Scabies, Periorbital Cellulitis and Recurrent Skin Abscesses due to Panton-Valentine Leukocidin-Positive Staphylococcus aureus Mimic Hyper IgE Syndrome in an Infant

We describe the clinical course of a 2-month-old infant who was evaluated for autosomal dominant Hyper IgE Syndrome based on eczema, periorbital cellulitis, skin abscesses, increased total IgE levels and blood eosinophilia. However, scabies and nasal colonization by Panton-Valentine Leucocidin-positive S. aureus were eventually diagnosed. After specific treatment, the child was asymptomatic

Outpatient decolonization after recurrent skin infection with Panton-Valentine leukocidin (PVL)-producing S. aureus - The importance of treatment repetition

Background: Recurrent skin abscesses are often associated with Panton-Valentine leukocidin-producing strains of S. aureus (PVL-SA). Decolonization measures are required along with treatment of active infections to prevent re-infection and spreading. Even though most PVL-SA patients are treated as outpatients, there are few studies that assess the effectiveness of outpatient topical decolonization in PVL-SA patients. Methods: We assessed the results of topical decolonization of PVL-SA in a retrospective review of patient files and personal interviews. Successful decolonization was defined as the absence of any skin abscesses for at least 6 months after completion of the final decolonization treatment. Clinical and demographic data was assessed. An intention-to-treat protocol was used. Results: Our cohort consisted of 115 symptomatic patients, 66% from PVL-positive MSSA and 19% from PVL-positive MRSA. The remaining 16% consisted of symptomatic patients with close contact to PVL-SA positive index patients but without detection of PVL-SA. The majority of patients were female (66%). The median age was 29.87% of the patients lived in multiple person households. Our results showed a 48% reduction in symptomatic PVL-SA cases after the first decolonization treatment. The results also showed that the decrease continued with each repeated decolonization treatment and reached 89% following the 5th treatment. A built multivariable Cox proportional-hazards model showed that the absence of PVL-SA detection (OR 2.0) and living in single person households (OR 2.4) were associated with an independently increased chance of successful decolonization. Conclusion: In our cohort, topical decolonization was a successful preventive measure for reducing the risk of PVL-SA skin abscesses in the outpatient setting. Special attention should be given to patients living in multiple person households because these settings could confer a risk that decolonization will not be successful

Severe infections of Panton-Valentine leukocidin positive Staphylococcus aureus in children

Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures

Clinical manifestations of Panton-Valentine leukocidin positive Staphylococcus aureus in children and adolescents

