Journal Article

Panton-Valentine Leukocidin Is Associated with Exacerbated Skin Manifestations and Inflammatory Response in Children with Community-Associated Staphylococcal Scarlet Fever

Wen-Tsung Lo, Ching-Shen Tang, Shyi-Jou Chen, Ching-Feng Huang, Min-Hua Tseng and Chih-Chien Wang

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 49, issue 7, pages e69-e75
Published in print October 2009 | ISSN: 1058-4838
Published online October 2009 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/605580
Panton-Valentine Leukocidin Is Associated with Exacerbated Skin Manifestations and Inflammatory Response in Children with Community-Associated Staphylococcal Scarlet Fever

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Background.Staphylococcal scarlet fever (SSF), a rare disease, was first described in 1900. The clinical features and outcomes in children with SSF caused by Panton-Valentine leukocidin (PVL)-positive and PVL-negative Staphylococcus aureus strains have not been compared prospectively.

Methods.The demographic data, selected clinical features, laboratory values, and outcomes for 49 consecutive children with community-acquired S. aureus SSF prospectively identified during an 11-year period were collected for analysis.

Results.The male-to-female ratio was 1.88, and the median age of the patients was 37 months. Cutaneous abscesses predominated among children with SSF. Methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) caused SSF in 26 and 23 children, respectively. Twenty-four isolates had results that were positive for PVL (5 MSSA and 19 MRSA isolates), and 25 had results that were negative for PVL (21 MSSA and 4 MRSA isolates). Polymerase chain reaction revealed that most (92%) contained only staphylococcal enterotoxin B (23 MSSA and 22 MRSA isolates). By multivariate analysis, children with PVL-positive isolates had significantly larger abscess sizes, higher white blood cell counts, higher C-reactive protein levels, and longer durations of fever, generalized scarlatiniform rashes, and hospital stays. Most (17 isolates; 89%) of the 19 PVL-positive MRSA isolates carried the staphylococcal cassette chromosome mec V T and all were multilocus sequence type 59.

Conclusion.SSF caused by PVL-positive S. aureus strains were associated with more-exacerbated skin manifestations and a greater systemic inflammatory response, compared with those cases caused by PVL-negative S. aureus . Clinical improvement after incision and drainage was achieved for most children with SSF caused by PVL-positive MRSA strains, despite treatment with an ineffective antibiotic.

Journal Article.  3847 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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