Severe Panton-Valentine-Leukocidin-Positive Staphylococcus aureus Infections in Pediatric Age: A Case Report and a Literature Review

Abstract

Background: Infections caused by S. aureus strains encoding Panton-Valentine leukocidin (PVL-SA) have become increasingly relevant in community settings and can cause severe conditions in pediatric populations. We present the pediatric case of an invasive disease caused by PVL-SA and provide a literature review of severe manifestations caused by these strains in children. Methods: A PubMed search (February 2024) found studies that included relevant clinical outcomes, diagnostics, and treatments, excluding cases of asymptomatic infection or in adult populations. A logistical multivariate analysis was used to find predictors of the need for intensive care. Results: A 10-year-old boy came to the attention of our Pediatric Infectious Diseases Unit with fever, chest pain, and tachypnea. A rapid worsening of his clinical conditions was observed, with the development of necrotizing pneumonia, osteomyelitis, deep vein thrombosis (DVT), and multiple abscesses. Blood cultures confirmed the presence of PVL-producing methicillin-resistant S. aureus (MRSA). The initial treatment included linezolid and ceftaroline and was later adjusted to clindamycin, daptomycin, and fosfomycin, with clinical improvement. Discussion: Our review collected 36 articles, including 156 pediatric cases of severe PVL-SA infection. Bacteremia was present in 49% of cases, lung infection in 47%, and osteomyelitis in 37%. The presence of pulmonary localization was predictive of the need for intensive care, O.R. 25.35 (7.46-86.09; p < 0.001). Anti-toxin molecules were used in about half the cases where information on treatment was reported. Our report highlights the capacity of PVL-SA to cause life-threatening complications in children, while also discussing the full range of its clinical spectrum and the most effective therapeutic approaches.

Keywords: Panton–Valentine leukocidin (PVL); Staphylococcus aureus (S. aureus); anti-toxin treatment; deep vein thrombosis (DVT); methicillin-resistant Staphylococcus aureus (MRSA); necrotizing pneumonia; osteomyelitis; pediatric infections.

Figure 1

Flow chart describing the study selection process.

Figure 2

Bar chart describing the countries where patients were treated and/or where they likely contracted the infection. Fifty-six patients from 14 studies were observed in Europe, fifty-two from 3 studies in Africa, thirty-four from 13 studies in Asia, and six and 8 from North America and South America, respectively.