Hintergrund: Infektionen durch Staphylococcus aureus, welche das Exotoxin Panton-Valentine Leukozidin exprimieren (PVL-SA), haben in den letzten Jahren international erheblich zugenommen. Ausgehend von einer PVL-SA Kolonisation des Nasenrachenraums sind rezidivierende Hautabszesse die häufigste klinische Manifestation. PVL-SA verursachen jedoch auch schwere invasive Infektionen. Zielsetzung: Ziel dieser Arbeit ist die Untersuchung klinischer Manifestationen von PVL-SA Infektionen in einer pädiatrischen Kohorte. Studienkollektiv: Von Januar 2012 bis Dezember 2017 wurden Kinder und Jugendliche mit PVL-SA Infektionen, die in der Kinderklinik der Charité behandelt wurden, erfasst. Diese Arbeit umfasst einen Fallbericht, eine Ausbruchsanalyse in einem Kindergarten, eine retrospektive Studie zu periorbitalen Infektionen und eine Fallserie zu Betroffenen mit schweren Infektionen. Ergebnisse: Es wurden 75 Kinder und Jugendliche in diese Studie aufgenommen. Klinische Manifestationen waren vorwiegend rezidivierende Hautabszesse. In dem Fallbericht wird ein Säugling mit Ekzem, Abszessen und erhöhtem IgE beschrieben, der bei Verdacht auf ein Hyper-IgE Syndrom umfangreich immunologisch und genetisch untersucht wurde, bevor die Diagnose einer Koinfektion von Scabies und PVL-SA gestellt wurde. Fünf Kinder der Kohorte besuchten einen Kindergarten, in dem ein PVL-SA Ausbruch dokumentiert und analysiert wurde: Bei sieben von 19 Familien konnte eine PVL-SA Kolonisation oder eine manifeste Infektion bei mehreren Familienmitgliedern nachgewiesen werden. Die Analysen der Isolate wiesen auf einen gemeinsamen Stamm hin. Im Vergleich mit internationalen Referenzisolaten zeigte sich eine nahe Verwandtschaft mit Isolaten aus einem regelmäßigen Reiseziel einer betroffenen Familie. Nach Auswertung der Fragebögen war es höchstwahrscheinlich zu einer interfamiliären Verbreitung über häufige Spielkontakte der Kinder gekommen. Bei 19 Kindern der Kohorte wurden periorbitale Infektionen, insbesondere rezidivierende Hordeola, beobachtet. Bei 10 weiteren Kindern traten schwere Infektionen (nekrotisierende Fasziitiden, nekrotisierende Pneumonien, Bakteriämien und Pyomyositiden) auf. Zwei dieser Fälle waren durch venöse Thrombosen kompliziert. Kein Patient und keine Patientin verstarben. Bei sechs der zehn Kinder gingen der schweren Infektion Hautabszesse bei dem Patienten, der Patientin oder Familienangehörigen voraus. Schlussfolgerung: In der vorliegenden Arbeit wurden verschiedene bereits zuvor bekannte Fakten zu PVL-SA bestätigt, jedoch auch neue Aspekte demonstriert: So war bisher nicht bekannt, dass 1. eine PVL-Kolonisation über einen langen Zeitraum asymptomatisch sein kann, 2. dass PVL-SA bei Kindern häufig periorbitale Infektionen, insbesondere rezidivierende Hordeola verursacht und 3. dass schwere pädiatrische PVL-SA Infektionen durch Identifikation und Behandlung von PVL-SA Trägern im familiären Umfeld möglicherweise vermeidbar wären. Aufbauend auf dieser Arbeit zielen künftige Studien der AG-PVL darauf hin, immunologische und genetische Risikofaktoren für (schwere) PVL-SA Infektionen zu identifizieren.Background: Infections due to Staphylococcus aureus expressing the exotoxin Panton-Valentine Leukocidin (PVL-SA) have internationally markedly increased over the last years. After nasopharyngeal colonization PVL-SA mostly cause recurrent skin and soft tissue infections, but severe invasive infections have frequently been reported. Objective: This work aims to investigate the clinical manifestations of PVL-SA associated infections in a pediatric cohort. Study population: From January 2012 to December 2017 children and adolescents treated with PVL-SA infections in the pediatric department of the Charité were recorded. This work comprises a case report, an outbreak analysis from a nursery school, a retrospective study on occurrence of periorbital infections and a case-series on patients with severe infections. Results: 75 patients were included in our study. Clinical manifestations were mainly recurrent skin abscesses. We report the case of an infant who was initially subjected to immunologic and genetic testing hyper-IgE syndrome due to eczema, abscesses and elevated IgE levels. Eventually, a co-infection with scabies and PVL-SA was diagnosed. Five children of the cohort attended a kindergarten, where a PVL-SA outbreak was analyzed. Individuals from seven of 19 families were either colonized with PVL-SA or symptomatic with isolates of a common strain. After comparison with international reference isolates we found similar isolates from a regular travel destination of an affected family. After evaluation of the questionnaires, interfamilial distribution was most likely to have occurred through frequent play contacts of the children. Nineteen of the 75 patients reported periorbital infections, especially recurrent hordeola. Further ten children suffered from severe infections (necrotizing fasciitis, necrotizing pneumonia, bacteremia and pyomyositis). In two cases, venous thrombosis was also observed. None of the patients died. Conclusions: The four publications confirmed various previously known facts about PVL-SA and demonstrated new aspects: 1. PVL-SA colonization can be asymptomatic, 2. PVL-SA can cause periorital infections in children, in particular recurrent hordeola, and 3. severe infections in children could possibly be prevented by identification and treatment of close contact PVL-SA carriers. Based on this work, future studies of the AG-PVL focus on the identification of immunologic and genetic risk factors for (severe) PVL-SA infections

