Case series of children in a UK hospital infected with Panton-Valentine Leucocidin positive Staphylococcus aureus: further features of an emerging infection

Abstract

Aims To describe the clinical features and presentations of cases of Panton-Valentine Leucocidin (PVL) positive Staphylococcus aureus in children in a UK hospital from 2010 to 2011. Methods Retrospective review of case notes of fourteen patients who attended between 2010 to 2011, with reference laboratory confirmed PVL positive Staphylococcus aureus (PVL-SA) infection. Results Fourteen children, age range five days to twelve years, were seen at this hospital with PVL positive Staphylococcus aureus infections. This compares to six cases in 2008-2009. Three presented aged less than a week of age; the mean age of presentation was four years (median three years). All patients presented with superficial or deep skin infections. All but three patients were previously fit and well. One child presented with lymphadenopathy, two with a pustular rash, one with cellulitis and the remainder with abscesses. Of these, four children presented with perineal or buttock abscesses. Six had a personal history of recurrent skin infections or abscesses. Seven had close family members with a history of skin infections. Eight patients presented to the surgical team, three to the medical team, and three were managed by the emergency department. Ten patients were admitted and seven required incision and drainage of abscesses under general anaesthetic. Nine children had MRSA, and five MSSA. Five of the patients9 families received a topical decolonisation regime to eradicate carriage of Staphylococcus aureus. Conclusions The incidence of PVL positive staphylococcal infections is increasing in our hospital. These infections can be both MRSA and MSSA. Of concern is the fact that three of our patients presented with PVL-SA infections in the first week of life. PVL-SA is known to cause severe infections which may present to medical or surgical teams; they often require surgical intervention. Features suggestive of paediatric PVL infection in this case series include a history in the patient, or family, of recurrent infections and abscesses. Our current management includes a topical decolonisation regime for all family members.