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Cited by 1,514Antimicrobial Resistance in StaphylococcusPneumonia and Respiratory InfectionsStreptococcal Infections and Treatments

Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients

Gillet, Yves, Issartel, Bertrand, Vanhems, Philippe, Fournet, Jean-Christophe, Lina, Gerard, Bes, Michèle, Vandenesch, François, Piémont, Yves +3 more·2002·The Lancet
DOI 10.1016/s0140-6736(02)07877-7
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Abstract

Background Between 1986 and 1998, eight cases of community-acquired pneumonia due to Staphylococcus aureus strains carrying the gene for the Panton-Valentine leukocidin (PVL) were recorded in France, six of which were fatal. We aimed to assess the clinical features of these eight cases, and those of other cases identified prospectively, and to compare them with the characteristics of patients with pneumonia caused by PVL-negative strains.Methods We compared eight retrospective and eight prospective cases of PVL-positive S aureus pneumonia with 36 cases of PVL-negative S aureus pneumonia. For all patients, we recorded age, length of hospital stay, risk factors for infection, signs and symptoms, laboratory findings, antibiotic treatment, and serial radiological findings.Findings Median age was 14.8 years (IQR 5.4-24.0) for the PVL-positive patients and 70.1 years (59.2-81.4) for the others (p=0.001). Influenza-like illness had occurred during the 2 days before admission in 12 of the 16 PVL-positive patients, but in only three of 33 PVL-negative patients (p<0.001). PVL-positive infections were more often marked by: temperature greater than 39 degrees C (p=0.01), heart rate above 140 beats per min (p=0.02), haemoptysis (p=0.005), onset of pleural effusion during hospital stay (p=0.004), and leucopenia (p=0.001). The survival rate 48 h after admission was 63% for the PVL-positive patients and 94% for PVL-negative individuals (p=0.007). Histopathological examination of lungs at necropsy from three cases of necrotising pneumonia associated with PVL-positive S aureus showed extensive necrotic ulcerations of the tracheal and bronchial mucosa and massive haemorrhagic necrosis of interalveolar septa.Interpretation PVL-producing S aureus strains cause rapidly progressive, haemorrhagic, necrotising pneumonia, mainly in otherwise healthy children and young adults. The pneumonia is often preceded by influenza-like symptoms and has a high lethality rate.

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  • The recently emerged USA300 and USA400 clones act synergistically with influenza virus.

    “the recently emerged USA300 and USA400 clones that have been linked to a surge in necrotizing pneumonia in patients with influenza [9-11, 15, 29-31] act synergistically with influenza virus.”

    From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [30]

  • PVL has been proposed as a marker for the enhanced virulence of USA300 and USA400 clones, particularly when their ability to cause necrotizing pneumonia in humans has been considered.

    “which has been proposed as a marker for the enhanced virulence of USA300 and USA400 clones, particularly when their ability to cause necrotizing pneumonia in humans has been considered [30,31].”

    From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [30]

  • Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages, and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic.

    “Influenza-staphylococcal coinfections have increased following the emergence of the USA300 and USA400 lineages [9,11,30,31], and S. aureus has been identified as a common cause of death during the recent H1N1 influenza pandemic [12,15].”

    From Influenza virus primes mice for pneumonia from Staphylococcus aureus. (2011) · cites this paper as [30]

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Authors
Gillet, Y., Issartel, B., Vanhems, P., Fournet, J.-C., Lina, G., Bes, M., Vandenesch, F., Piémont, Y., Brousse, N., Floret, D., & Etienne, J.
Affiliations
  • Hôpital Edouard Herriot (FR)
  • Inserm (FR)
  • Hôpital Necker-Enfants Malades (FR)
  • Université de Strasbourg (FR)
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2002-03
Volume
359
Issue
9308
Pages
753-759
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(02)07877-7
OpenAlex
W2133530652
Cited by
1,514
References
38
Citations by year
2026: 23 · 2025: 26 · 2024: 24 · 2023: 38 · 2022: 36 · 2021: 31 · 2020: 46 · 2019: 47 · 2018: 38 · 2017: 50 · 2016: 61 · 2015: 52 · 2014: 76 · 2013: 72 · 2012: 84
FWCI
37.16
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Minnesota Department of Health
  • Centers for Disease Control and Prevention
Topics
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Health Sciences › Medicine › Epidemiology › Pneumonia and Respiratory Infections
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Streptococcal Infections and Treatments
Keywords
Staphylococcus aureus, Panton-Valentine leukocidin, necrotizing pneumonia, community-acquired pneumonia, children, influenza-like illness, hemorrhagic necrosis, pleural effusion, hemoptysis, leukopenia, mortality, virulence factors, clinical features
MeSH terms
Adolescent, Adult, Bacterial Toxins, Bronchi, Child, Child, Preschool, Exotoxins, Female, France, Humans, Leukocidins, Male, Necrosis, Pneumonia, Staphylococcal, Prospective Studies, Pulmonary Alveoli, Staphylococcus aureus, Trachea, Virulence, Community-Acquired Infections

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