title: Emergence of Panton-Valentine leukocidin-positive ST59 methicillin-susceptible Staphylococcus aureus with high cytolytic peptide expression in association with community-acquired pediatric osteomyelitis complicated by pulmonary embolism.
abstract: A 15-year-old boy, who had had a furuncle on his femur, developed femoral pyomyositis and osteomyelitis complicated by septic pulmonary embolism. Panton-Valentine leukocidin-positive (PVL(+)) ST59 methicillin-susceptible Staphylococcus aureus (MSSA) was isolated from pus and blood. Chemotherapy was started with cefazolin, followed by combination therapy with meropenem/vancomycin with surgery. The MSSA (strain KS1) was positive for increased levels of cytolytic peptide (psmα and hld) and staphylococcal enterotoxin B (SEB), and manifested IS1216V-mediated multidrug resistance (to erythromycin, clindamycin, kanamycin, streptomycin, and chloramphenicol), similar to a genome-analyzed reference strain (PM1) of ST59/SCCmecV(5C2&5) community-associated methicillin-resistant S. aureus (Taiwan CA-MRSA), but unlike another reference strain (M013) of Taiwan CA-MRSA in terms of resistance. The data suggest that CA-MSSA KS1, characterized by PVL, increased levels of cytolytic peptide, SEB, and multidrug resistance, is a possible ancestral strain of Taiwan CA-MRSA and causes the unique association of osteomyelitis and septic pulmonary embolism, requiring complicated management.
authors: Department of Pediatrics, Kofu Municipal Hospital, Kofu, Japan.
authors: Emi
authors: E
authors: Sawanobori
authors: Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan; Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors: Wei-Chun
authors: WC
authors: Hung
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors: Tomomi
authors: T
authors: Takano
authors: Department of Orthopedic Surgery, Kofu Municipal Hospital, Kofu, Japan.
authors: Koji
authors: K
authors: Hachuda
authors: Department of Orthopedic Surgery, Kofu Municipal Hospital, Kofu, Japan.
authors: Tadahiro
authors: T
authors: Horiuchi
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors: Wataru
authors: W
authors: Higuchi
authors: Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors: Wei-Wen
authors: WW
authors: Hung
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; International Medical Education and Research Center, Niigata, Japan.
authors: Yasuhisa
authors: Y
authors: Iwao
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
authors: Akihito
authors: A
authors: Nishiyama
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; International Medical Education and Research Center, Niigata, Japan.
authors: Ivan
authors: I
authors: Reva
authors: International Medical Education and Research Center, Niigata, Japan.
authors: Galina
authors: G
authors: Reva
authors: Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan.
authors: Lee-Jene
authors: LJ
authors: Teng
authors: Division of Bacteriology, Department of Infectious Disease Control and International Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; International Medical Education and Research Center, Niigata, Japan. Electronic address: tatsuoy@imerc.jp.
authors: Tatsuo
authors: T
authors: Yamamoto
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000235:genetics / Q000378:metabolism*; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D003646:Debridement; D005098:Exotoxins / Q000235:genetics*; D005838:Genotype; D006801:Humans; D007956:Leukocidins / Q000235:genetics*; D008297:Male; D058889:Molecular Typing; D010019:Osteomyelitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D013203:Staphylococcal Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D013211:Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000378:metabolism; D013624:Taiwan
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: antibiotic treatment; community-associated methicillin-susceptible Staphylococcus aureus (CA-MSSA); genotype; pediatric osteomyelitis; septic pulmonary embolism