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Original article

Vol. 148 No. 3738 (2018)

Paediatric musculoskeletal infections with Panton-Valentine leucocidin

  • Maciej K. Albiński
  • Nicolas Lutz
  • Dimitri Ceroni
  • Daniel N'Dele
  • Pierre-Yves Zambelli
  • Aline Bregou
DOI
https://doi.org/10.4414/smw.2018.14669
Cite this as:
Swiss Med Wkly. 2018;148:w14669
Published
23.09.2018

Summary

AIMS OF THE STUDY

Paediatric musculoskeletal infections by Panton-Valentine leucocidin (PVL)-producing Staphylococcus aureus constitute a rare, but highly critical event. They are characterised by a rapid course of marked inflammation, worsening under conservative therapy and a high rate of recurrence. This study aimed to illustrate the importance of paediatric PVL-producing S. aureus musculoskeletal infections in western Switzerland.

METHODS

Case records, clinical parameters and biological assessments of children with musculoskeletal infections due to PVL-producing S. aureus who attended the University Hospitals of Lausanne and Geneva from 2008 to 2016 were studied retrospectively.

RESULTS

Of the nine cases (seven male), four presented with haematogenous acute osteomyelitis, two with septic arthritis, and three with skin and soft tissue infections. Laboratory analysis revealed mean values for white blood cell count of 12,700/mm3, C-reactive protein (CRP) 171mg/l, erythrocyte sedimentation rate (ESR) 62 mm/h and platelet count 241,000/mm3. Notably, fever and laboratory values were higher for osteoarticular infections. PVL was produced by methicillin-sensitive S. aureus (MSSA) in eight cases and by community-acquired methicillin-resistant S. aureus (CA-MRSA) in one case. PVL was identified in blood cultures (six cases), operative samples (seven cases) and an oral swab (one case). Treatment relied on surgical procedures, endorsed by two-agent antimicrobial therapy for up to 9 weeks. Complications included recurrent infections (five cases), pathological fracture (one case) and growth arrest (two cases), as well as an important psychological impact (one case).

CONCLUSION

The results of this study highlight the low prevalence of PVL-producing S. aureus musculoskeletal infections in the paediatric population in our region. Nevertheless, given the importance of complications, the recurrence rate and the duration of treatment, clinicians caring for children need to be especially well versed with the peculiarity of this entity. Retrospective case series. Level of evidence: IV

