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P.V.L.

P.V.L. Christopher Jones 2011. What is it NOT?. MRSA ESBL Any other form of antibiotic resistant bacterium (Although antibiotic resistance might be incidentally present). What is it then?. P anton-Vale ntine Leukocidin A virulence enhancing cytotoxin Discovered in 1894

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P.V.L.

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  1. P.V.L. Christopher Jones 2011

  2. What is it NOT? • MRSA • ESBL • Any other form of antibiotic resistant bacterium • (Although antibiotic resistance might be incidentally present)

  3. What is it then? • Panton-Valentine Leukocidin • A virulence enhancing cytotoxin • Discovered in 1894 • Named after Sir Philip Noel Panton and Francis Valentine after they associated it with soft tissue infections in 1932

  4. Where does it come from? • Arises as a result of bacteriophage infection of Staph Aureus (MSSA or MRSA) • Genetic material integrated into the bacterial chromosome

  5. What does it do? • Causes a release of two proteins (LukS-PV & Lukf-PV) from the bacterium • These join together to form a protein ring in the membrane of host cells (esp white blood cells) with a central pore • Result in leakage of intracellular contents and formation of superantigens, undermining targeted immune response

  6. Why is it significant?(medically) • Aggressive Staph Aureus infection • Causes severe local tissue necrosis • Necrotising fasciitis • Necrotising Pneumonia.....

  7. Necrotising Pneumonia • PVL pneumonia • Necrotising vasculitis • Pulmonary haemorrhage • Pulmonary infarction • Leukopenia (from destruction of WBCs) • Shock • 75% mortality if not diagnosed early and treated aggressively.

  8. Why is it significant?(epidemiologically) • Linked to: • Overcrowding • Communal residences • Contact sports • Skin damage • Local Royal Marine base

  9. Management • Consider possibility of diagnosis (especially in infection in healthy adults) • Appropriate infection control measures • Microbiology – culture and sensitivity • “Virology” – polymerase chain reaction testing • Antimicrobials • MSSA: flucloxacillin, erythromycin, clindamycin • MRSA: clindamycin, rifampicinanddoxycyclineorfusidic acid ortrimethoprim

  10. Infection Control • Remember: • The microbiologists are your friends • The infection control nurses are not always your enemies

  11. The End http://www.drchrismjones.net/medcalc/pvl.ppsx

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