight the low prevalence of PVL-producing S. aureus musculoskeletal infections in the paediatric population in our region. Nevertheless, given the importance of complications, the recurrence rate and the duration of treatment, clinicians caring for children need to be especially well versed with the peculiarity of this entity. Retrospective case series. Level of evidence: IV

Erythrocyte Sedimentation Rate for Assisted Diagnosis of Pediatric Osteomyelitis: A Meta-Analysis

“…The aforementioned search approach resulted in 260 papers, of which 8 were eventually included in the qualitative analysis. ( Figure 1 ): Butbul-Aviel et al, 12 Riise et al, 11 Paakkonen et al, 10 Reitzenstein et al, 8 Nduaguba et al, 13 Maciej K et al, 14 Zulian et al, 15 Chen et al 16 Of this, 2 were from USA, 1 each from Finland, Israel, Norway, China, Switzerland, and Italy. A total of 1016 patients were enrolled from 2005 until 2021.…”

Acute Prosthetic Joint Infections with Poor Outcome Caused by Staphylococcus Aureus Strains Producing the Panton–Valentine Leukocidin

“…Over the last decade, the emergence of PVL-producing SA strains has become an increasing concern due to their ability to induce severe osteoarticular and multifocal infections, particularly in children [ 36 , 37 , 38 ]. Moreover, a new species of particularly aggressive community-acquired MRSA, producing PVL, has been reported to be responsible for deep, multifocal skin abscesses in long-term familial clusters [ 39 ].…”

Surveillance of osteoarticular infections caused by Staphylococcus aureus in a paediatric hospital in Mexico City

“…PVL toxin has been detected in both MSSA and MRSA isolates ( Albiński et al., 2018 ; Hoppe et al., 2019 ). It is recognized that there are geographic differences in its distribution; in Europe, most pvl -containing strains are MSSA ( Bouras et al., 2018 ; Hardy et al., 2019 ), while in the USA, they are predominant in CA-MRSAs (74-100%) ( Ritz and Curtis, 2012 ).…”