Association of Recurrent Furunculosis with Panton-Valentine Leukocidin and the Genetic Background of Staphylococcus aureus

Abstract

Staphylococcus aureus is a major cause of skin and soft tissue infections, such as furuncles, carbuncles, and abscesses, but it also frequently colonizes the human skin and mucosa without causing clinical symptoms. Panton-Valentine leukocidin (PVL) is a pore-forming toxin that has been associated with soft tissue infections and necrotizing pneumonia. We have compared the genotypes, virulence gene repertoires, and phage patterns of 74 furunculosis isolates with those of 108 control strains from healthy nasal carriers. The large majority of furunculosis strains were methicillin sensitive. Clonal cluster (CC) 121 (CC121) and CC22 accounted for 70% of the furunculosis strains but for only 8% of the nasal isolates. The PVL-encoding genes luk-PV were detected in 85% of furunculosis strains, while their prevalence among colonizing S. aureus strains was below 1%. luk-PV genes were distributed over several lineages (CCs 5, 8, 22, 30, and 121 and sequence type 59). Even within the same lineages, luk-PV-positive phages characterized furunculosis strains, while their luk-PV-negative variants were frequent among nasal strains. The very tight epidemiological linkage between luk-PV and furunculosis, which could be separated from the genetic background of the S. aureus strain as well as from the gene makeup of the luk-PV-transducing phage, lends support to the notion of an important role for PVL in human furunculosis. These results make a case for the determination of luk-PV in recurrent soft tissue infections with methicillin-sensitive as well as methicillin-resistant S. aureus.Skin and soft tissue infections (SSTIs) are the most frequent type of disease caused by Staphylococcus aureus outside the hospital setting. SSTIs comprise a diverse range of clinical pictures, such as furuncles, carbuncles, subcutaneous abscesses, folliculitis, bullous impetigo, and staphylococcal scalded skin syndrome (23

Antibacterial Activity of Cold Atmospheric Pressure Argon Plasma against 78 Genetically Different (<b><i>mecA</i></b>, <b><i>luk-P</i></b>, <b><i>agr</i></b> or Capsular Polysaccharide Type) <b><i>Staphylococcus aureus </i></b>Strains

“…Thereof, 19 S. aureus strains were obtained from the nasal cavity of asymptomatic carriers from Northern Germany (T, SH strains) [30], 6 strains were obtained from the nasal cavity of asymptomatic carriers from Szczecin, Poland (SZ strains) [31], 20 strains were obtained from patients from the University Hospital of Greifswald (BK strains) [30], and 17 strains were obtained from patients with furunculosis from a mature furuncle during the acute phase of skin infection or by a surgeon during abscess incision, as described in Masiuk et al [31] (H strains). All these strains were analysed for their clonal relationship ( spa typing), and genotyped (multiplex PCR) for a range of virulence factors, methicillin resistance (mecA) and luk-PV genes [30,31]. Based on this detailed characterization, we randomly selected strains from each clinical cohort (nasal colonization, blood culture, furunculosis) for subsequent analyses, representing the whole spectrum of virulence factors (table 1).…”

Staphylococcus aureus toxins – Their functions and genetics

“…CA-MRSA cause typical 11 diseases, namely skin and soft tissue infections (SSTIs), as well as necrotizing 12 pneumonia. However, PVL is not restricted to CA-MRSA, but the toxin is also found in the 13 majority of MSSA strains isolated from patients with community-acquired SSTIs 14 (Monecke, Slickers et al 2007;Masiuk, Kopron et al 2010). In contrast, the genes are Tseng, Kyme et al 2009;Villaruz, Bubeck Wardenburg et al 2009;Olsen, Kobayashi et 26 al.…”

“…as well as necrotizing pneumonia (Gillet, Issartel et al 2002), its role in these diseases 5 has remained under discussion. The genes of the F and S subunits are phage-encoded 6 (Table 2) and can thus be acquired by horizontal gene transfer (Kaneko,Kimura et al 7 1998; Masiuk, Kopron et al 2010). PVL genes are found in most CA-MRSA strains, which 8 exhibit increased virulence, e.g.…”

Rapid Detection of Panton-Valentine Leukocidin in Staphylococcus aureus Cultures by Use of a Lateral Flow Assay Based on Monoclonal Antibodies

“…PVL is frequently detected in S. aureus isolates from skin and soft-tissue infections (SSTI) (4,5) and is associated with chronic/ recurrent infections, such as furunculosis, especially in young and previously healthy adults. PVL-positive S. aureus can also cause more severe diseases, such as necrotizing pneumonia.…”