References

  1. Ritz N, Curtis N. The role of Panton-Valentine leukocidin in Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. 2012;31(5):514–8. doi:.https://doi.org/10.1097/INF.0b013e31824f18cb
  2. Gijón M, Bellusci M, Petraitiene B, Noguera-Julian A, Zilinskaite V, Sanchez Moreno P, et al. Factors associated with severity in invasive community-acquired Staphylococcus aureus infections in children: a prospective European multicentre study. Clin Microbiol Infect. 2016;22(7):643.e1–6. doi:.https://doi.org/10.1016/j.cmi.2016.04.004
  3. Shallcross LJ, Fragaszy E, Johnson AM, Hayward AC. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: a systematic review and meta-analysis. Lancet Infect Dis. 2013;13(1):43–54. doi:.https://doi.org/10.1016/S1473-3099(12)70238-4
  4. Martínez-Aguilar G, Avalos-Mishaan A, Hulten K, Hammerman W, Mason EO, Jr, Kaplan SL. Community-acquired, methicillin-resistant and methicillin-susceptible Staphylococcus aureus musculoskeletal infections in children. Pediatr Infect Dis J. 2004;23(8):701–6. doi:.https://doi.org/10.1097/01.inf.0000133044.79130.2a
  5. Bocchini CE, Hulten KG, Mason EO, Jr, Gonzalez BE, Hammerman WA, Kaplan SL. Panton-Valentine leukocidin genes are associated with enhanced inflammatory response and local disease in acute hematogenous Staphylococcus aureus osteomyelitis in children. Pediatrics. 2006;117(2):433–40. doi:.https://doi.org/10.1542/peds.2005-0566
  6. Sdougkos G, Chini V, Papanastasiou DA, Christodoulou G, Tagaris G, Dimitracopoulos G, et al. Methicillin-resistant Staphylococcus aureus producing Panton-Valentine leukocidin as a cause of acute osteomyelitis in children. Clin Microbiol Infect. 2007;13(6):651–4. doi:.https://doi.org/10.1111/j.1469-0691.2007.01713.x
  7. Dohin B, Gillet Y, Kohler R, Lina G, Vandenesch F, Vanhems P, et al. Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J. 2007;26(11):1042–8. doi:.https://doi.org/10.1097/INF.0b013e318133a85e
  8. Gillet Y, Dohin B, Dumitrescu O, Lina G, Vandenesch F, Etienne J, et al. Infections ostéoarticulaires à staphylocoques dorés sécréteurs de la leucocidine de Panton-Valentine [Osteoarticular infections with staphylococcus aureus secreting Panton-Valentine leucocidin]. Arch Pediatr. 2007;14(Suppl 2):S102–7. Article in French. doi:.https://doi.org/10.1016/S0929-693X(07)80043-1
  9. Cunnington A, Brick T, Cooper M, Danin J, Hunt D, Jeanes A, et al. Severe invasive Panton-Valentine Leucocidin positive Staphylococcus aureus infections in children in London, UK. J Infect. 2009;59(1):28–36. doi:.https://doi.org/10.1016/j.jinf.2009.05.003
  10. Morrey BF, Bianco AJ, Jr, Rhodes KH. Septic arthritis in children. Orthop Clin North Am. 1975;6(4):923–34.
  11. Jaton L, Pillonel T, Jaton K, Dory E, Prod’hom G, Blanc DS, et al. Common skin infection due to Panton-Valentine leucocidin-producing Staphylococcus aureus strains in asylum seekers from Eritrea: a genome-based investigation of a suspected outbreak. Clin Microbiol Infect. 2016;22(8):739.e5–8. doi:.https://doi.org/10.1016/j.cmi.2016.05.026
  12. Mégevand C, Gervaix A, Heininger U, Berger C, Aebi C, Vaudaux B, et al.; Paediatric Infectious Disease Group Switzerland Staphylococcus aureus Study Group. Molecular epidemiology of the nasal colonization by methicillin-susceptible Staphylococcus aureus in Swiss children. Clin Microbiol Infect. 2010;16(9):1414–20. doi:.https://doi.org/10.1111/j.1469-0691.2009.03090.x
  13. Petrovic-Jeremic L, Kuljic-Kapulica N, Ristanovic E, Josic D, Lepsanovic Z. Prevalence of Panton-Valentine leukocidin genes in community-associated methicillin-resistant Staphylococcus aureus in the District of Pomoravlje. Vojnosanit Pregl. 2016;73(3):256–60. doi:.https://doi.org/10.2298/VSP140715003P
  14. Gillet-Vittori L, Afanetti M, Dupont A, Gondon E, Dupont D. Infections sévères à Staphylococcus aureus sécréteurs de la leucocidine de Panton–Valentine chez l’enfant : un large spectre de presentations cliniques [Life-threatening Panton-Valentine leukocidin-associated staphylococcal infections in children. A broad spectrum of clinical presentations]. Arch Pediatr. 2014;21(11):1220–5. Article in French. doi:.https://doi.org/10.1016/j.arcped.2014.08.016
  15. Shallcross LJ, Williams K, Hopkins S, Aldridge RW, Johnson AM, Hayward AC. Panton-Valentine leukocidin associated staphylococcal disease: a cross-sectional study at a London hospital, England. Clin Microbiol Infect. 2010;16(11):1644–8. doi:.https://doi.org/10.1111/j.1469-0691.2010.03153.x
  16. Boyle-Vavra S, Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton-Valentine leukocidin. Lab Invest. 2007;87(1):3–9. doi:.https://doi.org/10.1038/labinvest.3700501
  17. Couvé-Deacon E, Tristan A, Pestourie N, Faure C, Doffoel-Hantz V, Garnier F, et al. Outbreak of Panton-Valentine Leukocidin-Associated Methicillin-Susceptible Staphylococcus aureus Infection in a Rugby Team, France, 2010-2011. Emerg Infect Dis. 2016;22(1):96–9. doi:.https://doi.org/10.3201/eid2201.150597
  18. Boubaker K, Diebold P, Blanc DS, Vandenesch F, Praz G, Dupuis G, et al. Panton-valentine leukocidin and staphyloccoccal skin infections in schoolchildren. Emerg Infect Dis. 2004;10(1):121–4. doi:.https://doi.org/10.3201/eid1001.030144
  19. Gillet Y, Dumitrescu O, Tristan A, Dauwalder O, Javouhey E, Floret D, et al. Pragmatic management of Panton-Valentine leukocidin-associated staphylococcal diseases. Int J Antimicrob Agents. 2011;38(6):457–64. doi:.https://doi.org/10.1016/j.ijantimicag.2011.05.003
  20. Dumitrescu O, Boisset S, Badiou C, Bes M, Benito Y, Reverdy ME, et al. Effect of antibiotics on Staphylococcus aureus producing Panton-Valentine leukocidin. Antimicrob Agents Chemother. 2007;51(4):1515–9. doi:.https://doi.org/10.1128/AAC.01201-06
  21. Dumitrescu O, Badiou C, Bes M, Reverdy ME, Vandenesch F, Etienne J, et al. Effect of antibiotics, alone and in combination, on Panton-Valentine leukocidin production by a Staphylococcus aureus reference strain. Clin Microbiol Infect. 2008;14(4):384–8. doi:.https://doi.org/10.1111/j.1469-0691.2007.01947.x

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