FREQUENCY OF PANTON VALENTINE LEUCOCIDIN GENE IN STAPHYLOCOCCUS AUREUS FROM SKIN AND SOFT TISSUE INFECTIONS

Authors

  • Asma Akram Continental Medical College, Lahore
  • Mateen Izhar Shaikh Zayed Hospital Lahore
  • Chetan Lal shaikh zayed hospital lahore
  • Hirra Ghaffar cintinental medical college, lahore
  • Saira Zafar continental medical college, lahore
  • Asim Saifullah children hospital lahore
  • Adnan Yaseen shaikh zayed hospital lahore

Abstract

Background: Staphylococcus aureus harbouring Panton Valentine Leucocidin gene are emerging and spreading worldwide. PVL gene was first identified by Noel Panton and Francis Valentine in 1932 who explained its ability to lyse leucocytes and its main relationship with skin and soft tissue infections. In Pakistan only limited data is available on the frequency and molecular analysis of PVL gene positive Staph aureus.  Therefore, this study was conducted to understand the clinical epidemiology of PVL positive Staph aureus in our setup. Objectives of the study was aimed to determine the frequency of PVL gene in Staph aureus obtained from pus samples from skin and soft tissue infections from various departments; indoor and outdoor of a tertiary care hospital of Lahore. Methods: 384 Staph aureus isolates from skin and soft tissue infections were selected from both indoor and outdoor departments of hospital. After identification by phenotypic methods, they were processed by PCR using luk-F and luk-S primers for the detection of PVL gene. Results: 186 out of 384 Staph aureus isolates were positive for PVL gene. Overall frequency of PVL gene was 49%. Frequency of PVL gene in Staph aureus was 44.9% in males and 53.5% in females. The highest frequency of PVL gene was detected in paediatric age group. A large majority of positive isolates were from pus samples other than swabs and from the general surgery department. They mostly belong to indoor with indoor outdoor ratio of approximately 2:1. Frequencies of PVL gene in MRSA and MSSA were 51% and 44% respectively. Frequency of PVL gene was found to be high in Ciprofloxacin sensitive, Gentamicin sensitive, Erythromycin resistant and Fusidic acid resistant isolates. Conclusion: Almost half of Staph aureus isolates were found PVL positive. They were mostly multidrug resistant came from indoor setup. This situation is very alarming so, there is a need to adopt strict infection control policies in the hospitals to limit the widespread and injudicious use of antibiotics. There is also a need to apply PVL positive Staph aureus treatment to the effected individuals which involve not only antibiotics but also the decolonization of effected individuals and their close contacts.Keywords: Penton Valentine Leucocidin; Methicillin Resistant Staph aureus; Methicillin Sensitive Staph aureus; Multidrug Resistant; Polymerization Chain Reaction; Skin and Soft Tissue Infections

Author Biographies

Asma Akram, Continental Medical College, Lahore

senior demonstrator continental medical college lahore pakistan

Mateen Izhar, Shaikh Zayed Hospital Lahore

Chairman and Dean and Head of department of pathology shaikh zayed hospital lahore

Chetan Lal, shaikh zayed hospital lahore

assistant professor of microbiology , department of microbiology shaikh zayed hospital lahore

Hirra Ghaffar, cintinental medical college, lahore

senior demonstrator continental medical college

Saira Zafar, continental medical college, lahore

assistant professor of microbiology , department of pathology, continental medical college, lahorer

Asim Saifullah, children hospital lahore

senior registrar , department of orthopedic surgery , children hospital lahore

Adnan Yaseen, shaikh zayed hospital lahore

senior technician molecular microbiology laboratory shaikh zayed hospital lahore.

References

Sarwar FY, Sherwani AH, Hussain MS, Zeb M, Sarwar I. Identification of Staphylococcus aureus in Pus samples and its Anti-microbial Susceptibility against Imipenem, Tobramycin and Linezolid. Int J Basic Med Sci Pharm 2014;4(1):9–12.

McNeil JC, Hulten KG, Kaplan SL, Mason EO. Decreased susceptibilities to Retapamulin, Mupirocin, and Chlorhexidine among Staphylococcus aureus isolates causing skin and soft tissue infections in otherwise healthy children. Antimicrob Agents chemother 2014;58(5):2878–83.

Sina H, Ahoyo TA, Moussaoui W, Keller D, Bankolé HS, Barogui Y, et al. Variability of antibiotic susceptibility and toxin production of Staphylococcus aureus strains isolated from skin, soft tissue, and bone related infections. BMC Microbiol 2013;13(1):188.

Holmes A, Ganner M, McGuane S, Pitt TL, Cookson BD, Kearns AM. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency, characterization, and association with clinical disease. J Clin Microbiol 2005;43(5):2384–90.

