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Community-Acquired Infections Due to Staphylococcus Argenteus Lineage Isolates Harbouring the Panton- Valentine Leucocidin, France, 2014

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Community-Acquired Infections Due to Staphylococcus Argenteus Lineage Isolates Harbouring the Panton- Valentine Leucocidin, France, 2014 Rapid communications Community-acquired infections due to Staphylococcus argenteus lineage isolates harbouring the Panton- Valentine leucocidin, France, 2014 C Dupieux ([email protected])1,2, R Blondé3, C Bouchiat1,2, H Meugnier1,2, M Bes1,2, S Laurent3, F Vandenesch1,2, F Laurent1,2, A Tristan1,2 1. Centre National de Référence des Staphylocoques, Centre de Biologie et de Pathologie Est, Hospices Civils de Lyon, Bron, France 2. CIRI, International Center for Infectiology Research, INSERM U1111, CNRS UMR5308, Université de Lyon, Ecole Normale Supérieure de Lyon, France 3. Service de Réanimation, Centre Hospitalier de Mayotte, Mamoudzou, France Citation style for this article: Dupieux C, Blondé R, Bouchiat C, Meugnier H, Bes M, Laurent S, Vandenesch F, Laurent F, Tristan A. Community-acquired infections due to Staphylococcus argenteus lineage isolates harbouring the Panton-Valentine leucocidin, France, 2014. Euro Surveill. 2015;20(23):pii=21154. Available online: http://www. eurosurveillance.org Article submitted on 29 May 2015 / published on 11 June 2015 We describe two cases of human infections caused to hospital. At that time, she presented with cough, by Staphylococcus aureus clonal complex (CC) 75, haemoptysis and chest pain. Body temperature was also called Staphylococcus argenteus, harbouring the high at 39.1°C and heart rate was 119/min. Laboratory Panton-Valentine leucocidin (PVL). These two sporadic findings showed a white blood cell count of 17.4 x 109/L cases were community-acquired, and identified in (norm: 4–10.5 x 109/L), a C-reactive protein (CRP) of France in 2014. Both had an epidemiological link with 251 mg/L (norm: <3 mg/L), and abnormal liver function Mayotte, an overseas department of France located tests (alanine and aspartate transaminases, alkaline in the Indian Ocean off the south-eastern African phosphatase and gammaglutamyl transpeptidase were coast. This report illustrates that, contrary to previous all elevated). A chest radiography revealed a bilateral descriptions, S. argenteus can acquire important viru- abscessed pneumonia with right pleural effusion. Blood lence factors and be responsible for severe infections. cultures were immediately initiated but no pulmonary sample was taken prior to antibiotherapy at the hospi- In 2014, two cases of human infections caused by tal. Treatment was started with ceftriaxone-spiramycin Staphylococcus aureus isolates belonging to clonal on the same day. The next day, blood culture was posi- complex (CC) 75 lineage, also called Staphylococcus tive with S. aureus. As the strain was susceptible to argenteus, harbouring the Panton-Valentine leucocidin meticillin and positive for Panton-Valentine leucocidin (PVL) occurred in France. The two cases were sporadic (PVL) by polymerase chain reaction (PCR), treatment and community-acquired, and had an epidemiological was changed to intravenous oxacillin and clindamycin link with Mayotte, a French archipelago in the Indian per os. After initiation of this treatment, fever disap- Ocean. The two strains affecting the respective cases peared in only one day while haemoptysis persisted for were both isolated from blood culture. seven days. No other pathogen was identified. After 21 days, treatment was stopped due to a drug rash with Description eosinophilia and systemic symptoms (DRESS) syn- drome and replaced by linezolid up to a total duration Case 1 of five weeks. S. aureus decolonisation was performed In January 2014, a French woman of Comorian ori- during hospitalisation to eradicate nasal carriage and gin in her mid-twenties presented to the Emergency to prevent recurrences. Department of a hospital in Lyon, with an eight-day his- tory of deterioration of the general condition, chills and Case 2 cough complicated by haemoptysis starting the day In November 2014, an 18-month-old child living in before. The symptoms had appeared three weeks after Mayotte presented at a dispensary with a three-day the excision of a recurrent abscess in the left thigh history of fever and right lower limb pain. They were for which the patient had initially received oral treat- referred to the hospital Emergency Department of ment with amoxicillin-clavulanic acid during five days, Mamoudzou. At the time of admission, the clinical then roxithromycin during the following eight days. examination led to suspect arthritis of the right knee Interview of the patient revealed a travel to Mayotte six with a skin lesion in front and inflammatory extension months earlier. The patient was immediately admitted to the rest of the leg. Body temperature was 39.8 °C www.eurosurveillance.org 