title: [Life-threatening Panton-Valentine leukocidin-associated staphylococcal infections in children. A broad spectrum of clinical presentations].
abstract: Panton-Valentine leukocidin (PVL) is a major toxic virulence factor secreted by community-acquired methicillin-sensitive or methicillin-resistant Staphylococcus aureus (SA). SA-PVL can be responsible for life-threatening infections in healthy children with a wide spectrum of clinical presentations involving lung, skin, and soft tissues or bones and joints. PVL production should always be considered in severe SA infections. The pediatric medicine community remains poorly informed regarding the therapeutic management of this infection, which should be early and aggressive. Intravenous empiric antibiotics against SA and its toxins must be given with early and sometimes iterative surgical procedures to drain abscesses and to stop bacterial proliferation and necrosis in the tissues. Here, we report the cases of three patients admitted for SA-PVL infections to the pediatric intensive care unit. Initial clinical presentation in the three patients was multifocal osteomyelitis associated with necrotizing pneumonia; severe skin infection with septic shock; and non-necrotic pneumonia with pleural and pericardial effusion. Appropriate treatments resulted in a good outcome in all cases. Following these illustrations, we describe a number of practical key points in the optimal medical and surgical management of severe SA-PVL infections, with a review of the literature.
authors.affiliation: Service de réanimation pédiatrique, hôpitaux pédiatriques, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France. Electronic address: laura.gillet.vittori@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Gillet-Vittori
authors.affiliation: Service de réanimation pédiatrique, hôpitaux pédiatriques, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
authors.forename: M
authors.initials: M
authors.lastname: Afanetti
authors.affiliation: Service de réanimation pédiatrique, hôpitaux pédiatriques, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
authors.forename: A
authors.initials: A
authors.lastname: Dupont
authors.affiliation: Service de réanimation pédiatrique, hôpitaux pédiatriques, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Gondon
authors.affiliation: Service de réanimation pédiatrique, hôpitaux pédiatriques, CHU Lenval, 57, avenue de la Californie, 06000 Nice, France.
authors.forename: D
authors.initials: D
authors.lastname: Dupont
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000235:genetics*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D005098:Exotoxins / Q000235:genetics*; D006801:Humans; D007223:Infant; D007956:Leukocidins / Q000235:genetics*; D008279:Magnetic Resonance Imaging; D008297:Male; D009336:Necrosis; D010019:Osteomyelitis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000628:therapy; D013211:Staphylococcus aureus / Q000235:genetics* / Q000472:pathogenicity*; D014774:Virulence / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin