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Jhelum H, Čerina D, Harbort CJ, Lindner A, Hanitsch LG, Leistner R, Schröder JT, von Bernuth H, Stegemann MS, Schürmann M, Zychlinsky A, Krüger R, Marsman G. Panton-Valentine leukocidin-induced neutrophil extracellular traps lack antimicrobial activity and are readily induced in patients with recurrent PVL + -Staphylococcus aureus infections. J Leukoc Biol 2024; 115:222-234. [PMID: 37943843 DOI: 10.1093/jleuko/qiad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023] Open
Abstract
Staphylococcus aureus strains that produce the toxin Panton-Valentine leukocidin (PVL-SA) frequently cause recurrent skin and soft tissue infections. PVL binds to and kills human neutrophils, resulting in the formation of neutrophil extracellular traps (NETs), but the pathomechanism has not been extensively studied. Furthermore, it is unclear why some individuals colonized with PVL-SA experience recurring infections whereas others are asymptomatic. We thus aimed to (1) investigate how PVL exerts its pathogenicity on neutrophils and (2) identify factors that could help to explain the predisposition of patients with recurring infections. We provide genetic and pharmacological evidence that PVL-induced NET formation is independent of NADPH oxidase and reactive oxygen species production. Moreover, through NET proteome analysis we identified that the protein content of PVL-induced NETs is different from NETs induced by mitogen or the microbial toxin nigericin. The abundance of the proteins cathelicidin (CAMP), elastase (NE), and proteinase 3 (PRTN3) was lower on PVL-induced NETs, and as such they were unable to kill S. aureus. Furthermore, we found that neutrophils from affected patients express higher levels of CD45, one of the PVL receptors, and are more susceptible to be killed at a low PVL concentration than control neutrophils. Neutrophils from patients that experience recurring PVL-positive infections may thus be more sensitive to PVL-induced NET formation, which might impair their ability to combat the infection.
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Affiliation(s)
- Hina Jhelum
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117, Berlin, Germany
| | - Dora Čerina
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117, Berlin, Germany
| | - C J Harbort
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Lindner
- Institute of Tropical Medicine and International Health, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Leif Gunnar Hanitsch
- Department of Medical Immunology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Jennyver-Tabea Schröder
- Department of Pediatric Surgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Horst von Bernuth
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Department of Immunology, Labor Berlin GmbH, Sylter Straße 2, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
- Berlin-Brandenburg Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Miriam Songa Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Mariana Schürmann
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Arturo Zychlinsky
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117, Berlin, Germany
| | - Renate Krüger
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Gerben Marsman
- Department of Cellular Microbiology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117, Berlin, Germany
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Martins DM, Cardoso EM, Capellari L, Botelho LAB, Ferreira FA. Detection of Staphylococcus aureus from nares of elderly living in a Brazilian nursing home. Diagn Microbiol Infect Dis 2024; 108:116089. [PMID: 37931385 DOI: 10.1016/j.diagmicrobio.2023.116089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/23/2023] [Accepted: 09/14/2023] [Indexed: 11/08/2023]
Abstract
Asymptomatically nasal colonization by Staphylococcus aureus is a well-established risk factor for S. aureus infections. The aimed of the study was to identify the prevalence and factors associated with nasal carriage of S. aureus and Methicillin-resistant S. aureus (MRSA) from individuals residing in one Brazilian nursing home (NH). Three time-separate nasal swab collections were obtained from the elderly enrolled. The S. aureus isolates identified were submitted to Antimicrobial Susceptibility test (AST). The study showed a high prevalence of S. aureus (n = 9; 60%) and MRSA (n = 4; 26.7%) among elderly. Resistance to erythromycin was the most detected. S. aureus or MRSA colonization could not be associated to the data collected on demographics, personal habits, and medical history of the participants. Despite the small number of individuals enrolled, our study can contribute to improve the control of S. aureus and MRSA dissemination within the community, especially among the most vulnerable like the elderly.
