title: Panton-Valentine Leukocidin associated Staphylococcus aureus infections in London, England: clinical and socio-demographic characterisation, management, burden of disease and associated costs.
abstract: Routine notification of Staphylococcus aureus producing the Panton-Valentine Leucocidin toxin (PVL-SA) to the North East & Central London Health Protection Unit, a communicable disease control unit covering a population of 2.8 million, identified 115 cases in 2009-2010, including 99 skin and soft tissue infections (SSTIs), 15 severe infections and one asymptomatic colonisation. Most cases occurred in children and young adults, unequally distributed geographically and socio-economically. The majority of infections were community acquired and 60% were caused by methicillin resistant strains. Overall, 27% of cases had previous SSTIs, and 32% had contacts with SSTIs suggestive of PVL-SA albeit these were not confirmed microbiologically. This suggests that characteristics of PVL-SA infection in cases and their families are not recognised as such leading to delay in diagnosis and low case ascertainment. A lack of governance around effective case management may also be contributing to the burden of disease. Further studies are recommended to evaluate key aspects of PVL-SA management including the effectiveness of decolonisation in the elimination of carriage and prevention of local spread.
authors.affiliation: North East and Central London Health Protection Unit, 151 Buckingham Palace Road, London SW1W 9SZ, United Kingdom. michael.edelstein@doctors.org.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Edelstein
authors.forename: Angela
authors.initials: A
authors.lastname: Kearns
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cordery
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000235:genetics*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003430:Cross-Sectional Studies; D005098:Exotoxins / Q000235:genetics*; D005260:Female; D005843:Geography; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012959:Socioeconomic Factors; D013203:Staphylococcal Infections / Q000191:economics / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000235:genetics* / Q000302:isolation & purification; D037521:Virulence Factors / Q000235:genetics*; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors