Abstract
IntroductionCertain Staphylococcus aureus strains produce Panton-Valentine leukocidin, a toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or severe infection. This report documents a confirmed case of methicillin-sensitive Staphylococcus aureus strain harboring Panton-Valentine leukocidin genes from Trinidad and Tobago. To the best of our knowledge, this is the first time that such a case has been identified and reported from this country.Case presentationA 13-year-old Trinidadian boy of African descent presented with upper respiratory symptoms and gastroenteritis-like syptoms. About two weeks later he was re-admitted to our hospital complaining of pain and weakness affecting his left leg, where he had received an intramuscular injection of an anti-emetic drug. He deteriorated and developed septic arthritis, necrotizing fasciitis and septic shock with acute respiratory distress syndrome, leading to death within 48 hours of admission despite intensive care treatment. The infection was caused by S. aureus. Bacterial isolates from specimens recovered from our patient before and after his death were analyzed using microarray DNA analysis and spa typing, and the results revealed that the S. aureus isolates belonged to clonal complex 8, were methicillin-susceptible and positive for Panton-Valentine leukocidin. An autopsy revealed multi-organ failure and histological tissue stains of several organs were also performed and showed involvement of his lungs, liver, kidneys and thymus, which showed Hassal's corpuscles.ConclusionRapid identification of Panton-Valentine leukocidin in methicillin-sensitive S. aureus isolates causing severe infections is necessary so as not to miss their potentially devastating consequences. Early feedback from the clinical laboratories is crucial.
Highlights
Certain Staphylococcus aureus strains produce Panton-Valentine leukocidin, a toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or severe infection
Staphylococcus aureus has a variety of different virulence factors
We describe here the first confirmed case from Trinidad and Tobago, or, from any English speaking Caribbean island, of a fatal multi-organ failure caused by a PVL-producing methicillin-susceptible S. aureus (MSSA) infection in a previously healthy child
Summary
Staphylococcus aureus has a variety of different virulence factors. Among these, there are hemolysins and leukocidins [1]. This report stresses the fact that invasive infections due to MSSA could have innocuous symptoms, should not be treated lightly since such infections may have a high mortality rate, and that PVL in MSSA still remains a clinically important issue Case presentation This is a report of a previously active and healthy 13year-old Trinidadian boy of African descent with no past medical history, significant history of trauma or travel abroad. The isolates from blood specimens and from swab and tissue specimens at autopsy were further analyzed using spa typing [5] and microarray analysis [6] This allowed us to detect virulence- and resistance-associated genes as well as to assign the isolates to clonal complexes (CC). The repeat pattern of spa type t400 (11-19-12-21-17-3434-22-25) is related to other clonal complex 8 spa types (such as t008, 11-19-12-21-17-34-24-34-22-25 or t009, 11-12-21-17-34-24-34-22-24-34-22-33-25)
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