Idiopathic neonatal necrotising fasciitis caused by community-acquired MSSA encoding Panton Valentine Leukocidin genes
Neonatal necrotising fasciitis is very rare in comparison to the adult presentation of the disease and a Plastic Surgeon may only encounter one such case during his or her career. Often this is initially misdiagnosed and managed as simple cellulitis. It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. The causative organism is usually Streptococcus or polymicrobial, as is the case in the adult population. We present the case of a previously healthy 11-day-old infant with idiopathic, rapidly progressive necrotising fasciitis of the back, cause by Methicillin sensitive Staphylococcus aureus (MSSA) infection. The strain was isolated and found to encode the Panton-Valentine Leukocidin genes, which have been associated with particularly severe necrotising infections in other sites, with high mortality. These strains are the subject of specific treatment and eradication guidance in the UK but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.
Available from: Alain Muselli
- "Treatment of such infections continues to report therapeutic failures (Nichols 1999) because of its complications that may develop kidney failure (Pereira et al., 2012). PVL may be responsible for serious infections, especially in children in neonatology (Dunlop and Eadie, 2011), but also in cases of infections with multidrug-resistant germs (Nichols 1999). Efficient and prompt treatment does not exist until now (Gillet et al., 2011). "
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ABSTRACT: Skin and soft tissue infections (SSTI) caused by staphylococcal toxins including Panton-Valentine leukocidin (PVL) have increased these last years. Treatment of these complicated infections is often difficult. The search for new methods and new antimicrobial substances is necessary. Natural products such as essential oils appear among the possible solutions. The objective of our work was to prove the effectiveness of treatment of these infections with essential oils in vivo on Wistar rats; we have chosen the oil of Origanum glandulosum from Algeria to perform this treatment because of its antiseptic properties. The treatment was done on infections induced in Wistar rats using PVL producing Staphylococcus aureus strain isolated from Tlemcen University Hospital. The results of our experiment have shown a significant decrease in the number of colonies collected from rats treated by the concentrations of 1 and 5% of O. glandulosum essential oil. The treatment of skin infections especially wounds caused by PVL positive S. aureus is possible with the essential oil of O. glandulosum which seems to be effective in eradicating the germ from infected wounds.
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We report three cases of severe infections in infants caused by Panton-Valentine leukocidin positive Staphylococcus aureus and evolved with a positive outcome. The literature of Panton-Valentine leukocidin positive Staphylococcus aureus infections in infants is reviewed.
Our findings suggest that a prompt identification of Panton-Valentine leukocidin positive Staphylococcus aureus and an appropriate therapy can reduce mortality and long-term sequelae. Further research is needed to specify features of Panton-Valentine leukocidin positive Staphylococcus aureus infections in infants.
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