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Affiliation(s)
- Damaris Miriã Martins
- Laboratório de Genética Molecular Bacteriana (GeMBac), Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Emanuela Mendes Cardoso
- Laboratório de Genética Molecular Bacteriana (GeMBac), Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Lilian Capellari
- Laboratório de Genética Molecular Bacteriana (GeMBac), Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Larissa Alvarenga Batista Botelho
- Departamento de Microbiologia Medica, Instituto de Microbiologia Paulo de Goes, Centro de Ciencias da Saude, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fabienne Antunes Ferreira
- Laboratório de Genética Molecular Bacteriana (GeMBac), Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina (UFSC), Florianópolis, SC, Brazil.
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Balakirski G, Hofmann SC. [Genitoanal infections caused by Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus : Smear infection or sexually transmitted disease?]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:55-60. [PMID: 37982858 DOI: 10.1007/s00105-023-05255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
Panton-Valentine leukocidin (PVL) is a pore-forming exotoxin produced by certain Staphylococcus (S.) aureus strains, which is responsible for the increased virulence of the pathogen. Thus, infections caused by PVL-positive S. aureus tend to recur. Usually, the infection is a smear infection, which can cause folliculitis and purulent lid margin inflammation in addition to the classic mucocutaneous abscesses. Recently, recurrent genitoanal infections caused by PVL-positive S. aureus have also been described. In most cases, this is a sexually transmitted disease. Currently, it is assumed that most infections are imported from abroad. In addition to treatment of these infections, decolonization should be performed for prophylaxis of recurrence.
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Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland.
| | - Silke C Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
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Characterization of PVL-Positive MRSA Isolates in Northern Bavaria, Germany over an Eight-Year Period. Microorganisms 2022; 11:microorganisms11010054. [PMID: 36677346 PMCID: PMC9867130 DOI: 10.3390/microorganisms11010054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Community-acquired methicillin-resistant Staphylococcus aureus strains (CA-MRSA) are spread worldwide and often cause recurring and persistent infections in humans. CA-MRSA strains frequently carry Panton-Valentine leukocidin (PVL) as a distinctive virulence factor. This study investigates the molecular epidemiology, antibiotic resistance and clinical characteristics of PVL-positive MRSA strains in Northern Bavaria, Germany, isolated over an eight-year period. METHODS Strains were identified by MALDI-TOF MS and antibiotic susceptibility was tested by automated microdilution (VITEK 2) or disk diffusion. PVL-encoding genes and mecA were detected by PCR. MRSA clonal complexes (CC) and lineages were assigned by genotyping via DNA microarray and spa-typing. RESULTS In total, 131 PVL-positive MRSA were collected from five hospital sites between 2009 and 2016. Predominant lineages were CC8-MRSA-[IV+ACME], USA300 (27/131; 20.6%); CC30-MRSA-IV, Southwest Pacific Clone (26/131; 19.8%) and CC80-MRSA-IV (25/131; 19.1%). Other CCs were detected less frequently. Resistance against erythromycin and clindamycin was prevalent, whereas all strains were sensitive towards vancomycin and linezolid. In total, 100 cases (76.3%) were causally linked to an infection. The majority (102/131; 77.9%) of isolates were detected in skin swabs or swabs from surgical sites. CONCLUSIONS During the sample period we found an increase in the PVL-positive MRSA lineages CC30 and CC1. Compared to less-abundant lineages CC1 or CC22, the predominant lineages CC8, CC30 and CC80 harbored a broader resistance spectrum. Furthermore, these lineages are probably associated with a travel and migration background. In the spatio-temporal setting we investigated, these were arguably drivers of diversification and change in the landscape of PVL-positive MRSA.
