Irrelevance of Panton-Valentine leukocidin in hidradenitis suppurativa: results from a pilot, observational study

Monica Corazza,Elisa Mazzoni,Carlo Contini,Elisa Mazzola,Silva Saraceni,Roberto Pora,Alessandro Borghi,Martina Maritati,Ilaria Bononi,Vincenzo Bettoli

doi:10.1007/s10096-020-04002-7

Monica Corazza, Elisa Mazzoni + Show 8 more

Open Access

https://doi.org/10.1007/s10096-020-04002-7

Copy DOI

Abstract

Panton-Valentine leukocidin (PVL) appears to be a virulence factor which, among others, can exacerbate the pathogenicity of Staphylococcus aureus infections, especially inducing severe necrotic, deep-seated skin infections, abscesses, and recurrences. These peculiarities have some overlaps with hidradenitis suppurativa (HS). Our main aim was to assess if S. aureus producing PVL could have some role in influencing clinical features and/or course of HS, specifically in the suppuration and recurrence of lesions. This pilot, mono-centric, observational study included all adult subjects affected with HS consecutively referring to our HS clinic over a 3-month period. Clinically evident suppuration and at least 2 weeks wash out from any antibiotic were the main inclusion criteria. Purulent material from HS skin lesions was collected with swabs in order to isolate micro-organisms, with specific regard to S. aureus. Detection of PVL was performed by real-time quantitative PCR (RT-qPCR). We also analyzed purulent material from suppurative skin lesions other than HS, as a control. Thirty HS patients were included; 29 purulent lesions (96.7%) harbored at least one bacterial species. Five (16.7%) swab samples were positive for S. aureus, none of which was positive for PVL genes. Among the 30 purulent disorders included as controls, 8 (26.3%) were positive for S. aureus; of these, 4 strains (50%) expressed LPV. The study results seem to exclude the pathogenetic involvement of S. aureus producing PVL in HS; as a result, PVL does not seem to represent a potential target in the future development of HS treatments.

Highlights

Hidradenitis suppurativa (HS), known as acne inversa, is a chronic-relapsing, debilitating inflammatory disease of the hair follicle, which affects apocrine gland-bearing skin, mostMonica Corazza, Alessandro Borghi, and Vincenzo Bettoli contributed to this study and share first authorship.Pathology, Oncology and Experimental Biology, Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy 4 Palermo, Italy commonly the axillae, inguinal regions, anogenital area, and infra- and inter-mammary folds [1]
Continuous variables were presented as mean ± standard deviation (SD) and categorical variables as frequencies and percentages
Comparisons between groups were made using t test for quantitative variables, while Pearson’s chi-squared test or the Fisher exact test was used for qualitative variables

Summary

Introduction

Hidradenitis suppurativa (HS), known as acne inversa, is a chronic-relapsing, debilitating inflammatory disease of the hair follicle, which affects apocrine gland-bearing skin, most. The role of bacterial infection in the initiation or propagation of HS remains under investigation [6, 7]. HS lesions may act synergistically with a dysfunctional immune response, involving both the innate and adaptive immune systems, which leads to a chronic, relapsing inflammatory scenario. It appears to be a highly relevant virulence factor which, among others, can exacerbate the pathogenicity of S. aureus infections [12]. PVL seems to be a marker for severity and recurrence [15]. Based on these assumptions, we were interested in assessing if S. aureus producing PVL could have some role in influencing clinical features and/or the course of HS, especially in the suppuration and recurrence of lesions

Study design and patients

Discussion

Results

Compliance with ethical standards