Pleuropulmonary complications of PVL-positive Staphylococcus aureus infection in children.
It is increasingly recognized world-wide that Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus (PVL-SA) is associated with a highly aggressive and often fatal form of community-acquired pneumonia. We report four children who presented with severe pleuropulmonary complications due to infection by community-acquired methicillin-sensitive S. aureus (CA-MSSA), producing PVL toxin. The complications included bilateral multilobular infiltrates, pneumatocoeles, recurrent pneumothoraces, pleural effusion, empyema, lung abscess and diaphragmatic paralysis. This case series highlights the diverse pleuropulmonary manifestations of this potentially lethal infection and the importance of heightened awareness, early recognition and aggressive therapy.


CONCLUSIONS
Complicated pneumonia in a previously fit young patient with a history of preceding 'flu-like' illness or skin/soft tissue infection should raise the suspicion of infection by PVL-positive Staphylococcus aureus (PVL-SA). Severe pleuropulmonary complications are a feature of this disease.
Children's Hospital, Leicester Royal Infirmary, Leicester, UK.
Biju
B
Thomas
Arun
A
Pugalenthi
Mark
M
Chilvers
D000293:Adolescent; D001427:Bacterial Toxins / Q000302:isolation & purification; D002648:Child; D017714:Community-Acquired Infections / Q000382:microbiology; D005098:Exotoxins / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000302:isolation & purification; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D010995:Pleural Diseases / Q000382:microbiology*; D018410:Pneumonia, Bacterial / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus / Q000302:isolation & purification
D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D008712:Methicillin