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EDITORIALS: Marina Morgan Staphylococcus aureus, Panton-Valentine leukocidin, and necrotising pneumonia BMJ 2005; 331: 793-794 [Full text]

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Staphylococcus Aureus strains with the Panton-Valentine Leukocidin (PVL) gene are probably not rare.

Laura Shallcross, Anne M. Johnson, Andrew C. Hayward   (13 October 2005)

Staphylococcus Aureus strains with the Panton-Valentine Leukocidin (PVL) gene are probably not rare. 13 October 2005
Laura Shallcross, Senior House Officer John Radcliffe Hospital Oxford OX3 9DU, Anne M. Johnson, Andrew C. Hayward Send response to journal: Re: Staphylococcus Aureus strains with the Panton-Valentine Leukocidin (PVL) gene are probably not rare.	In a recent BMJ editorial it was reported that infection with staphylococci with the PVL gene was rare, and that only 4.6% of isolates from skin and soft tissue infections were PVL positive.(1) The cited UK study in fact showed that whilst only 4.9% of all staphylococcal disease isolates (23/470) were PVL positive, 15/63 (24%) of isolates from skin and soft tissue infections and 7/16 (44%) of isolates from abscesses were PVL positive.(2) Studies elsewhere have also shown that the PVL gene is common in staphylococcal strains causing skin and soft tissue infections. Nolte et al in Germany found that 71% of staphylococci from skin abscesses or furuncles were PVL positive.(3) Lina et al in a study of strains sent to the French staphylococcal reference centre detected the PVL gene in 93% of S.aureus strains associated with recurrent boils, 55% of cellulitis and 50% of cutaneous abscesses.(4) Issartel et al showed that 89% of staphylococci from surgically drained abscesses in New Caledonia were PVL positive.(5) Although skin and soft tissue infections are one of the most common manifestations of staphylococcal infection they are often treated empirically without microbiological confirmation so strain collections are likely to under-represent these organisms leading to a false impression that PVL positive strains are rare. Given the association of PVL with community acquired MRSA and with potentially severe infections there is a clear need for research to understand the epidemiology and antimicrobial resistance profiles of these PVL positive strains. 1 Morgan M. Staphylococcus aureus, Panton-Valentine leukocidin, and necrotising pneumonia. BMJ 2005;331:793-4 2 Holmes A, Ganner M, McGuane S, Pitt TL, Cookson B, Kearns AM. Staphyloccus aureus Isolates carrying Panton-Valentine Leucocidin Genes in England and Wales: Frequency, characterization and association with clinical disease. J Clin Micro 2005;43:2384-90 3 Nolte O, Haag H, Zimmerman A, Geiss HK. Staphylococcus aureus positive for Pantoin-Valentine leukocidin genes but susceptible to methicillin in patients with furuncles. Eur J Clin Microbiol Infect Dis 2005;24:477-479 4 Lina G, Piemont Y, Godall-Gamot F, Bes M, Peter MO, Gauduchon V, Vandenesch F, Etienne J. Involvement of Panton Valentine Leucocidin- producing staphyloccus aureus in primary skin infections and pneumonia CID 1999;29:1128-1132 5 Issartel B, Tristan A, Lechavallier S, Bruyere F, Lina G, Garin B, Lacassin F, Bes M, Vandenesch F, Etienne J. Frequent carriage of Panton- Valentine Leucocidin Genes by Staphylococcus aureus isolates from surgically drained abscesses. J Clin Micro 2005;43:3203-07 Competing interests: None declared