Supersac G, Prévost G, Piémont Y. Sequencing of leucocidin R from Staphylococcus aureus P83 suggests that staphylococcal leucocidins and gamma-hemolysin are members of a single, two-component family of toxin. Infect Immun 1993;61:580–7.

Prévost G, Supersac G, Colin DA, Couppie P, Sire S. The new family of leucotoxins from Staphylococcus aureus: structural and biological properties. In: PLENUM PRESS, 1994; p.284–93.

Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002;359(9308):753–9.

Breurec S, Fall C, Pouillot R, Boisier P, Brisse S, Diene‐Sarr F, et al. Epidemiology of methicillin‐susceptible Staphylococcus aureus lineages in five major African towns: high prevalence of Panton–Valentine leukocidin genes. Clin Microbiol Infect 2011;17(4):633–9.

Yu F, Chen Z, Liu C, Zhang X, Lin X, Chi S, et al. Prevalence of Staphylococcus aureus carrying Panton–Valentine leukocidin genes among isolates from hospitalised patients in China. Clin Microbiol Infect 2008;14(4):381–4.

Monecke S, Slickers P, Ellington MJ, Kearns AM, Ehricht R. High diversity of Panton–Valentine leukocidin-positive, methicillin-susceptible isolates of Staphylococcus aureus and implications for the evolution of community-associated methicillin-resistant S. aureus. Clin Microbiol Infect 2007;13(12):1157–64.

Rossney AS, Shore AC, Morgan PM, Fitzgibbon MM, O'Connell B, Coleman DC. The emergence and importation of diverse genotypes of methicillin-resistant Staphylococcus aureus (MRSA) harboring the Panton-Valentine leukocidin gene (pvl) reveal that pvl is a poor marker for community-acquired MRSA strains in Ireland. J Clin Microbiol 2007;45(8):2554–63.

Kim JS, Park JS, Song W, Kim HS, Cho HC, Lee KM, et al. Panton-Valentine leukocidin positive Staphylococcus aureus isolated from blood in Korea. Korean J Lab Med 2007;27(4):286–91.

Hsu LY, Koh TH, Kurup A, Low J, Chlebicki MP, Tan BH. High incidence of Panton-Valentine leukocidin-producing Staphylococcus aureus in a tertiary care public hospital in Singapore. Clin Infect Dis 2005;1:486–9.

Karahan ZC, Tekeli A, Adaleti R, Koyuncu E, Dolapci I, Akan OA. Investigation of Panton-Valentine Leukocidin Genes and SCC mec Types in Clinical Staphylococcus aureus Isolates from Turkey. Microb Drug Resist 2008;14(3):203–10.

Skiest DJ, Brown K, Cooper TW, Hoffman-Roberts H, Mussa HR, Elliott AC. Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. J Infect 2007;54(5):427–34.

Kaur H, Purwar S, Saini A, Kaur H, Karadesai SG, Kholkute SD, et al. Status of methicillin-resistant Staphylococcus aureus infections and evaluation of PVL producing strains in Belgaum, South India. JKIMSU 2012;1(2):43–51.

Madzgalla S, Syed MA, Khan MA, Rehman SS, Müller E, Reissig A, et al. Molecular characterization of Staphylococcus aureus isolates causing skin and soft tissue infections in patients from Malakand, Pakistan. Eur J Clin Microbiol Infect Dis 2016;35(9):1541–7.

Havaei SA, Moghadam SO, Pourmand MR, Faghri J. Prevalence of genes encoding bi-component leukocidins among clinical isolates of methicillin resistant Staphylococcus aureus. Iranian J Public Health 2010;39(1):8.

Ellington MJ, Perry C, Ganner M, Warner M, Smith IM, Hill RL, et al. Clinical and molecular epidemiology of ciprofloxacin-susceptible MRSA encoding PVL in England and Wales. Eur J Clin Microbiol Infect Dis 2009;28(9):1113.

Bhutia KO, Singh TS. The prevalence and risk factors which are associated with Staphylococcus aureus and methicillin resistant S. aureus which harboured the Panton Valentine Leukocidin gene in Sikkim. J Clin Diagn Res 2012;6(3):393–9.

Boyle-Vavra S, Daum RS. Community-acquired methicillin-resistant Staphylococcus aureus: the role of Panton–Valentine leukocidin. Laboratory investigation. 2007 Jan;87(1):3.

Bhatta DR, Cavaco LM, Nath G, Kumar K, Gaur A, Gokhale S, Bhatta DR. Association of Panton Valentine Leukocidin (PVL) genes with methicillin resistant Staphylococcus aureus (MRSA) in Western Nepal: a matter of concern for community infections (a hospital based prospective study). BMC infectious diseases. 2016 May 15;16(1):199.

Published

2020-09-07