Panton-Valentine Leukocidin associated Staphylococcus aureus infections in London, England: Clinical and socio-demographic characterisation, management, burden of disease and associated costs

Abstract

Routine notification of Staphylococcus aureus producing the Panton-Valentine Leucocidin toxin (PVL-SA) to the North East & Central London Health Protection Unit, a communicable disease control unit covering a population of 2.8 million, identified 115 cases in 2009-2010, including 99 skin and soft tissue infections (SSTIs), 15 severe infections and one asymptomatic colonisation. Most cases occurred in children and young adults, unequally distributed geographically and socio-economically. The majority of infections were community acquired and 60% were caused by methicillin resistant strains. Overall, 27% of cases had previous SSTIs, and 32% had contacts with SSTIs suggestive of PVL-SA albeit these were not confirmed microbiologically. This suggests that characteristics of PVL-SA infection in cases and their families are not recognised as such leading to delay in diagnosis and low case ascertainment. A lack of governance around effective case management may also be contributing to the burden of disease. Further studies are recommended to evaluate key aspects of PVL-SA management including the effectiveness of decolonisation in the elimination of carriage and prevention of local spread.

Outpatient decolonization after recurrent skin infection with Panton-Valentine leukocidin (PVL)-producing S. aureus—The importance of treatment repetition

“…The patients in our cohort were on average 29 years old, confirming earlier studies on patients with community-onset PVL-SA-associated skin abscess [30,31]. Whether there are socio-cultural or medico-biological factors driving this observation is unclear.…”

“…PVL-SA-positive patients are often symptomatic for several months, before they are finally diagnosed and treated for PVL-SA [16,[26][27][28][29]. Our results thus underscore earlier work that shows that a diagnosis can be challenging in areas with low PVL-SA prevalence [6,30].…”

Bacterial skin flora and contamination of blood components: do we defer blood donors wisely?

“…The lifetime prevalence of atopic skin symptoms in elderly German persons (mean age 63 years) was found to be 4·3% [36]. As certain pathogenic and resistant bacterial strains are spreading in the community, an atopic or even a healthy person may harbour pathogenic species as part of transient flora [37].…”

Staphylococcus aureus abscesses: methicillin-resistance or Panton-Valentine leukocidin presence?

“…PVL-positive infections have been described across Europe, but it has been difficult to establish the true prevalence in children, as samples received by reference laboratories are highly selected and not representative of the whole spectrum of the disease 4. The aims of our study were: (i) to determine the prevalence of PVL in community-onset skin and soft-tissue infections (SSTIs) S aureus infections, (ii) to compare epidemiological and microbiological characteristics among children with PVL-positive and PVL-negative isolates and (iii) to analyse the influence of methicillin resistance and PVL presence on the clinical characteristics of these infections.…”