Abstract

Panton–Valentine leukocidin (PVL)-producing Staphylococcus aureus is emerging as a serious problem worldwide. Whilst usually causing skin and soft-tissue infections, particularly recurrent abscesses, there has in the last 10 years been an increase in the incidence of an associated devastating pneumonia affecting previously healthy young people and associated with a very high mortality. There are no evidence-based guidelines to consult for the management of PVL-associated staphylococcal pneumonia. The literature contains less than 100 cases, with widely differing antimicrobial therapies and the occasional use of other adjunctive therapies such as intravenous immunoglobulin, activated protein C and extracorporeal membrane oxygenation. This literature review focuses on the salient features of diagnosis and management, with particular attention to the choice of antimicrobials.

Keywords: Panton–Valentine leukocidin; Necrotising pneumonia; Community-associated methicillin-resistant Staphylococcus aureus; CA-MRSA

Article Outline

1. Introduction

2. Panton–Valentine leukocidin (PVL)

3. Incidence of PVL-associated pneumonia

4. MRSA producing PVL: CA-MRSA

5. Pathogenesis of PVL-associated staphylococcal pneumonia

6. Clinical presentation and diagnosis of PVL-associated staphylococcal pneumonia

7. Laboratory investigations

8. Radiological investigations

9. Treatment of PVL-associated staphylococcal pneumonia

10. Adjunctive therapy for PVL-associated infections

11. Conclusion

References