Idiopathic neonatal necrotising fasciitis caused by community-acquired MSSA encoding Panton Valentine Leukocidin genes

• Published in: Journal of plastic, reconstructive & aesthetic surgery Vol. 64; no. 11; pp. 1522 - 1524
• Main Authors: Dunlop, Rebecca L.E., Eadie, Patricia
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.11.2011; Elsevier
• Subjects: Bacterial diseases; Bacterial diseases of the nervous system. Bacterial myositis; Bacterial Toxins - genetics; Bacterial Typing Techniques; Biological and medical sciences; Buttocks; Combined Modality Therapy; Community-Acquired Infections - microbiology; Community-Acquired Infections - therapy; Exotoxins - genetics; Fasciitis, Necrotizing - microbiology; Fasciitis, Necrotizing - therapy; Gene Transfer, Horizontal - genetics; Human bacterial diseases; Humans; Infant, Newborn; Infectious diseases; Leukocidins - genetics; Male; Medical sciences; Methicillin Resistance - genetics; Microbial Sensitivity Tests; MSSA; Necrotising fasciitis; Neonatal; Panton Valentine Leukocidin; Plastic Surgery; Staphylococcal Infections - microbiology; Staphylococcal Infections - therapy; Staphylococcus aureus - genetics; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; MSSA; Neonatal; Panton Valentine Leukocidin; Necrotising fasciitis; Human; Panton Valentine; Connective tissue disease; Skin disease; Cytokine; Idiopathic; Infection; Panton-Valentine leukocidin; Community acquired infection; Newborn; Treatment; Gene; Surgery; Necrotizing fasciitis; Bacteriosis; Leukocidin
• ISSN: 1748-6815; 1878-0539; 1878-0539
• DOI: 10.1016/j.bjps.2011.03.041

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. 1–3 It generally affects previously healthy babies, the site is often the lower back area and a history of minor skin trauma may be elicited. 2,4–6 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. 7 These strains are the subject of specific treatment and eradication guidance in the UK 7 but awareness of this and the importance of obtaining detailed culture typing is likely to be low amongst Plastic Surgeons.