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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 9, 1239-1242.
doi: 10.1302/0301-620X.89B9.19485  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Panton-Valentine leukocidin-secreting Staphylococcus aureus causing severe musculoskeletal sepsis in children

A NEW THREAT

P. D. Mitchell, FRCS(Tr & Orth), MD, Honorary Lecturer and Specialist Registrar in Orthopaedic Surgery1; D. M. Hunt, FRCS, Consultant Orthopaedic Surgeon1; H. Lyall, MRCPCH, MD, Consultant Paediatrician2; M. Nolan, FRCPath, Consultant Microbiologist3; and G. Tudor-Williams, MRCP, Consultant Paediatrician2

1 Department of Orthopaedic Surgery
2 Paediatric Infectious Disease Unit
3 Department of Microbiology, St. Mary’s Hospital, Praed Street, London W2 1NY, UK.

Correspondence should be sent to Mr D. M. Hunt; e-mail: davidhunt{at}uk-consultants.co.uk

Panton-Valentine leukocidin secreted by Staphylococcus aureus is known to cause severe skin, soft tissue and lung infections. However, until recently it has not been described as causing life-threatening musculoskeletal infection. We present four patients suffering from osteomyelitis, septic arthritis, widespread intravascular thrombosis and overwhelming sepsis from proven Panton-Valentine leukocidin-secreting Staphylococcus aureus. Aggressive, early and repeated surgical intervention is required in the treatment of these patients.

The Panton-Valentine leukocidin toxin not only destroys host neutrophils, immunocompromising the patient, but also increases the risk of intravascular coagulopathy. This combination leads to widespread involvement of bone with glutinous pus which is difficult to drain, and makes the delivery of antibiotics and eradication of infection very difficult without surgical intervention.






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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General