Common Skin Infections

Panton-Valentine leukocidin (PVL) associated disease and MRSA

PVL is a pore-forming toxin produced by several strains of staph aureus including community-acquired methicillin-resistant staph aureus. It is associated with recurrent necrotic skin and soft-tissue infections. Risk factors include compromised skin integrity; skin-to-skin contact with infected individuals and sharing of contaminated towels. It is common in students sharing accommodation and in individuals such as wrestlers or those indulging in contact sports. I recently saw a case of beard furunculosis due to PVL staphs in a professional cage-fighter. Infection of the hair follicle is the most common PVL-associated disease and usually presents as a large skin abscess, boils or furuncles with surrounding erythema. The lesions are often multiple and are often associated with systemic upset, e.g. fever. You need to specifically request PVL testing on the swab if you are suspicious of PVL, as labs won't routinely do it.

The treatment of choice is surgical drainage of the abscess but if antibiotics are needed, Clindamycin, Linezolid and Rifampicin can be used although specialist microbiology advice should be sought in these cases.

Clinical Tip: Occurs in students, contact sports, deep abscesses

One of the reasons why PVL staphs are important to recognise is that it can cause widespread septicaemia and pulmonary infection and fatalities have been reported.

Clinical Tip: Get patients to stop smoking if they have had MRSA/PVL infections

Clinical Tip: MRSA /PVL patients and their families should be advised to decolonise their living environments by using alcohol wipes/gel to toilet handles/computer keyboards/fridge doors etc and decontaminate pets

PVL staph abscesses in a teenage patient

Streptococcal toxic shock syndrome is very similar to the above, associated with invasive Group A Strep (throat, wounds, soft-tissue).