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Volume 48, Number 5, October 2015

Emergence of Panton-Valentine leukocidin-positive ST59 methicillin-susceptible Staphylococcus aureus with high cytolytic peptide expression in association with community-acquired pediatric osteomyelitis complicated by pulmonary embolism 

Emi Sawanobori, Wei-Chun Hung, Tomomi Takano, Koji Hachuda, Tadahiro Horiuchi, Wataru Higuchi, Wei-Wen Hung, Yasuhisa Iwao, Akihito Nishiyama, Ivan Reva, Galina Reva, Lee-Jene Teng, Tatsuo Yamamoto

Received: December 30, 2013    Revised: April 19, 2014    Accepted: April 23, 2014   


Corresponding author:

Tatsuo Yamamoto, Corresponding author. International Medical Education and Research Center, Fukusumi Building II, 1-86-12 Higashinakadori, Chuo-ku, Niigata 951-8116, Japan. 


Background and purpose: 

A 15-year-old boy, who had had a furuncle on his femur, developed femoral pyomyositis and osteomyelitis complicated by septic pulmonary embolism. Panton-Valentine leukocidin-positive (PVL+) ST59 methicillin-susceptible Staphylococcus aureus (MSSA) was isolated from pus and blood. Chemotherapy was started with cefazolin, followed by combination therapy with meropenem/vancomycin with surgery. The MSSA (strain KS1) was positive for increased levels of cytolytic peptide (psmα and hld) and staphylococcal enterotoxin B (SEB), and manifested IS1216V-mediated multidrug resistance (to erythromycin, clindamycin, kanamycin, streptomycin, and chloramphenicol), similar to a genome-analyzed reference strain (PM1) of ST59/SCCmecV(5C2&5) community-associated methicillin-resistant S. aureus (Taiwan CA-MRSA), but unlike another reference strain (M013) of Taiwan CA-MRSA in terms of resistance. The data suggest that CA-MSSA KS1, characterized by PVL, increased levels of cytolytic peptide, SEB, and multidrug resistance, is a possible ancestral strain of Taiwan CA-MRSA and causes the unique association of osteomyelitis and septic pulmonary embolism, requiring complicated management.


Key words:

antibiotic treatment, community-associated methicillin-susceptible Staphylococcus aureus (CA-MSSA), genotype, pediatric osteomyelitis, septic pulmonary embolism