PVL Staphylococcus aureus osteomyelitis complicating septic arthritis in a UK soldier serving in Iraq. 2009

J G Penn-Barwell, and S Finnikin, and I Sargeant, and K Porter
Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD. Jowan@doctors.net.uk

Musculoskeletal infections caused by Panton-Valentine Leukocidin (PVL) secreting Stapylococcus aureus in children and adolescents have previously been reported. We report the first adult case in a 26 year-old British Army soldier who presented with a S. aureus septic arthritis. He was treated by surgical washout and antibiotics and discharged but was readmitted five months later with an ipsilateral femoral osteomyelitis requiring debridement. The causative S. aureus grown from tissue biopsy taken at time of surgery was found to encode the PVL gene. Whilst there is evidence that soldiers in Iraq have a greater rate of S. aureus colonisation on their skin, the proportion that encode the PVL gene is similar to that observed in the UK. Soldiers are however, subject to the known risk factors that increase vulnerability to PVL secreting S. aureus infection. Military clinicians need to be aware of PVL secreting S. aureus and have a low threshold for requesting specific testing in aggressive musculoskeletal S. aureus infections.

UI MeSH Term Description Entries
D007493 Iraq A country bordering the Persian Gulf, between Iran and Kuwait. The capital is Baghdad. Republic of Iraq
D007956 Leukocidins Pore forming proteins originally discovered for toxic activity to LEUKOCYTES. They are EXOTOXINS produced by some pathogenic STAPHYLOCOCCUS and STREPTOCOCCUS that destroy leukocytes by lysis of the cytoplasmic granules and are partially responsible for the pathogenicity of the organisms. Leucocidin,Leukocidin,Leukocidin Proteins,Proteins, Leukocidin
D008297 Male Males
D008889 Military Personnel Persons including soldiers involved with the armed forces. Air Force Personnel,Armed Forces Personnel,Army Personnel,Coast Guard,Marines,Navy Personnel,Sailors,Soldiers,Submariners,Military,Force Personnel, Air,Personnel, Air Force,Personnel, Armed Forces,Personnel, Army,Personnel, Military,Personnel, Navy,Sailor,Soldier,Submariner
D010019 Osteomyelitis INFLAMMATION of the bone as a result of infection. It may be caused by a variety of infectious agents, especially pyogenic (PUS - producing) BACTERIA. Osteomyelitides
D005098 Exotoxins Toxins produced, especially by bacterial or fungal cells, and released into the culture medium or environment. Exotoxin
D005436 Floxacillin Antibiotic analog of CLOXACILLIN. Flucloxacillin,Fluorochloroxacillin
D006113 United Kingdom Country in northwestern Europe including Great Britain and the northern one-sixth of the island of Ireland, located between the North Sea and north Atlantic Ocean. The capital is London. Great Britain,Isle of Man
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults

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