Severe invasive Panton-Valentine Leucocidin positive Staphylococcus aureus infections in children in London, UK

• Published in: The Journal of infection Vol. 59; no. 1; pp. 28 - 36
• Main Authors: Cunnington, A, Brick, T, Cooper, M, Danin, J, Hunt, D, Jeanes, A, Kearns, A.M, Nolan, M, Lyall, H
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-07-2009; Elsevier
• Subjects: Adolescent; Bacterial diseases; Bacterial Toxins - genetics; Biological and medical sciences; Child; Child, Preschool; Disease Progression; Exotoxins - genetics; Female; General aspects; Human bacterial diseases; Humans; Infectious Disease; Infectious diseases; Leukocidins - genetics; London - epidemiology; Male; Medical sciences; Musculoskeletal infection; Panton-Valentine Leucocidin; Risk Factors; Sepsis; Staphylococcal Infections - diagnosis; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal infections, streptococcal infections, pneumococcal infections; Staphylococcus aureus; Staphylococcus aureus - genetics; Staphylococcus aureus - isolation & purification; Staphylococcus aureus - pathogenicity; Venous Thrombosis - complications; United Kingdom; Europe; London; Panton-Valentine Leucocidin; Sepsis; Child; Staphylococcus aureus; Musculoskeletal infection; Human; Infection; Panton-Valentine leukocidin; Cytokine; Bacteriosis; Bacteria; Micrococcales; Micrococcaceae; Staphylococcal infection
• ISSN: 0163-4453; 1532-2742
• DOI: 10.1016/j.jinf.2009.05.003

Summary Objective To describe the features of invasive Panton-Valentine Leucocidin positive Staphylococcus aureus (PVL-SA) in children at a London teaching hospital, from 2004 to 2008. Methods Retrospective case note review. Results Eleven previously healthy children, 7 male, median age 9 years (range 7 months–13 years), had invasive infections due to unrelated community-acquired meticillin-sensitive PVL-SA. Possible risk factors were identified in 10 cases. Eight patients had complicated musculoskeletal infections, 2 had pneumonia, and 1 had a massive retropharyngeal abscess. At admission neutropenia was present in 2 patients, deep vein thrombosis in 3, and initial blood cultures were positive in 8. Patients with musculoskeletal involvement had a median of 3 (range 1–6) sites of infection, and required median 5 (range 1–11) operative procedures. Eight patients were admitted to PICU, 7 had septic shock. Median duration of hospital stay was 51 (range 14–255) days. One child died and 5 have long-term morbidity. Conclusions The clinical features of invasive PVL-SA in this series were similar to those reported from USA and Europe. Musculoskeletal infection was the most common manifestation, frequently progressing to multiple sites and severe sepsis. Most cases had risk factors and clinical features which might have allowed earlier diagnosis, and possibly improved outcome.