Periorbital infections and conjunctivitis due to Panton-Valentine Leukocidin (PVL) positive Staphylococcus aureus in children

Abstract Background Colonisation with Panton-Valentine Leukocidin expressing strains of Staphylococcus aureus (PVL + SA) is characterised by recurrent skin and soft tissue infections. While periorbital and orbital infections are common in children and frequently caused by S. aureus the role of PVL + SA in recurrent eye infections has not been studied. This study aimed to detect and report frequency and recurrence of periorbital or orbital infections as additional symptoms of PVL + SA colonisation in children. Methods We conducted a retrospective cohort study of pediatric patients who were treated for PVL + SA skin and soft tissue infection in our in- and outpatient clinics in Berlin, Germany from January 2012 to January 2017. We identified cases with periorbital or orbital infections in the year prior to the first PVL + SA evidence. In these cases, we conducted follow-up interviews by phone to determine recurrence of symptoms after the completion of decolonisation procedures. Results Fifty pediatric patients (age range: one week to 17 years) were evaluated and treated for PVL + SA infections in the reported time period. 19 patients (38%) reported periorbital infection or conjunctivitis, with recurrent hordeola as the most frequent finding (n = 9; 18%). Reappearance of hordeola (n = 5) was associated with recurrence of skin and soft tissue infections and/or de novo detection of PVL + SA. No further hordeola or other eye infections occurred after successful decolonisation. Conclusion Our findings suggest a frequent involvement of periorbital skin in children with PVL + SA infections. Pediatric patients with recurrent periorbital infections might benefit from PVL + SA screening and consecutive decolonisation procedures

Pyoderma outbreak among kindergarten families: Association with a Panton-Valentine leukocidin (PVL)-producing S. aureus strain

Objectives: We report on an outbreak of skin and soft tissue infections (SSTI) among kindergarten families. We analyzed the transmission route and aimed to control the outbreak. Methods: The transmission route was investigated by nasal screening for Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA), subsequent microbiological investigation including whole genome sequencing and a questionnaire-based analysis of epidemiological information. The control measures included distribution of outbreak information to all individuals at risk and implementation of a Staphylococcus aureus decontamination protocol. Results: Individuals from 7 of 19 families were either colonized or showed signs of SSTI such as massive abscesses or eye lid infections. We found 10 PVL-SA isolates in 9 individuals. In the WGS-analysis all isolates were found identical with a maximum of 17 allele difference. The clones were methicillin-susceptible but cotrimoxazole resistant. In comparison to PVL-SAs from an international strain collection, the outbreak clone showed close genetical relatedness to PVL-SAs from a non-European country. The questionnaire results showed frequent travels of one family to this area. The results also demonstrated likely transmission via direct contact between families. After initiation of Staphylococcus aureus decontamination no further case was detected. Conclusions: Our outbreak investigation showed the introduction of a PVL-SA strain into a kindergarten likely as a result of international travel and further transmission by direct contact. The implementation of a Staphylococcus aureus decontamination protocol was able to control the outbreak

Allele-based neighbor-joining (NJ) tree, using cgMLST profiles of <i>S</i>. <i>aureus</i> from the suspected outbreak (10 isolates from 9 individuals) and from the NRCs strain collection (countries A-D).

<p>Allele-based neighbor-joining (NJ) tree, using cgMLST profiles of <i>S</i>. <i>aureus</i> from the suspected outbreak (10 isolates from 9 individuals) and from the NRCs strain collection (countries A-D).</p

Performance of a modular ton-scale pixel-readout liquid argon time projection chamber

The Module-0 Demonstrator is a single-phase 600 kg liquid argon time projection chamber operated as a prototype for the DUNE liquid argon near detector. Based on the ArgonCube design concept, Module-0 features a novel 80k-channel pixelated charge readout and advanced high-coverage photon detection system. In this paper, we present an analysis of an eight-day data set consisting of 25 million cosmic ray events collected in the spring of 2021. We use this sample to demonstrate the imaging performance of the charge and light readout systems as well as the signal correlations between the two. We also report argon purity and detector uniformity measurements, and provide comparisons to detector simulations