Panton-Valentine leucocidin associated Staphylococcus aureus infectionsBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4083 (Published 16 October 2009) Cite this as: BMJ 2009;339:b4083
All rapid responses
The Authors have righly pointed out in the article more Prevalence of
Methicillin Sensitive Staphylococcus aureus with PVL in the UK,which is
classically noted in clinical presentation.
In addition it may be also worth considering Staphylococcus aureus
with PVL in Athletes involved in Contact sports like Rugby,Wrestling with
recurrent boil and skin infection infections ,especially if involving
more than one athlete.
Like the authors pointed out for household contacts,
personnel hygiene and decolonisation would help in this setting as
well,with avoidance of sharing fomites like contaminated towel.
In UK the turn-around time for results from SRU in suspected PVL
infections is from 48hrs to 7days (in rare delay due to transportation).It
may be worth introducing in house testing for PVL genes lukS-PV and lukF-
PV as additional cards in laboratories already using Molecular Diagnostic
testing methods for MRSA and others PCR systems
which allow for this addition.This would shorten turnaround time and would
also be saving lives especially with expected aggressive infections
following Primary Pandemic influenza infection.
Competing interests: No competing interests
We would like to commend the authors of this editorial for raising
awareness of disease related to Panton Valentine Leucocidin Staphylococcus
Aureus (PVLSA) infection within the world wide community along with the
potentially destructive nature of the infection. Early diagnosis with
targeted surgical and microbiological treatment combined with screening of
close family relatives for the presence of the disease being the clear
In the UK looking specifically at the disease monitoring by the
Health Protection Agency, it can be clearly seen that the numbers of PVLSA
infections has risen steadily since 2005, with a two fold increase from
2005 to 2006 (1). Disease surveillance studies have also shown that PVL
related disease occurs primarily in clusters within the community as
opposed to the hospital environment (1).
The editorial by Etienne and Dumitrescu comments on the potential for
rapidly progressing musculoskeletal infection however we would like to
emphasise the problems of PVL osteomyelitis based on our experience in the
Orthopaedic Department in this centre. We have seen several
musculoskeletal PVL infections both soft tissue based as well as
osteomyelitis. Within the orthopaedic literature there have been several
case reports of PVL osteomyelitis reported in children and from these
cases it has been noted that the infection is more aggressive and
difficult to treat compared to convential osteomyelitis (2, 3). From our
experience of a case of PVL osteomyelitis of the proximal tibia we found
that an aggressive bone and soft tissue debridement and antibiotics alone
were inadequate to treat the infection and that transposition of a well
vascularised muscle flap early in the treatment course would have been
The literature and Health Protection Agency figures show that PVLSA
infection remains a rare diagnosis in the UK possibly due to the lack of
awareness. We completely concur with the original editorial highlighting
the emerging danger of PVL strains especially in musculoskeletal
infections. Based on our experience of PVL osteomyelitis and its
potentially destructive nature we would recommend clinical awareness and
testing, early aggressive debridement and use of a muscle flap together
with antibiotic therapy and seeking the advice of a specialist
microbiologist along with an infection control team in the management of
these aggressive infections.
Matthew Hall – Orthopaedic Specialist Registrar, Derriford Hospital,
Jane Steer – Consultant Microbiologist, Derriford Hospital, Plymouth
Jonathan Keenan – Consultant Orthopaedic Surgeon, Derriford Hospital,
1. Guidance on the diagnosis and management of PVL-associated
Staphylococcus aureus infections (PVL SA) in England. August 2008. Lewis
D, Campbell R, Cookson B, Day C, Duerden B, Duckworth G, Hawkey P, Howe R,
Jeffries D, Kearns A, Morgan M, McCartney C, Nathwani D, Pearson A, Steer
J. Health Protection Agency. www.hpa.org.uk.
2. Gillet Y, Dohin B, Dumitresco O, Lina G, Vandenesch F, Etienne, J,
Floret D. Osteoarticular infections with Staphylococcus aureus secreting
Panton-Valentine leucocidin. Arch Pediatr 2007; Oct 14 Suppl 2: S102-7.
3. Dohin B, Gillet Y, Kohler R, Lina G, Vandenesch F, Vanhems P,
Floret D, Etienne J. Pediatric bone and joint infections caused by Panton-
Valentine leukocidin-positive Staphylococcus aureus. Pediatr Infect Dis J
2007; Nov 26(11): 1042-8.
Competing interests: No competing interests