Methicillin sensitive Staphylococcus auras producing Panton-Valentine
leukocidin toxin in Trinidad & Tobago: a case report
Journal of Medical Case Reports 2011, 5:157 doi:10.1186/1752-1947-5-157
Patrick E Akpaka
Stefan Monecke
William H Swanston
AV Chalapathi Rao
Renee Schulz
Paul N Levett
ISSN 1752-1947
Article type Case report
Submission date 21 August 2010
Acceptance date 20 April 2011
Publication date 20 April 2011
Introduction Certain Staphylococcus aureus strains produce Panton-Valentine leukocidin, a
toxin that lyses white blood cells causing extensive tissue necrosis and chronic, recurrent or
severe infection. This report documents a confirmed case of methicillin-sensitive Staphylococcus
aureus strain harboring Panton-Valentine leukocidin genes from Trinidad and Tobago. To the
best of our knowledge, this is the first time that such a case has been identified and reported from
this country.
Case presentation A 13-year-old Trinidadian boy of African descent presented with upper
respiratory symptoms and gastroenteritis-like syptoms. About two weeks later he was readmitted
to our hospital complaining of pain and weakness affecting his left leg, where he had
received an intramuscular injection of an anti-emetic drug. He deteriorated and developed septic
arthritis, necrotizing fasciitis and septic shock with acute respiratory distress syndrome, leading
to death within 48 hours of admission despite intensive care treatment. The infection was caused
by S. aureus. Bacterial isolates from specimens recovered from our patient before and after his
death were analyzed using microarray DNA analysis and spa typing, and the results revealed that
the S. aureus isolates belonged to clonal complex 8, were methicillin-susceptible and positive for
Panton-Valentine leukocidin. An autopsy revealed multi-organ failure and histological tissue
stains of several organs were also performed and showed involvement of his lungs, liver, kidneys
and thymus, which showed Hassal?s corpuscles.
Conclusion Rapid identification of Panton-Valentine leukocidin in methicillin-sensitive S.
aureus isolates causing severe infections is necessary so as not to miss their potentially
devastating consequences. Early feedback from the clinical laboratories is crucial.
