Clinical Correlates of Panton-Valentine Leukocidin (PVL), PVL Isoforms, and Clonal Complex in the Staphylococcus aureus Population of Northern Australia

• Published in: The Journal of infectious diseases Vol. 202; no. 5; pp. 760 - 769
• Main Authors: Tong, Steven Y. C., Lilliebridge, Rachael A., Bishop, Emma J., Cheng, Allen C., Holt, Deborah C., McDonald, Malcolm I., Giffard, Philip M., Currie, Bart J., Boutlis, Craig S.
• Format: Journal Article
• Language: English
• Published: Oxford The University of Chicago Press 01.09.2010; University of Chicago Press; Oxford University Press
• Subjects: Adult; Anti-Bacterial Agents - pharmacology; BACTERIA; Bacterial Toxins - genetics; Bacterial Toxins - metabolism; Bacteriology; Biological and medical sciences; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-Acquired Infections - physiopathology; Epidemiology; Exotoxins - genetics; Exotoxins - metabolism; Female; Fundamental and applied biological sciences. Psychology; Health outcomes; Humans; Infections; Infectious diseases; Leukocidins; Leukocidins - genetics; Leukocidins - metabolism; Male; Medical sciences; Methicillin - pharmacology; Methicillin resistance; Methicillin resistant staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Methicillin-Resistant Staphylococcus aureus - pathogenicity; Microbiology; Miscellaneous; Northern Territory - epidemiology; Predisposing factors; Prevalence; Protein isoforms; Protein Isoforms - genetics; Sepsis; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcal Infections - physiopathology; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - genetics; Staphylococcus aureus - isolation & purification; Staphylococcus aureus - pathogenicity; Australia; Oceania; Northern Territory; Infection; Toxin; Molecular form; Bacteria; Micrococcales; Leucocidine; Micrococcaceae; Staphylococcus aureus
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/655396

Background. Regional differences in the prevalence of Panton-Valentine leukocidin (PVL) and PVL isoform- harboring strains as well as in the local population structure of Staphylococcus aureus may influence the clinical spectrum of S. aureus infections. Methods. Using a prospective collection of S. aureus isolates from northern Australia, we determined differences between infections caused by (1) PVL+ and PVL− isolates, (2) PVL histidine (H) isoform- and PVL arginine (R) isoform-harboring isolates, and (3) different lineages, including the genetically divergent clonal complex (CC) 75 and the PVL+ CC93. Results. PVL+ isolates comprised 54% (128/239) of community-associated methicillin-resistant isolates and 40% (95/239) of methicillin-susceptible S. aureus (MSSA) isolates. There were 113 H isoform- and 110 R isoform-harboring isolates. PVL was associated with truly community-acquired disease, younger age, and presentation with sepsis. We found no differences in infections due to H isoform-harboring isolates, compared with R isoform-harboring isolates. CC93 was the most prevalent lineage. The genetically divergent CC75 caused clinical disease similar to that of other S. aureus clones. Conclusions. PVL+ and PVL− infections are clearly distinct. MSSA contributes a large but underrecognized burden of PVL+ disease. Compared with elsewhere in the world, there is a relative abundance of the clade that contains CC93 and CC121 in both northern Australia and Asia.