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Leistner R, G. Hanitsch L, Krüger R, K. Lindner A, S. Stegemann M, Nurjadi D. Skin Infections Due to Panton-Valentine Leukocidin-Producing S. Aureus. DEUTSCHES ARZTEBLATT INTERNATIONAL 2022; 119:775-784. [PMID: 36097397 PMCID: PMC9884843 DOI: 10.3238/arztebl.m2022.0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/15/2022] [Accepted: 08/16/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) strains are frequently associated with large, recurring abscesses in otherwise healthy young individuals. The typical clinical presentation and the recommended diagnostic evaluation and treatment are not widely known. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to international recommendations. RESULTS PVL-SA can cause leukocytolysis and dermatonecrosis through specific cell-wall pore formation. Unlike other types of pyoderma, such conditions caused by PVL-SA have no particular site of predilection. In Germany, the PVL gene can be detected in 61.3% (252/411) of skin and soft tissue infections with S. aureus. Skin and soft tissue infections with PVL-SA recur three times as frequently as those due to PVL-negative S. aureus. They are diagnosed by S. aureus culture from wound swabs and combined nasal/pharyngeal swabs, along with PCR for gene detection. The acute treatment of the skin abscesses consists of drainage, followed by antimicrobial therapy if needed. Important secondary preventive measures include topical cleansing with mupirocin nasal ointment and whole-body washing with chlorhexidine or octenidine. The limited evidence (level IIb) concerning PVL-SA is mainly derived from nonrandomized cohort studies and experimental analyses. CONCLUSION PVL-SA skin infections are easily distinguished from other skin diseases with targeted history-taking and diagnostic evaluation.
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Affiliation(s)
- Rasmus Leistner
- Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
| | - Leif G. Hanitsch
- Institute of Medical Immunology, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
| | - Renate Krüger
- Department of Pediatric Pneumology, Immunology and Intensive Care, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
| | - Andreas K. Lindner
- Institute of Tropical Medicine and International Health, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- European network on imported Staphylococcus aureus
| | - Miriam S. Stegemann
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
- Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg; Department of Infectious Diseases and Microbiology, University Medical Center Schleswig-Holstein, Lübeck
- European network on imported Staphylococcus aureus
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Selb R, Albert-Braun S, Weltzien A, Schürmann J, Werner G, Layer F. Characterization of Methicillin-resistant Staphylococcus aureus From Children at Hospital Admission: Experiences From a Hospital in a German Metropolitan Area. Pediatr Infect Dis J 2022; 41:720-727. [PMID: 35703280 DOI: 10.1097/inf.0000000000003596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Since the 1990s, community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) are described as emerging independent of health care. CA-MRSA is associated with the colonization and infection of healthy, immunocompetent younger individuals. While skin and soft tissue infections (SSTI) are predominant, life-threatening syndromes can also occur. METHODS In this retrospective study, we investigated MRSA stains isolated from community-onset infections and from MRSA screening of children at admission to a tertiary-care hospital in 2012-2018. In total, 102 isolates were subjected to antibiotic susceptibility testing by broth microdilution, spa -typing, multilocus sequence typing, SCC mec typing and virulence/resistance gene detection by polymerase chain reaction. RESULTS The majority of isolates originated from community-onset infections (80/102), of these primarily from SSTI (70/80). Additional strains were isolated by MRSA screening (22/102). In total 61.8% of the MRSA carried the gene for the Panton-Valentine leukocidin ( lukPV ). Molecular characterization of isolates revealed various epidemic MRSA clones, circulating in both community and hospital settings. Most prevalent epidemic lineages were isolates of the "European CA-MRSA clone" (CC80-MRSA-IV), the "Bengal Bay clone" (ST772-MRSA-V), or the "USA300 NAE clone" (ST8-MRSA-IVa). CONCLUSIONS Our data highlight the importance of CA-MRSA causing SSTI in children. More frequent microbiological and molecular analysis of these strains is important for targeted treatment and can provide valuable data for molecular surveillance of the pathogen.
