title: Super-sticky familial infections caused by Panton-Valentine leukocidin-positive ST22 community-acquired methicillin-resistant Staphylococcus aureus in Japan.
abstract: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which often produces Panton-Valentine leukocidin (PVL), is an emerging threat in the community. In Japan, for example, PVL-positive ST8 CA-MRSA (USA 300), which originated from the United States, persisted in families for a year and caused severe invasive infection in a child. In this study, we describe a long-term familial infection cluster caused by novel PVL-positive CA-MRSA, which most probably originated from India. This MRSA persisted in related families for more than 2 years with colonization of, for example, the nares and cheek. At least 6 of 12 members (50%) developed deep cutaneous abscesses, including recurrent and multifocal abscesses, every 1.2 months on average. All MRSA isolates from colonization and abscesses were the same, albeit with a variant in pulsed-field gel electrophoresis analysis. The MRSA exhibited the genotype ST22/spa113(t005)/SCCmecIVa/coagulase gene (coa) novel type and strong hemolysis activity. Moreover, the MRSA exhibited high biofilm formation (which was markedly enhanced by sub-MICs of oxacillin). Some patients were treated with levofloxacin, with successful MRSA eradication even from the whole body surface sites; however, short-term patient follow-up was not sufficient to demonstrate eradication of the familial infection cluster. The data suggest that PVL-positive novel ST22 CA-MRSA emerged in Japan, causing a long-term familial infection cluster, and that the success of ST22 CA-MRSA as both a colonizer and a pathogen could result from the combination of its strong biofilm formation and other virulence factors. A long-term patient (or carrier) follow-up is needed in the community.
authors.affiliation: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. tatsuoy@med.niigata-u.ac.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Tomomi
authors.initials: T
authors.lastname: Takano
authors.forename: Shizuka
authors.initials: S
authors.lastname: Yabe
authors.forename: Wataru
authors.initials: W
authors.lastname: Higuchi
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Iwao
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Isobe
authors.forename: Kyoko
authors.initials: K
authors.lastname: Ozaki
authors.forename: Misao
authors.initials: M
authors.lastname: Takano
authors.forename: Ivan
authors.initials: I
authors.lastname: Reva
authors.forename: Akihito
authors.initials: A
authors.lastname: Nishiyama
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism*; D018441:Biofilms / Q000254:growth & development*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003030:Coagulase / Q000235:genetics; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D004269:DNA, Bacterial / Q000235:genetics; D005098:Exotoxins / Q000235:genetics / Q000378:metabolism*; D005190:Family; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007956:Leukocidins / Q000235:genetics / Q000378:metabolism*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D001427:Bacterial Toxins; D003030:Coagulase; D004269:DNA, Bacterial; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin