Penn-Barwell J G, Finnikin S, Sargeant I, Porter K
Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD.
J R Army Med Corps. 2009 Sep;155(3):208-9. doi: 10.1136/jramc-155-03-08.
Musculoskeletal infections caused by Panton-Valentine Leukocidin (PVL) secreting Stapylococcus aureus in children and adolescents have previously been reported. We report the first adult case in a 26 year-old British Army soldier who presented with a S. aureus septic arthritis. He was treated by surgical washout and antibiotics and discharged but was readmitted five months later with an ipsilateral femoral osteomyelitis requiring debridement. The causative S. aureus grown from tissue biopsy taken at time of surgery was found to encode the PVL gene. Whilst there is evidence that soldiers in Iraq have a greater rate of S. aureus colonisation on their skin, the proportion that encode the PVL gene is similar to that observed in the UK. Soldiers are however, subject to the known risk factors that increase vulnerability to PVL secreting S. aureus infection. Military clinicians need to be aware of PVL secreting S. aureus and have a low threshold for requesting specific testing in aggressive musculoskeletal S. aureus infections.
此前已有报道称，儿童和青少年中由分泌杀白细胞素（PVL）的金黄色葡萄球菌引起的肌肉骨骼感染。我们报告了首例成年病例，一名26岁的英国陆军士兵，他患了金黄色葡萄球菌性化脓性关节炎。他接受了手术冲洗和抗生素治疗后出院，但五个月后因同侧股骨骨髓炎再次入院，需要进行清创术。从手术时采集的组织活检中培养出的致病性金黄色葡萄球菌被发现编码PVL基因。虽然有证据表明在伊拉克的士兵皮肤金黄色葡萄球菌定植率更高，但编码PVL基因的比例与在英国观察到的相似。然而，士兵们面临着已知的增加对分泌PVL的金黄色葡萄球菌感染易感性的风险因素。军事临床医生需要了解分泌PVL的金黄色葡萄球菌，并在侵袭性肌肉骨骼金黄色葡萄球菌感染中对要求进行特定检测的阈值较低。