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Affiliation(s)
- Regina Selb
- From the Unit for Mycotic and Parasitic Agents and Mycobacteria, Department of Infectious Diseases, Robert Koch Institute, Berlin, Germany
- European Public Health Microbiology Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Alexandra Weltzien
- Department of Paediatric Surgery, Varisano Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - Jacqueline Schürmann
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
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Lynch L, Shrotri M, Brown CS, Heathcock RT. Is decolonisation to prevent PVL-positive Staphylococcus aureus infection in the population effective? A systematic review. J Hosp Infect 2021; 121:91-104. [PMID: 34973237 DOI: 10.1016/j.jhin.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/26/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Panton-Valentine Leukocidin (PVL) producing Staphylococcus aureus is associated with recurrent skin and soft tissue infections and occasionally invasive infections. There is limited evidence to support current public health guidance on decolonisation of cases and household contacts. METHODS This systematic review (CRD42020189906) investigated the efficacy of decolonisation against PVL-positive S. aureus to inform future public health practice. It included studies of cases with PVL-positive infections providing information on the efficacy of decolonisation of cases, carriers, or contacts of cases. Studies were assessed for the risk of bias using the GRADE approach and summarised to inform a narrative synthesis. RESULTS The search identified 20, mostly observational, studies with small samples and lacking control groups. Studies with longer follow-ups found that, while early post-decolonisation screening was negative for most individuals, testing over subsequent months identified re-colonisation in some. There is no high quality evidence to show whether decolonisation is effective in reducing (re)infection or long-term carriage of PVL-positive S. aureus and the low quality evidence available indicates it may not be effective in eradicating carriage or reducing future disease. Furthermore, there may be risks associated with decolonisation, for example, potentially increased risk of infection from other microbes, opportunity costs and negative impacts of repeated testing for asymptomatic carriage. CONCLUSIONS Further research is required to better understand what affects the ability of decolonisation efforts to reduce risk to cases and their contacts, including strain, host and environmental factors.
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Affiliation(s)
- Lucy Lynch
- Public Health England, London, United Kingdom.
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Capasso L, Cerullo J, Lo Vecchio A, Coppola C, Lepore L, Marra V, Antonaki E, Raimondi F. An unusual aggressive presentation of late onset sepsis due to Staphylococcus aureus MRSA producing Panton-Valentine Leukocidin in preterm neonate. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021147. [PMID: 33944831 PMCID: PMC8142768 DOI: 10.23750/abm.v92is1.9885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
We report an unusual and rare case of infection from methicillin resistant Staphylococcus aureus (MRSA) producing Panton-Valentine leukocidin in a preterm neonate in NICU. On day of life 8, a preterm baby boy suddenly developed arthritis, giant cutaneous abscesses and an osteomyelitic focus with pour clinical condition. This very aggressive presentation of infection from MRSA push us to test Panton-Valentine leukocidin resulted positive and to test contacts to discover the bearer of the germ. MRSA producing Panton-Valentine leukocidin is an unusual case of infection in preterm neonate that has not been reported elsewhere. A very aggressive sepsis in neonates from Staphilococcus aureus should evoke the need to test Panton-Valentine leukocidin to rapidly establish an appropriate treatment. We underline also the importance to test contacts to establish promptly a decontaminant therapy.
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Affiliation(s)
- Letizia Capasso
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Napoli, Italy..
| | - Julia Cerullo
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Napoli, Italy.
| | - Andrea Lo Vecchio
- Pediatric Infectious Diseases Unit. Departement of Translational Medical Science. University Federico II, Napoli, Italy..
| | - Clara Coppola
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Napoli, Italy.
| | - Lorenza Lepore
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Napoli. Italy.
| | - Valentina Marra
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Via Pansini 5, 80131. Napoli. Italy.
| | - Eleni Antonaki
- Department of Molecular Medicine and Medical Biotechnology - Division of Bacteriology and Mycology, University of Naples. Federico II, Naples, Italy.
| | - Francesco Raimondi
- Neonatology, Pediatrics. Departement of Translational Medical Science. University Federico II, Napoli. Italy.
