1. P.V.L. Christopher Jones 2011

2. What is it NOT? MRSA ESBL Any other form of antibiotic resistant bacterium (Although antibiotic resistance might be incidentally present)

3. What is it then? Panton-Valentine Leukocidin A virulence enhancing cytotoxin Discovered in 1894 Named after Sir Philip Noel Panton and Francis Valentine after they associated it with soft tissue infections in 1932

4. Where does it come from? Arises as a result of bacteriophage infection of Staph Aureus (MSSA or MRSA) Genetic material integrated into the bacterial chromosome

5. What does it do? Causes a release of two proteins (LukS- PV & Lukf-PV) from the bacterium These join together to form a protein ring in the membrane of host cells (esp white blood cells) with a central pore Result in leakage of intracellular contents and formation of superantigens, undermining targeted immune response

6. Why is it significant? (medically) Aggressive Staph Aureus infection Causes severe local tissue necrosis Necrotising fasciitis Necrotising Pneumonia.....

7. Necrotising Pneumonia PVL pneumonia Necrotising vasculitis Pulmonary haemorrhage Pulmonary infarction Leukopenia (from destruction of WBCs) Shock 75% mortality if not diagnosed early and treated aggressively.

8. Why is it significant? (epidemiologically) Linked to: –Overcrowding –Communal residences –Contact sports –Skin damage Local Royal Marine base

9. Management Consider possibility of diagnosis (especially in infection in healthy adults) Appropriate infection control measures Microbiology – culture and sensitivity “Virology” – polymerase chain reaction testing Antimicrobials MSSA: flucloxacillin, erythromycin, clindamycin MRSA: clindamycin, rifampicin and doxycycline or fusidic acid or trimethoprim

10. Infection Control Remember: –The microbiologists are your friends –The infection control nurses are not always your enemies

11. http://www.drchrismjones.net/medcalc/pvl.ppsx