Practice Easily Missed?

PVL positive Staphylococcus aureus skin infections

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5343 (Published 09 September 2011) Cite this as: BMJ 2011;343:d5343
  1. A Fogo, dermatology registrar 1,
  2. N Kemp, general practitioner2,
  3. R Morris-Jones, consultant dermatologist1
  1. 1Dermatology Department, King’s College Hospital, London SE5 9RS, UK
  2. 2Elm Lodge Surgery, London SE24 9HJ
  1. Correspondence to: A Fogo abigailfogo{at}nhs.net
  • Accepted 19 July 2011

Patients presenting with recurrent skin abscesses may be infected with the rapidly emerging and highly pathogenic strains of Staphylococcus aureus that carry the virulence factor Panton-Valentine leukocidin (PVL). PVL positive S aureus can be acquired in the community and lead to recurrent and potentially serious infections of the skin and necrotising pneumonia.

Case scenario

A 39 year old woman presented with recurrent deep painful abscesses (figure) and was one of 30 similar patients referred to our dermatology unit over the past 12 months. She was otherwise well with no intercurrent illness. Routine skin swabs taken by her general practitioner grew meticillin sensitive S aureus, but the abscesses did not resolve after several weeks of oral flucloxacillin. Further swabs were therefore taken and the S aureus isolate was sent to the national staphylococcal reference unit for typing. This confirmed PVL positive S aureus, which is not easily eradicated from skin infections with conventional courses of flucloxacillin or erythromycin. The patient subsequently required a four week course of rifampicin and clindamycin, plus five days of chlorhexidine wash and nasal mupirocin, to clear the lesions completely. No relapse was seen six months later.

Top: Necrotising abscesses typical of PVL positive S aureus infection. Bottom: Cutaneous abscess with purulent discharge, central ulceration, and severe soft tissue inflammation

How common is PVL positive S aureus skin infection?

  • Recent (2010) data from the United Kingdom found that 20% of S aureus isolates from skin or soft tissue infections contained PVL positive S aureus,1 and although the sample may have been biased towards the more severe skin or soft tissue …

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