Panton-Valentine leukocidin is associated with exacerbated skin manifestations and inflammatory response in children with community-associated staphylococcal scarlet fever.
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.


CONCLUSIONS
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.
Lo
Wen-Tsung
WT
Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Tang
Ching-Shen
CS
Chen
Shyi-Jou
SJ
Huang
Ching-Feng
CF
Tseng
Min-Hua
MH
Wang
Chih-Chien
CC
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D004322:Drainage; D004768:Enterotoxins / Q000235:genetics; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D011446:Prospective Studies; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology*; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification*; D016896:Treatment Outcome; D037521:Virulence Factors / Q000235:genetics*
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004768:Enterotoxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors; C031818:enterotoxin B, staphylococcal