Pediatric bone and joint infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus

Pediatr Infect Dis J. 2007 Nov;26(11):1042-8. doi: 10.1097/INF.0b013e318133a85e.


Background: Panton-Valentine leukocidin (PVL) is a necrotizing toxin secreted by Staphylococcus aureus. PVL-positive S. aureus osteomyelitis and arthritis have been described.

Methods: We analyzed demographic, clinical, laboratory, microbiologic, and imaging data in a study group of 14 pediatric cases with PVL-positive S. aureus osteomyelitis and arthritis diagnosed between 2001 and 2005 and compared results with a control group of 17 pediatric cases of PVL-negative S. aureus osteomyelitis and arthritis treated in our institution during the same period. Treatments and outcome were studied.

Results: The severity of PVL-positive S. aureus bone and joint infections was indicated by the presence of severe sepsis in all cases and of septic shock in 6 of the 14 patients. By comparison, severe sepsis was not noted in the control group (P = 0.004). On admission, the median C-reactive protein value was significantly higher in the study group (202.6 mg/L versus 83 mg/L in the control group; P = 0.001). Eleven patients with PVL-positive infection had local extension of the infection by magnetic resonance imaging and 7 patients had severe deep-seated infectious complications by computed tomography. By contrast only 1 patient in the control group presented with bone abscess without extension and none had deep-seated infection (P < 0.001). The median length of hospitalization was 45.5 days in the study group versus 13 days in the control group (P < 0.001). The median duration of intravenous antibacterial chemotherapy was 48 days versus 11.3 days in the control group (P < 0.001). Ten patients (71%) of the study group required surgical procedures with a mean of 3 procedures (range, 1-5) whereas 3 patients (17%) of the control group required 1 surgical drainage each (P = 0.002). All the patients survived, but only 2 patients of the study group were free of long-term complications, whereas there were no long-term complications noted in the control group.

Conclusion: PVL-positive S. aureus bone and joint infection is severe and requires prolonged treatment. Local complications are more frequent and often need repeated surgical drainage.

MeSH terms

  • Adolescent
  • Arthritis, Infectious / diagnostic imaging
  • Arthritis, Infectious / microbiology*
  • Arthritis, Infectious / surgery
  • Bacterial Toxins / genetics*
  • Exotoxins / genetics*
  • Female
  • Humans
  • Infant
  • Leukocidins / genetics*
  • Magnetic Resonance Imaging
  • Male
  • Osteomyelitis* / diagnostic imaging
  • Osteomyelitis* / microbiology
  • Osteomyelitis* / physiopathology
  • Osteomyelitis* / surgery
  • Radiography
  • Sepsis / microbiology
  • Severity of Illness Index
  • Shock, Septic / microbiology
  • Staphylococcal Infections / diagnostic imaging
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / physiopathology
  • Staphylococcal Infections / surgery
  • Staphylococcus aureus* / drug effects
  • Staphylococcus aureus* / genetics


  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin