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      High Prevalence of Panton-Valentine Leukocidin (PVL) Genes in Nosocomial-Acquired Staphylococcus aureus Isolated from Tertiary Care Hospitals in Nepal

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          Abstract

          Methicillin-resistant Staphylococcus aureus (MRSA) carrying the important virulence determinant, Panton-Valentine leukocidin (PVL), is an emerging infectious pathogen associated with skin and soft tissue infections as well as life-threatening invasive diseases. In carrying out the first PVL prevalence study in Nepal, we screened 73 nosocomial isolates of S. aureus from 2 tertiary care Nepali hospitals and obtained an overall PVL-positivity rate of 35.6% among the hospital isolates: 26.1% of MRSA and 51.9% of methicillin sensitive S. aureus (MSSA) isolates were found to be positive for the PVL genes. PVL prevalence was not associated with a specific (i) infection site, (ii) age group, or (iii) hospital of origin. It was found to be positively associated with heterogeneous MRSA (73.3%) compared to homogeneous MRSA (3.2%) and MSSA (51.9%); negatively associated with multiresistant MRSA (22%) compared to nonmultiresistant MRSA (60%) and MSSA (51.9%); and positively associated with macrolide-streptogramin B resistance (93.8%) compared to macrolide-lincosamide-streptogramin B resistance (0%) and no-resistance (45.8%) types. Macrolide-streptogramin B resistance was confirmed by the presence of msr(A) gene. Restriction pattern analyses provided evidence to support the circulation of a limited number of clones of PVL-positive MRSA, arguing for the adaptability of these isolates to a hospital setting.

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          Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles.

          Loren G Miller, Francoise Perdreau-Remington, Gunter Rieg … (2005)
          Necrotizing fasciitis is a life-threatening infection requiring urgent surgical and medical therapy. Staphylococcus aureus has been a very uncommon cause of necrotizing fasciitis, but we have recently noted an alarming number of these infections caused by community-associated methicillin-resistant S. aureus (MRSA). We reviewed the records of 843 patients whose wound cultures grew MRSA at our center from January 15, 2003, to April 15, 2004. Among this cohort, 14 were identified as patients presenting from the community with clinical and intraoperative findings of necrotizing fasciitis, necrotizing myositis, or both. The median age of the patients was 46 years (range, 28 to 68), and 71 percent were men. Coexisting conditions or risk factors included current or past injection-drug use (43 percent); previous MRSA infection, diabetes, and chronic hepatitis C (21 percent each); and cancer and human immunodeficiency virus infection or the acquired immunodeficiency syndrome (7 percent each). Four patients (29 percent) had no serious coexisting conditions or risk factors. All patients received combined medical and surgical therapy, and none died, but they had serious complications, including the need for reconstructive surgery and prolonged stay in the intensive care unit. Wound cultures were monomicrobial for MRSA in 86 percent, and 40 percent of patients (4 of 10) for whom blood cultures were obtained had positive results. All MRSA isolates were susceptible in vitro to clindamycin, trimethoprim-sulfamethoxazole, and rifampin. All recovered isolates belonged to the same genotype (multilocus sequence type ST8, pulsed-field type USA300, and staphylococcal cassette chromosome mec type IV [SCCmecIV]) and carried the Panton-Valentine leukocidin (pvl), lukD, and lukE genes, but no other toxin genes were detected. Necrotizing fasciitis caused by community-associated MRSA is an emerging clinical entity. In areas in which community-associated MRSA infection is endemic, empirical treatment of suspected necrotizing fasciitis should include antibiotics predictably active against this pathogen. Copyright 2005 Massachusetts Medical Society.
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            Prevalence of Staphylococcus aureus carrying Panton-Valentine leukocidin genes among isolates from hospitalised patients in China.

            F Yu, Z. Chen, C. Liu … (2008)
            Between January 2005 and January 2006, 25 (12.8%) of 195 Staphylococcus aureus isolates were positive for Panton-Valentine leukocidin (PVL) genes in a teaching hospital in Wenzhou, China. Nineteen (11.9%) of 160 hospital-acquired isolates, and six (17.1%) of 35 community-acquired isolates, harboured lukS/F-PV. Six sequence types (ST88, ST239, ST398, ST25, ST30 and ST59) were found among 18 PVL-positive methicillin-resistant isolates with SCCmec types I, III, IIIA or IV. Only ST88 was found among seven PVL-positive methicillin-susceptible S. aureus isolates. The PVL-positive isolates were associated with lung infection, bloodstream infection and soft-tissue pyogenic infection. Overall, there was a high prevalence of PVL genes in genetically diverse S. aureus isolates.
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              Panton-Valentine leucocidin and gamma-hemolysin from Staphylococcus aureus ATCC 49775 are encoded by distinct genetic loci and have different biological activities.

              G Prévost, B Cribier, P Couppié … (1995)
              Staphylococcus aureus ATCC 49775 produces three proteins recognized by affinity-purified antibodies against the S component of Panton-Valentine leucocidin (LukS-PV) and two proteins recognized by affinity-purified antibodies against the F component of this toxin (LukF-PV). Purification of these proteins and cloning of the corresponding genes provided evidence for the presence of two loci. The first one, encoding Panton-Valentine leucocidin, consisted of two cotranscribed open reading frames, lukS-PV and lukF-PV, coding the class S and the class F components, respectively. The second one coded for a gamma-hemolysin and consisted of two transcription units, the first one encoding an HlgA-like protein, a class S component, and the second one encoding two cotranscribed open reading frames identical to HlgC and HlgB, class S and class F components, respectively, from gamma-hemolysin from the reference strain Smith 5R. It appears that the Panton-Valentine leucocidin from S. aureus ATCC 49775 (V8 strain) should not be confused with leucocidin from ATCC 27733 (another isolate of V8 strain), which had 95% identity with HlgC and HlgB from gamma-hemolysin. The cosecretion of these five proteins led to six possible synergistic combinations between F and S components. Two of these combinations (LukS-PV-LukF-PV and HlgA-LukF-PV) had dermonecrotic activity on rabbit skin, and all six were leukocytolytic on glass-adsorbed leukocytes. Only three were hemolytic on rabbit erythrocytes, the two gamma-hemolysin combinations and the combination LukF-PV-HlgA.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Biomed Res Int
                Journal ID (iso-abbrev): Biomed Res Int
                Journal ID (publisher-id): BMRI
                Title: BioMed Research International
                Publisher: Hindawi Publishing Corporation
                ISSN (Print): 2314-6133
                ISSN (Electronic): 2314-6141
                Publication date (Print): 2014
                Publication date (Electronic): 18 June 2014
                Volume: 2014
                Electronic Location Identifier: 790350
                Affiliations
                1Tri-Chandra Campus, Tribhuvan University, G.P.O. Box 3285, Kathmandu, Nepal
                2New Drug Discovery Research, Ranbaxy Research Laboratories, R & D III, Sector-18, Gurgaon, India
                3Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
                4Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
                Author notes

                Academic Editor: Ana Lucia Nascimento

                Article
                DOI: 10.1155/2014/790350
                PMC ID: 4087282
                PubMed ID: 25045702
                SO-VID: f80c0a4b-f304-4831-8ce6-1a6442e50492
                Copyright © Copyright © 2014 Bidya Shrestha et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 7 March 2014
                Date revision received : 1 June 2014
                Date accepted : 4 June 2014
                Categories
                Subject: Research Article

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