Mechanisms of DiseaseAssociation between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients
Introduction
Staphylococus aureus is responsible for about 2% of cases of community-acquired pneumonia1 and at least 10% of cases of nosocomial pneumonia.1, 2 Most patients with S aureus pneumonia are elderly and have serious underlying disorders such as cardiovascular disease, malignant disease, chronic pulmonary disease, and diabetes mellitus.3, 4, 5 The lethality rate ranges from 30% to 80%.3, 4
Panton-Valentine leukocidin (PVL) is an extracellular product of S aureus. PVL was detected in fewer than 5% of S aureus isolates in a general hospital.6 We have found it to be associated with primary skin infections such as furunculosis, and severe necrotising pneumonia.7 In 1998, a review of S aureus infections reported to the French Reference Centre for Staphylococcal Toxaemia (Lyon, France) between 1986 and 1998 revealed eight cases of severe community-acquired pneumonia caused by S aureus strains carrying the PVL gene, six of which were fatal.7 The patients were all immunocompetent children or young adults. All had a preceding influenza-like syndrome before developing pneumonia, and the six deaths occurred shortly after diagnosis. Necropsy showed diffuse necrotising haemorrhagic pneumonia. We investigated the clinical features and the prognosis of this illness, and compared them with those of S aureus pneumonia caused by PVL-negative strains.
Section snippets
Patients
Since 1985, S aureus strains have been sent to the French Reference Centre for Staphylococcal Toxaemia for various purposes, such as the detection of toxin production in S aureus toxin-associated diseases or severe staphylococcal suppurative infections. From this collection, a subset of 172 S aureus isolates, representative of all staphylococcal infections, was chosen in 1998 to assess the importance of PVL in various clinical syndromes.7 27 S aureus strains were associated with
Results
Preliminary analyses showed that the patients in the prospective study differed from the retrospective cases only in their lower rate of haemoptysis (p= 0·007). We therefore pooled all PVL-positive cases for subsequent analysis.
Table 1 shows the baseline characteristics of the cases of necrotising pneumonia due to PVL-positive S aureus compared with those caused by PVL-negative S aureus. PV-positive patients were younger than the others, but the median interval between symptom onset and
Discussion
Pneumonia caused by PVL-positive S aureus seems to be a specific disease entity with a poor prognosis. It occurs in otherwise healthy children and young adults and is preceded by an influenza-like syndrome. It is characterised by fever, haemoptysis, and leucopenia, and rapidly progresses to acute respiratory distress syndrome. The lethality rate is high. Because of the necrotic histopathological appearance of the lungs, we designate this illness “S aureus necrotising pneumonia”. The disease is
GLOSSARY
- leukocidin
- Group of bacterial toxins that kill leucocytes by creating pores in the cell membrane; as well as S aureus Panton-Valentine leukocidin, the group includes Pasteurella haemolytica leukotoxin, Actinobacillus actimycetemcomitans leukotoxin, Listeria monocytogenes listeriolysin, Escherichia coli haemolysin, and Fusobacterium necrophorum leukotoxin.
- pore-forming toxin
- These toxins work by inducing holes in the plasma membrane of eukaryotic cells, thus breaking the permeability barrier that
References (35)
- et al.
The clinical spectrum of Staphylococcus aureus pulmonary infection
Chest
(1990) - et al.
Validation of a pneumonia prognostic index using the MedisGroups comparative hospital database
Am J Med
(1993) - et al.
Characterization of a novel structural member, LukE-LukD, of the bi-component staphylococcal leucotoxins family
FEBS Lett
(1998) - et al.
Complete nucleotide sequence and molecular characterization of the temperate staphylococcal bacteriophage phiPVL carrying Panton-Valentine leukocidin genes
Gene
(1998) - et al.
Phage conversion of Panton-Valentine leukocidin in Staphylococcus aureus: molecular analysis of a PVL-converting phage, phiSLT
Gene
(2001) - et al.
Crystal structure of the F component of the Panton-Valentine leucocidin
Int J Med Microbiol
(2000) - et al.
The interaction of Staphylococcus aureus bi-component gamma-hemolysins and leucocidins with cells and lipid membranes
Biochim Biophys Acta
(1998) - et al.
Pore formation by two-component leukocidin from Staphylococcus aureus within the membrane of human polymorphonuclear leukocytes
Biochem Biophys Acta
(1993) - et al.
Metastatic staphylococcal lung abscess due to a cutaneous furuncle
Neth J Med
(1995) - et al.
Respiratory tract infections
Nosocomial infections in combined medical-surgical intensive care units in the United States
Infect Control Hosp Epidemiol
Bacteremic Staphylococcus aureus pneumonia
Scand J Infect Dis
The current spectrum of Staphylococcus aureus infection in a tertiary care hospital
Medicine (Baltimore)
Epidemiological data on Staphylococcus aureus strains producing synergohymenotropic toxins
J Med Microbiol
Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia
Clin Infect Dis
Involvement of enterotoxins G and I in staphylococcal toxic shock syndrome and staphylococcal scarlet fever
J Clin Microbiol
Identification of methicillin-resistant strains of staphylococci by polymerase chain reaction
J Clin Microbiol
Cited by (1322)
Detection of Staphylococcus aureus virulence gene pvl based on CRISPR strip
2024, Frontiers in ImmunologyHigh-dose intravenous immunoglobulin versus albumin 4% in paediatric toxic shock syndrome: A randomised controlled feasibility study
2024, Archives of Disease in ChildhoodMolecular Characteristics and Pathogenicity of Staphylococcus aureus Exotoxins
2024, International Journal of Molecular Sciences