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Open Access Case report

Methicillin sensitive Staphylococcus aureus producing Panton-Valentine leukocidin toxin in Trinidad & Tobago: a case report

Patrick E Akpaka1*, Stefan Monecke2, William H Swanston13, AV Chalapathi Rao13, Renee Schulz4 and Paul N Levett4

Author Affiliations

1 Microbiology/Pathology Unit, Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad

2 Institute for Medical Microbiology and Hygiene, Carl Gustav Carus Faculty of Medicine, Technical University of Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany

3 Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Uriah Butler Highway, Champs Fleurs, Trinidad

4 Saskatchewan Disease Control Laboratory, 5 Research Drive, Regina, Saskatchewan, S4S 0A4, Canada

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Journal of Medical Case Reports 2011, 5:157  doi:10.1186/1752-1947-5-157

Published: 20 April 2011

Abstract

Introduction

Certain Staphylococcus aureus strains produce Panton-Valentine leukocidin, a toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or severe infection. This report documents a confirmed case of methicillin-sensitive Staphylococcus aureus strain harboring Panton-Valentine leukocidin genes from Trinidad and Tobago. To the best of our knowledge, this is the first time that such a case has been identified and reported from this country.

Case presentation

A 13-year-old Trinidadian boy of African descent presented with upper respiratory symptoms and gastroenteritis-like syptoms. About two weeks later he was re-admitted to our hospital complaining of pain and weakness affecting his left leg, where he had received an intramuscular injection of an anti-emetic drug. He deteriorated and developed septic arthritis, necrotizing fasciitis and septic shock with acute respiratory distress syndrome, leading to death within 48 hours of admission despite intensive care treatment. The infection was caused by S. aureus. Bacterial isolates from specimens recovered from our patient before and after his death were analyzed using microarray DNA analysis and spa typing, and the results revealed that the S. aureus isolates belonged to clonal complex 8, were methicillin-susceptible and positive for Panton-Valentine leukocidin. An autopsy revealed multi-organ failure and histological tissue stains of several organs were also performed and showed involvement of his lungs, liver, kidneys and thymus, which showed Hassal's corpuscles.

Conclusion

Rapid identification of Panton-Valentine leukocidin in methicillin-sensitive S. aureus isolates causing severe infections is necessary so as not to miss their potentially devastating consequences. Early feedback from the clinical laboratories is crucial.