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Ismail H, Govender NP, Singh-Moodley A, van Schalkwyk E, Shuping L, Moema I, Feller G, Mogokotleng R, Strasheim W, Lowe M, Mpembe R, Naicker S, Maphanga TG, De Abreu C, Ismail F, Ismail N, Allam M, Ismail A, Singh T, Matuka O, Duba T, Perovic O. An outbreak of cutaneous abscesses caused by Panton-Valentine leukocidin-producing methicillin-susceptible Staphylococcus aureus among gold mine workers, South Africa, November 2017 to March 2018. BMC Infect Dis 2020; 20:621. [PMID: 32831057 PMCID: PMC7446146 DOI: 10.1186/s12879-020-05352-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/16/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We aimed to describe an outbreak of cutaneous abscesses caused by Panton-Valentine leukocidin (PVL)-producing methicillin-susceptible Staphylococcus aureus (MSSA) among gold mine workers. METHODS In February 2018, we retrospectively reviewed a random sample of 50 medical records from 243 cases and conducted face-to-face interviews using a structured questionnaire. Pus aspirates were sent to the National Institute for Communicable Diseases from prospectively-identified cases (November 2017-March 2018). Nasopharyngeal swabs were collected during a colonisation survey in February 2018. Staphylococcus aureus isolates were screened with a conventional PCR for lukS/F-PV. Pulsed-field gel electrophoresis (PFGE) was performed to determine the genetic relatedness among the isolates. A sample of isolates were selected for whole genome sequencing (WGS). We conducted an assessment on biological risks associated with mining activities. RESULTS From January 2017 to February 2018, 10% (350/3582) of mine workers sought care for cutaneous abscesses. Forty-seven medical files were available for review, 96% were male (n = 45) with a mean age of 43 years (SD = 7). About 52% (24/46) were involved in stoping and 28% (13/47) worked on a particular level. We cultured S. aureus from 79% (30/38) of cases with a submitted specimen and 14% (12/83) from colonisation swabs. All isolates were susceptible to cloxacillin. Seventy-one percent of S. aureus isolates (30/42) were PVL-PCR-positive. Six PFGE clusters were identified, 57% (21/37) were closely related. WGS analysis found nine different sequence types. PFGE and WGS analysis showed more than one cluster of S. aureus infections involving closely related isolates. Test reports for feed and product water of the mine showed that total plate counts were above the limits of 1000 cfu/ml, coliform counts > 10 cfu/100 ml and presence of faecal coliforms. Best practices were poorly implemented as some mine workers washed protective clothing with untreated water and hung them for drying at the underground surface. CONCLUSIONS PVL-producing MSSA caused an outbreak of cutaneous abscesses among underground workers at a gold mining company. To our knowledge, no other outbreaks of PVL-producing S. aureus involving skin and soft tissue infections have been reported in mining facilities in South Africa. We recommend that worker awareness of infection prevention and control practices be strengthened.
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Affiliation(s)
- Husna Ismail
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Ashika Singh-Moodley
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Erika van Schalkwyk
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Liliwe Shuping
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Itumeleng Moema
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Gal Feller
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Ruth Mogokotleng
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Wilhelmina Strasheim
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Michelle Lowe
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Ruth Mpembe
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Serisha Naicker
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Tsidiso G Maphanga
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Cecilia De Abreu
- Centre for Tuberculosis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Farzana Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Nazir Ismail
- Centre for Tuberculosis, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Mushal Allam
- Sequencing Core Facility, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Arshad Ismail
- Sequencing Core Facility, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa
| | - Tanusha Singh
- Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa.,Immunology and Microbiology, National Institute for Occupational Health, a division of the National Health Laboratory Service, 25 Hospital Street, Constitution Hill, Johannesburg, 2000, South Africa
| | - Onnicah Matuka
- Immunology and Microbiology, National Institute for Occupational Health, a division of the National Health Laboratory Service, 25 Hospital Street, Constitution Hill, Johannesburg, 2000, South Africa
| | - Thabang Duba
- Immunology and Microbiology, National Institute for Occupational Health, a division of the National Health Laboratory Service, 25 Hospital Street, Constitution Hill, Johannesburg, 2000, South Africa
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a division of the National Health Laboratory Service, 1 Modderfontein Road, Sandringham, Johannesburg, 2131, South Africa.,Faculty of Health Sciences, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193, South Africa
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10
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Hoppe PA, Holzhauer S, Lala B, Bührer C, Gratopp A, Hanitsch LG, Humme D, Kieslich M, Kallinich T, Lau S, Leistner R, Niebank M, Pokrywka A, Ringe H, Schaper AS, Schröder JT, Schwarz C, Staab D, Stegemann MS, Thee S, Varnholt V, von Bernuth H, Weber-Carstens S, Wendt A, Krüger R. Severe infections of Panton-Valentine leukocidin positive Staphylococcus aureus in children. Medicine (Baltimore) 2019; 98:e17185. [PMID: 31567961 PMCID: PMC6756729 DOI: 10.1097/md.0000000000017185] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.
