Abstract
IntroductionPanton Valentine leukocidin (PVL) is a virulence factor which is associated with methicillin sensitive and resistant Staphylococcus aureus (MSSA/MRSA) causing skin and soft tissue infections (SSTI). This study aimed to evaluate a novel lateral flow immunoassay (LFI) for PVL detection in S. aureus cultures and to describe their genotypic characterization.MethodsThe study was carried out from January-August 2020 in Dubai, United Arab Emirates. S. aureus isolates associated with SSTI were tested for PVL detection using LFI. DNA microarray-based assays were used for molecular characterization including detection of pvl genes.ResultsOne-hundred thirty-five patients with a clinical diagnosis of SSTIs were recruited. Sixty-six patients received antibiotics, mostly beta lactams (n=36) and topical fusidic acid (n=15). One-hundred twenty-nine isolates (MRSA: n=43; MSSA: n=86) were tested by LFI and DNA microarrays. All 76 (58.9%) isolates which were unambiguously negative for the PVL in LFI were negative for pvl genes using the DNA microarray. All the LFI PVL positive isolates (n=53) had pvl genes detected. This translates into 100% each for sensitivity, specificity, positive and negative predictive values for the LFI. The LFI typically takes about 15 min inclusive of a 10 min incubation period. Predominant S. aureus clonal complexes (CC) were CC30 (n=18), CC22 (n=13), CC5 (n=12), CC1 (n=11), CC152 (n=8), CC15 (n=7); CC97 (n=7); CC8 and CC20 (n=6 each). Among MRSA, the proportion of pvl-positives (35/43; 81%) was higher than among MSSA (n/N=18/86; 21%). The fusidic acid resistance gene fusC was detected in 14 MRSA (33%) compared to 8 MSSA (9%). A co-carriage of fusC and pvl genes was present in 7 MRSA and in one MSSA.ConclusionLFI shows excellent diagnostic accuracy indices for rapid identification of PVL in MSSA/MRSA in a setting with high prevalence of pvl +ve strains. The high occurrence of pvl and fusC genes in MRSA strains causing SSTI is of concern and needs constant surveillance.
Highlights
Panton Valentine leukocidin (PVL) is a virulence factor which is associated with methicillin sensitive and resistant Staphylococcus aureus (MSSA/Methicillin resistant S. aureus (MRSA)) causing skin and soft tissue infections (SSTI)
We describe the application of a novel lateral flow immunoassay for rapid PVL detection in S. aureus directly from bacterial cultures and in addition, we present data on the molecular characterization of a collection of Methicillin susceptible S. aureus (MSSA)/MRSA strains associated with SSTI
The fusidic acid resistance gene fusC was detected in 14 MRSA (33%) strains while only 8 MSSA (9%) were positive for this gene, 7 MRSA (CC5, CC30, CC1153) carried both, fusC and pvl genes
Summary
Panton Valentine leukocidin (PVL) is a virulence factor which is associated with methicillin sensitive and resistant Staphylococcus aureus (MSSA/MRSA) causing skin and soft tissue infections (SSTI). Panton Valentine leukocidin (PVL) is a virulence factor which is associated with S. aureus strains causing SSTI and severe forms of community acquired pneumonia (Gosbell, 2005; Wannet et al, 2005; Yamasaki et al, 2005; Marazza et al, 2007; Masiuk et al, 2010; Gillet et al, 2021). PVL consists of two distinct components which form polymeric pores in the membranes of white blood cells which leads to cell death This might explain the higher risk of complicated SSTI infection associated with PVL positive S. aureus strains (Szmigielski et al, 1998; Kaneko and Kamio, 2004). The pvl genes, lukS-PV and lukF-PV, are phage borne (Narita et al, 2001; Boakes et al, 2011), and since they are mobile, they can be found in different, unrelated lineages of S. aureus (Monecke et al, 2007; Monecke et al, 2011a)
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