1 and heart rate 193/min. Laboratory findings showed a argenteus lineage. Moreover, after 48 hours of growth, white blood cell count of 13.4 x 109/L and a CRP of 229 the two strains presented a lack of pigmentation typi- mg/L. Ultrasound revealed joint effusion which could cal of S. argenteus [3]. not be punctured. Blood cultures were immediately collected and treatment started with amoxicillin-clavu- Discussion lanic acid and gentamicin intravenously. The next day, This is, to the best of our knowledge, the first obser- the child was transferred to the intensive care unit due vation of S. argenteus lineage isolates harbouring the to worsening tachycardia and cold extremities despite PVL genes. S. argenteus has recently been described the infusion of a volume expander. Blood culture was as a novel species in the genus Staphylococcus, and positive with S. aureus susceptible to meticillin. Based is - as S. schweitzeri is – part of an S. aureus species on suspicion of a toxin-mediated infection, treatment complex [1]. Several studies previously described the was changed to clindamycin, gentamicin, linezolid and CC75 lineage as grouping clones of S. aureus belonging polyvalent immunoglobulins intravenously. Blood cul- to STs that are very distant from all other clones and ture became negative 48 hours after the initiation of characterised by the lack of staphyloxanthin (e.g. ST75, antibiotherapy. Three days after admission, ultrasound ST850, ST883, ST1223, ST1304, ST1850) [2-5]. Such showed joint effusion of the right knee associated with strains were isolated mainly from indigenous popula- a collection at the quadriceps bursa. Culture from pus tions in Australia and French Guyana [2,4,6], but also aspiration yielded an S. aureus isolate susceptible to in Cambodia, Fiji, Trinidad and Tobago, Thailand [7-10] meticillin. The S. aureus isolate was positive for PVL by and from animals in Africa [11,12]. No strain harbour- PCR. Treatment was continued intravenously with oxa- ing the PVL was described among these isolates, which cillin and clindamycin. Multiple pulmonary abscesses were considered as having an attenuated virulence appeared on the tenth day, which led to change treat- compared with other S. aureus strains [5,13,14]. ment for clindamycin-rifampicin and finally for amoxi- cillin-clavulanic acid-rifampicin orally for a total of six By confering cytotoxicity on neutrophils and mono- weeks, allowing the patient’s recovery. cytes-macrophages, PVL leads to a high degree of virulence [15]. PVL-positive strains are most frequently Analysis of strains responsible for skin and soft-tissue infections, but can Blood cultures from the two patients yielded S. also cause severe necrotising pneumonia or aggressive aureus isolates, which were sent to the French bone and joint infections [16]. The present results indi- national reference centre for staphylococci in Lyon for cate that some strains belonging to the S. argenteus characterisation. lineage are able to acquire the PVL phage. Moreover, the severity of the clinical presentation of the two The two strains were identified by matrix-assisted laser cases described in this report strongly suggests an desorption/ionization time-of-flight (Maldi-Tof) mass important role of PVL in their infections. spectrometry as S. aureus. Antimicrobial susceptibil- ity testing was performed by disk diffusion assay or on Both cases described had a link to Mayotte which automated Vitek2 system and interpreted according to indicates the potential geographical origin of these the 2013 guidelines of the Antibiogram Committee of isolates there. Enhanced surveillance is therefore nec- the French Society for Microbiology (CA-SFM). The fol- essary to determine whether PVL-positive S. argen- lowing panel of antibiotics was tested: penicillin, oxa- teus lineage might emerge as a cause of infections in cillin or cefoxitin, kanamycin, tobramycin, gentamicin, Mayotte and might disseminate further in France and erythromycin, clindamycin or lincomycin, pristinamy- in other countries. cin, levofloxacin or ofloxacin, tetracycline, rifampicin, trimethoprim-sulfamethoxazole, fusidic acid, fosfomy- cin, linezolid, teicoplanin, and vancomycin. The two Conflict of interest isolates were susceptible to meticillin and to all the None declared. antibiotics tested except penicillin. Further characterisation of the strains with the DNA Authors’ contributions microarray Identibac S. aureus Genotyping (Alere C. Dupieux was involved in clinical data collection with R. Technologies, Jena, Germany) for staphylococcal cas- Blondé and S. Laurent, and in writing. C. Bouchiat, M. Bes, sette chromosome (SCC) mec typing and toxin profil- H. Meugnier and A. Tristan carried out the analysis of strains ing [1] revealed that the two strains harboured the and revision of the drafts. F. Vandenesch, F. Laurent and A. PVL genes and belonged to the S. argenteus lineage Tristan critically
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