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Affiliation(s)
- Pia-Alice Hoppe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | | | | | - Daniel Humme
- Department of Dermatology, Venerology and Allergy
| | | | | | - Susanne Lau
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | - Hannelore Ringe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | - Carsten Schwarz
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Doris Staab
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | - Stephanie Thee
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Verena Varnholt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Horst von Bernuth
- Department of Pediatric Pneumology, Immunology and Intensive Care
- Department of Immunology, Labor Berlin Charité-Vivantes GmbH
- Berlin-Brandenburg Center for Regenerative Therapies
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine Campus Mitte and Campus-Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Wendt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Renate Krüger
- Department of Pediatric Pneumology, Immunology and Intensive Care
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11
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Durand G, Javerliat F, Bes M, Veyrieras JB, Guigon G, Mugnier N, Schicklin S, Kaneko G, Santiago-Allexant E, Bouchiat C, Martins-Simões P, Laurent F, Van Belkum A, Vandenesch F, Tristan A. Routine Whole-Genome Sequencing for Outbreak Investigations of Staphylococcus aureus in a National Reference Center. Front Microbiol 2018; 9:511. [PMID: 29616014 PMCID: PMC5869177 DOI: 10.3389/fmicb.2018.00511] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/06/2018] [Indexed: 11/25/2022] Open
Abstract
The French National Reference Center for Staphylococci currently uses DNA arrays and spa typing for the initial epidemiological characterization of Staphylococcus aureus strains. We here describe the use of whole-genome sequencing (WGS) to investigate retrospectively four distinct and virulent S. aureus lineages [clonal complexes (CCs): CC1, CC5, CC8, CC30] involved in hospital and community outbreaks or sporadic infections in France. We used a WGS bioinformatics pipeline based on de novo assembly (reference-free approach), single nucleotide polymorphism analysis, and on the inclusion of epidemiological markers. We examined the phylogeographic diversity of the French dominant hospital-acquired CC8-MRSA (methicillin-resistant S. aureus) Lyon clone through WGS analysis which did not demonstrate evidence of large-scale geographic clustering. We analyzed sporadic cases along with two outbreaks of a CC1-MSSA (methicillin-susceptible S. aureus) clone containing the Panton–Valentine leukocidin (PVL) and results showed that two sporadic cases were closely related. We investigated an outbreak of PVL-positive CC30-MSSA in a school environment and were able to reconstruct the transmission history between eight families. We explored different outbreaks among newborns due to the CC5-MRSA Geraldine clone and we found evidence of an unsuspected link between two otherwise distinct outbreaks. Here, WGS provides the resolving power to disprove transmission events indicated by conventional methods (same sequence type, spa type, toxin profile, and antibiotic resistance profile) and, most importantly, WGS can reveal unsuspected transmission events. Therefore, WGS allows to better describe and understand outbreaks and (inter-)national dissemination of S. aureus lineages. Our findings underscore the importance of adding WGS for (inter-)national surveillance of infections caused by virulent clones of S. aureus but also substantiate the fact that technological optimization at the bioinformatics level is still urgently needed for routine use. However, the greatest limitation of WGS analysis is the completeness and the correctness of the reference database being used and the conversion of floods of data into actionable results. The WGS bioinformatics pipeline (EpiSeqTM) we used here can easily generate a uniform database and associated metadata for epidemiological applications.
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Affiliation(s)
| | | | - Michèle Bes
- National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | | | | | | | | | - Gaël Kaneko
- Data Analytics Unit, bioMérieux, Marcy-I'Étoile, France
| | | | - Coralie Bouchiat
- National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | | | - Frederic Laurent
- National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | | | - François Vandenesch
- National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
| | - Anne Tristan
- National Reference Center for Staphylococci, Hospices Civils de Lyon, Lyon, France
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