Super-sticky familial infections caused by Panton–Valentine leukocidin-positive ST22 community-acquired methicillin-resistant Staphylococcus aureus in Japan

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 2012-04, Vol.18 (2), p.187-198
• Main Authors: Yamamoto, Tatsuo, Takano, Tomomi, Yabe, Shizuka, Higuchi, Wataru, Iwao, Yasuhisa, Isobe, Hirokazu, Ozaki, Kyoko, Takano, Misao, Reva, Ivan, Nishiyama, Akihito
• Format: Article
• Language: English
• Subjects: Abscess; Abscess - epidemiology; Abscess - microbiology; Abscesses; Adolescent; Adult; Aged; Bacterial Toxins - genetics; Bacterial Toxins - metabolism; Biofilm formation; Biofilms; Biofilms - growth & development; Carrier State - epidemiology; Carrier State - microbiology; Cheek; Child; Child, Preschool; Coagulase; Coagulase - genetics; Colonization; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA); Data processing; DNA, Bacterial - genetics; Drug resistance; Exotoxins - genetics; Exotoxins - metabolism; Familial infection; Family; Female; Genotypes; Hematology, Oncology and Palliative Medicine; Hemolysis; Humans; Infectious Diseases; Japan - epidemiology; leukocidin; Leukocidins - genetics; Leukocidins - metabolism; Levofloxacin; Male; Medical Microbiology; Medicine; Medicine & Public Health; Methicillin-Resistant Staphylococcus aureus - classification; Methicillin-Resistant Staphylococcus aureus - drug effects; Methicillin-Resistant Staphylococcus aureus - genetics; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Middle Aged; Original Article; Oxacillin; Panton–Valentine leukocidin (PVL); Pathogens; Pulsed-field gel electrophoresis; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus aureus; Virology; virulence factors; Young Adult
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1007/s10156-011-0316-0

Abstract Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), which often produces Panton–Valentine leukocidin (PVL), is an emerging threat in the community. In Japan, for example, PVL-positive ST8 CA-MRSA (USA 300), which originated from the United States, persisted in families for a year and caused severe invasive infection in a child. In this study, we describe a long-term familial infection cluster caused by novel PVL-positive CA-MRSA, which most probably originated from India. This MRSA persisted in related families for more than 2 years with colonization of, for example, the nares and cheek. At least 6 of 12 members (50%) developed deep cutaneous abscesses, including recurrent and multifocal abscesses, every 1.2 months on average. All MRSA isolates from colonization and abscesses were the same, albeit with a variant in pulsed-field gel electrophoresis analysis. The MRSA exhibited the genotype ST22/ spa 113(t005)/SCC mec IVa/coagulase gene ( coa ) novel type and strong hemolysis activity. Moreover, the MRSA exhibited high biofilm formation (which was markedly enhanced by sub-MICs of oxacillin). Some patients were treated with levofloxacin, with successful MRSA eradication even from the whole body surface sites; however, short-term patient follow-up was not sufficient to demonstrate eradication of the familial infection cluster. The data suggest that PVL-positive novel ST22 CA-MRSA emerged in Japan, causing a long-term familial infection cluster, and that the success of ST22 CA-MRSA as both a colonizer and a pathogen could result from the combination of its strong biofilm formation and other virulence factors. A long-term patient (or carrier) follow-up is needed in the community.