More than just a simple abscess: could it be caused by Panton-Valentine leukocidin positive Staphylococcus aureus?
OBJECTIVE
A 33-year-old woman presented with a three-day history of an abscess in the left alar region, four weeks after drainage of a breast abscess. The later infection was confirmed to be due to Panton-Valentine leukocidin positive, methicillin-resistant Staphylococcus aureus. This report aims to raise awareness of such infections, and to advise when Panton-Valentine leukocidin toxin testing is appropriate.


METHODS
Case report and discussion.


RESULTS
Although superficial Panton-Valentine leukocidin positive Staphylococcus aureus infections are relatively benign, more serious infections can be potentially life-threatening. Clinicians should be able to identify the features of potential Panton-Valentine leukocidin positive Staphylococcus aureus infection, in order to implement appropriate therapy.


CONCLUSIONS
Clinicians need to be aware of Panton-Valentine leukocidin positive Staphylococcus aureus infections, and should ask specific questions when investigating the clinical history of patients with recurrent abscesses, as this bacterial strain is not routinely assessed by microbiology departments. If such an infection is suspected, clinicians should be aware of local protocols regarding toxin testing, antibiotic choice and decolonisation agents.
Department of ENT, Arrowe Park Hospital, Wirral, UK. jonathanmanara@doctors.org.uk
J
J
Manara
P
P
Shears
D000038:Abscess / Q000188:drug therapy / Q000382:microbiology*; D000328:Adult; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000302:isolation & purification*; D001941:Breast Diseases / Q000601:surgery; D004322:Drainage; D005098:Exotoxins / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000302:isolation & purification*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D055171:Nasal Cartilages; D009668:Nose Diseases / Q000188:drug therapy / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D019980:Amoxicillin-Potassium Clavulanate Combination