Staphylococcal pneumonia associated with Panton-Valentine leucocidin (PVL) toxin

Panton-Valentine leukocidin (PVL) is a toxine which forms a pore-forming heptamer on neutrophil membrandes leading to neutrophil lysis. Invasive community-onset PVL producing staphylococcus aureus (S. aureus) induced diseases have emerged worldwide, but incidence vary and is strongly attributed to strain types and lineages. Unfortunately diagnostic microbiology laboratories do not routinely test for PVL. These strains have been reported to exceed in virulence hospital-acquired MRSA (methicillin-resistant S. aureus) causing sepsis, necrotizing fasciitis but in rare cases cause severe necrotizing pneumonia. PVL S. aureus necrotizing pneumonia requires early suspicion, particularly in young otherwise healthy individuals, when the clinical picture rapidly evolves, presenting with cavitary consolidation and bilateral infiltrates in the lung - which has been demonstrated within this article in a dramatic case - pleural effusion and hemoptysis. Prompt hospitalization and aggressive treatment with intravenous antimicrobial therapy is warranted to improve outcomes. However, in vitro findings suggest that some antibiotics binding to penicillin binding protein 1 may even increase bacterial PVL expression. In necrotizing pneumonia PVL S. aureus infection is prudent to antibiotic therapy at the highest safest dose at regular intervals to avoid a drop in concentration to sub-MIC. Decolonization and bioburden reduction are proven prophylactic methods also to prevent PVL S. aureus zoonotic cross infections.This manuscript with case presentation gives an overview on important aspects of PVL S. aureus epidemiology, antimicrobial treatment options and decolonization strategies.