Panton-Valentine leukocidin osteomyelitis in children: a growing threat

Abstract

Panton-Valentine leukocidin-producing Staphylococcus aureus osteomyelitis is associated with multiple complications including multiple abscesses, deep vein thrombosis and fulminant sepsis. This article reviews the literature concerning this emerging threat which is currently under-recognized.

Serious life-threatening multifocal infection in a child, caused by Panton-Valentine leucocidin-producingStaphylococcus aureus(PVL-MSSA)

“…It was found that people living in closed communities with close contact (prisons and military training camps) and those who participate in contact sports (gym, rugby, wrestling and judo) are at risk. In addition, poor personal hygiene and use of contaminated shared items, such as towels, can increase the risk of infection 2. Cutaneous infections are often recurrent.…”

“…PVL-MSSA can cause septic shock and could be fatal 9. It is also associated with osteomyelitis, septic arthritis and pyomyositis 2. A systematic review of 32 patients demonstrated that septic shock, influenza like prodrome and absence of previous skin and soft tissue infections are associated with fatal outcome.…”

“…PVL-MSSA is also found in invasive infections such as necrotising pneumonia3 and necrotising fasciitis 4. It is associated with osteomyelitis, septic arthritis and pyomyositis 2. This case demonstrates that severe non-traumatic groin pain in children should not be ignored and should be investigated similarly to traumatic hip pain.…”

“…PVL-MSSA is a cause of recurrent skin and soft tissue infections in otherwise fit and healthy patients 1. Those at risk include those in closed communities with close contact and those who participate in contact sports or through the use of contaminated shared items such as towels 2. PVL-MSSA is also found in invasive infections such as necrotising pneumonia3 and necrotising fasciitis 4.…”

The staphylococcal alpha-toxin and leukotoxins

“…The occurrence of PVL-producing strains does not exceed 2-5% among human routine clinical isolates in Europe, but can be higher in some other countries [111]. Associations with osteomyelitis and pyomyositis are now strongly suggested [117][118][119][120][121][122][123]. The locus encoding PVL is inside related bacteriophages [124][125][126][127]128].…”