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Folia Microbiol (2013) 58:225228 DOI 10.1007/s12223-012-0200-z
The first case of fatal pneumonia caused by PantonValentine leukocidin-producing Staphylococcus aureus in an infantin the Czech Republic
Helena Ambrozova & Vilma Maresova & Martin Fajt &
Petr Pavlicek & Hana Rohacova &
Ivana Machova & Petr Petras
Received: 12 July 2012 /Accepted: 5 October 2012 /Published online: 17 October 2012 # Institute of Microbiology, Academy of Sciences of the Czech Republic, v.v.i. 2012
Abstract PantonValentine leukocidin-producing strains of Staphylococcus aureus can cause severe skin and soft tissue infections and necrotizing pneumonia with a high mortality rate. This is a report on the first case of fatal pneumonia with mediastinitis in an infant in the Czech Republic. The causative agent was a methicillin-susceptible S. aureus strain with pronounced production of the PVL toxin and hyper-production of enterotoxin A.
AbbreviationsPVL PantonValentine leukocidinMRSA methicillin-resistant Staphylococcus aureus MSSA methicillin-susceptible Staphylococcus aureus
ENT ear, nose, and throat investigations NRL National Reference Laboratory RPLA reversed passive latex agglutination ICU intensive care unitCT computed tomography
Introduction
PantonValentine leukocidin (PVL) is a necrotizing exotoxin produced by both methicillin-susceptible and methicillin-resistant Staphylococcus aureus (MRSA) strains. PVL is a pore-forming toxin that causes damage to the membrane of leukocytes, leading to the destruction of white blood cells and tissue necrosis. Consequently, the immune response is altered, and the patient develops a highly virulent infection with a high mortality rate of up to 80 % (Kefala-Agoropoulou et al. 2010). The infection affects mostly younger patients. It is typically manifested by skin and soft tissue lesions (Daskalaki et al. 2010; Masiuk et al. 2010; Fontanilla et al. 2010) and often by fatal necrotizing pneumonia (Hidron et al. 2009; Kreienbuehl et al. 2011). In addition, PVL can be implicated in a number of other conditions such as bacteremia, sepsis, osteomyelitis, arthritis (Hall et al. 2010), myositis (Lehman et al. 2010), intravascular thrombosis (Kramkimel et al. 2009), brain abscess (Ramos et al. 2009), infectious endocarditis (Tsai et al. 2008), or Lemierre syndrome-imitating disease (Shivashankar et al. 2008). PVL-producing strains ofS. aureus are found globally, and necrotizing skin lesions have repeatedly been reported in travellers returning from the tropics (Schleucher et al. 2008).
H. Ambrozova : V. Maresova : H. Rohacova1st Department of Infectious Diseases, Bulovka Hospital, 2nd Faculty of Medicine, Charles University...