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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.
[pyomyositis]
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
(
+
)
)
ST
5
9
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
KS
1
)
was
positive
for
increased
levels
of
cytolytic
peptide
(
psmα
and
hld
)
and
staphylococcal
enterotoxin
B
(
SEB
)
,
and
manifested
IS
1216
V
-
mediated
multidrug
resistance
(
to
erythromycin
,
clindamycin
,
kanamycin
,
streptomycin
,
and
chloramphenicol
)
,
similar
to
a
genome-analyzed
reference
strain
(
PM
1
)
of
ST
5
9
/
SCCmecV
(
5
C
2
&
5
)
community-associated
methicillin-resistant
S
.
aureus
(
Taiwan
CA
-MRSA
)
,
but
unlike
another
reference
strain
(
M
013
)
of
Taiwan
CA
-MRSA
in
terms
of
resistance
.
The
data
suggest
that
CA
-MSSA
KS
1
,
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
.
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pyomyositis
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