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Review
. 2022 Nov 11;119(45):775-784.
doi: 10.3238/arztebl.m2022.0308.

Skin Infections Due to Panton-Valentine Leukocidin-Producing S. Aureus

Rasmus Leistner  1 , Leif G Hanitsch, Renate Krüger, Andreas K Lindner, Miriam S Stegemann, Dennis Nurjadi
Affiliations
Review

Skin Infections Due to Panton-Valentine Leukocidin-Producing S. Aureus

Rasmus Leistner et al. Dtsch Arztebl Int. .

Abstract

Background: Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) strains are frequently associated with large, recurring abscesses in otherwise healthy young individuals. The typical clinical presentation and the recommended diagnostic evaluation and treatment are not widely known.

Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to international recommendations.

Results: PVL-SA can cause leukocytolysis and dermatonecrosis through specific cell-wall pore formation. Unlike other types of pyoderma, such conditions caused by PVL-SA have no particular site of predilection. In Germany, the PVL gene can be detected in 61.3% (252/411) of skin and soft tissue infections with S. aureus. Skin and soft tissue infections with PVL-SA recur three times as frequently as those due to PVL-negative S. aureus. They are diagnosed by S. aureus culture from wound swabs and combined nasal/pharyngeal swabs, along with PCR for gene detection. The acute treatment of the skin abscesses consists of drainage, followed by antimicrobial therapy if needed. Important secondary preventive measures include topical cleansing with mupirocin nasal ointment and whole-body washing with chlorhexidine or octenidine. The limited evidence (level IIb) concerning PVL-SA is mainly derived from nonrandomized cohort studies and experimental analyses.

Conclusion: PVL-SA skin infections are easily distinguished from other skin diseases with targeted history-taking and diagnostic evaluation.

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Figures

Figure 1
Figure 1
clinical presentations (a) necrotizing pneumonia due to PVL-SA in a child (courtesy of the Department of Radiology, Charité – Universitätsmedizin Berlin); (b) typical presentation of a PVL-SA skin abscess on the back of the thigh before and during incision (courtesy of Dr. D. Humme, Department of Dermatology, Venereology and Allergology, Charité – Universitätsmedizin Berlin). PVL-SA, Panton-Valentine leukocidin-producing Staphylococcus aureus strains.
Figure 2
Figure 2
The clinical pyramid of infections with Panton-Valentine-leukocidin-producing S. aureus. Adapted from Shallcross et al (6), with permission from Elsevier.
Figure 3
Figure 3
Molecular pathogenesis of PVL-SA infection, PVL pore formation on cell membrane, leukocytes and epithelial cells PMN, polymorphonuclear leukocytes; PVL, Panton-Valentine leukocidin; PVL-SA, Panton-Valentine leukocidin-producing Staphylococcus aureus strains; ROS, reactive oxygen species
Figure 4
Figure 4
Repeated decolonization is associated with increasing success of decolonization (10). Reproduced with permission from Plos One.
See this image and copyright information in PMC

Comment in

  • Closer Interdisciplinary Networking Is Important.
    Schaumburg F, Löffler B, Becker K. Schaumburg F, et al. Dtsch Arztebl Int. 2023 May 30;120(21):375. doi: 10.3238/arztebl.m2023.0022. Dtsch Arztebl Int. 2023. PMID: 37530053 Free PMC article. No abstract available.

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