Panton-Valentine leukocidin-secreting Staphylococcus aureus causing severe musculoskeletal sepsis in children

Abstract

Panton-Valentine leukocidin secreted by Staphylococcus aureus is known to cause severe skin, soft tissue and lung infections. However, until recently it has not been described as causing life-threatening musculoskeletal infection. We present four patients suffering from osteomyelitis, septic arthritis, widespread intravascular thrombosis and overwhelming sepsis from proven Panton-Valentine leukocidin-secreting Staphylococcus aureus. Aggressive, early and repeated surgical intervention is required in the treatment of these patients. The Panton-Valentine leukocidin toxin not only destroys host neutrophils, immunocompromising the patient, but also increases the risk of intravascular coagulopathy. This combination leads to widespread involvement of bone with glutinous pus which is difficult to drain, and makes the delivery of antibiotics and eradication of infection very difficult without surgical intervention.

Etiología y evolución de las infecciones osteo-articulares 2009-2015: Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Uruguay

“…Estudios microbiológicos señalan que la gravedad de S. aureus no es una característica exclusiva de las cepas resistentes a meticilina, si bien éstas parecen poseer más atributos de virulencia, como la producción de una proteína de unión al colágeno (CNA) y de una exotoxina la leucocidina de PantonValantine que destruye los neutrófilos del hospedero generando inmunocompromiso y aumentando el riesgo de coagulopatía intravascular. Conduce además a la producción de material purulento más aglutinado, difícil de drenar y erradicar, por lo que el abordaje quirúrgico generalmente es más complejo y frecuente [36][37][38][39] . Las dos muertes se registraron también en este grupo etiológico.…”

Heavy chain-only antibodies and tetravalent bispecific antibody neutralizing Staphylococcus aureus leukotoxins

“…One of the toxins, Panton-Valentine leukocidin (PVL) is associated with human pyogenic necrotizing skin infections such as furuncles, cellulitis, and abscesses, and more severe septic infections such as osteomyelitis, bacteremia, purpura fulminans, and necrotizing pneumonia (1)(2)(3)(4)(5)(6)(7)(8). PVL with γ-hemolysins (HlgA/HlgB and HlgC/ HlgB) and LukE/LukD belongs to the bicomponent pore-forming leukotoxin family (9)(10)(11)(12)(13)(14), which are thought to contribute to virulence in various infection models (15)(16)(17)(18), although some groups disagree (19,20).…”

Tropical primary pyomyositis in children of the UK: an emerging medical challenge

“…PP can occur in any age group although it is common in the first and second decade of life. Children seldom have pre-existing conditions in comparison to adults [2][3][4][5][6][7][8][12][13][14][15][16]. Only two patients in our series had any preexisting medical problems although not directly linked.…”

“…We did not identify the PVL status of Staphylococcus aureus isolates in any of our patients. There is a suggestion in the literature to request PVL status of all Staphylococcus aureus isolates in suspected musculoskeletal sepsis [3].…”