Nasal Carriage in Staphylococcal Skin Infections

Tulloch, Luis G.

doi:10.1136/bmj.2.4893.912

Cited by 56 publications

(19 citation statements)

References 8 publications

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“…The implementation of a luk-PV test for the diagnosis of S. aureus infection would therefore provide important information for the treating clinician. Our findings are also relevant for therapy, because we and others have shown that the vast majority of patients with chronic furunculosis (87 to 100%) are nasal carriers of their infecting S. aureus strain (10,48,51). To prevent repeated reinfection, the elimination of this S. aureus strain from the whole body as well as the patient's environment should be the aim of therapy for chronic furunculosis (58,61).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2010

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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

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Section: Discussionmentioning

confidence: 99%

“…About 20% of the healthy population are persistent nasal S. aureus carriers (53,57). Patients suffering from chronic furunculosis are usually S. aureus carriers, and skin and nose isolates from a given patient commonly have identical characteristics (10,48,51).…”

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confidence: 99%

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

et al. 2010

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“…aureus is common in healthy persons, and is of considerable epidemiological importance in outbreaks of food-poisoning and other infective conditions. It has recently been suggested as the source of infection in some pyogenic skin diseases, including impetigo (Hobbs, Carruthers & Gough, 1947;Tulloch, 1954;Cruickshank, 1953). Fifty-four of the 100 impetigo patients yielding staphylococci from lesions harboured Staph.…”

Section: Bacteriological Methodsmentioning

confidence: 99%

Clinical and Bacteriological Aspects of Impetigo Contagiosa

Barrow¹

1955

Epidemiol. Infect.

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Summary1. The results of an investigation into the clinical, epidemiological and bacteriological features of impetigo contagiosa, with special reference to the type identification of staphylococci and streptococci, are reported and discussed.2. Of 106 impetigo cases studied, Staphylococcus aureus was isolated alone from 86 lesions (81 %), Streptococcus pyogenes alone from 6 (5·6 %), and a mixed growth of Staph. aureus and haemolytic streptococci in 14 instances (13·2 %).3. Of the 100 strains of Staph. aureus isolated from impetigo lesions, 63 were identical in phage type (‘type 71’), and a further 17 were closely related (‘weak 71’).4. Only one representative of ‘type 71’, and 9 of ‘weak 71’, were obtained from 164 strains of Staph. aureus from 200 persons in three control groups.5. Of 90 strains of Staph. aureus from impetigo lesions, 64 (71 %) were resistant to penicillin. Of these penicillin-resistant strains, 54 (84 %) were of ‘type 71’, or close variants.6. Strep, pyogenes was probably causative in at least 6 of the 18 patients yielding this organism from lesions; it was presumed to be a secondary invader in the remainder.7. It is doubtful if nasal carriage is of importance in the epidemiology of impetigo.8. It is concluded that there is a specific ‘type’ of staphylococcus associated with this form of impetigo.

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“…21 has shown that prolonged staphylococcal carriage in anterior nares could also be one of the causative factors for primary pyoderma. Tulloch et al 22 provided the strains of staphylococci isolated from a skin infection and from the anterior nares of the same patient were identical. This proved that nose is the primary source of infecting organisms in most cases of chronic staphylococcal skin infections.…”

Section: Discussionmentioning

confidence: 99%