金黄色葡萄球菌引起的皮肤感染，与潘顿-瓦伦丁白细胞素有关。
Skin Infections Due to Panton-Valentine Leukocidin-Producing S. Aureus.
机构信息
Division of Gastroenterology, Infectious Diseases and Rheumatology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Pediatric Pneumology, Immunology and Intensive Care, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg; Department of Infectious Diseases and Microbiology, University Medical Center Schleswig-Holstein, Lübeck; Interdisciplinary working group on infections with PVL-carrying Staphyloccus aureus, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin; European network on imported Staphylococcus aureus.
出版信息
Dtsch Arztebl Int. 2022 Nov 11;119(45):775-784. doi: 10.3238/arztebl.m2022.0308.
BACKGROUND
Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA) strains are frequently associated with large, recurring abscesses in otherwise healthy young individuals. The typical clinical presentation and the recommended diagnostic evaluation and treatment are not widely known.
METHODS
This review is based on pertinent publications retrieved by a selective search in PubMed, with special attention to international recommendations.
RESULTS
PVL-SA can cause leukocytolysis and dermatonecrosis through specific cell-wall pore formation. Unlike other types of pyoderma, such conditions caused by PVL-SA have no particular site of predilection. In Germany, the PVL gene can be detected in 61.3% (252/411) of skin and soft tissue infections with S. aureus. Skin and soft tissue infections with PVL-SA recur three times as frequently as those due to PVL-negative S. aureus. They are diagnosed by S. aureus culture from wound swabs and combined nasal/pharyngeal swabs, along with PCR for gene detection. The acute treatment of the skin abscesses consists of drainage, followed by antimicrobial therapy if needed. Important secondary preventive measures include topical cleansing with mupirocin nasal ointment and whole-body washing with chlorhexidine or octenidine. The limited evidence (level IIb) concerning PVL-SA is mainly derived from nonrandomized cohort studies and experimental analyses.
CONCLUSION
PVL-SA skin infections are easily distinguished from other skin diseases with targeted history-taking and diagnostic evaluation.
背景
产 Panton-Valentine 白细胞素（PVL）金黄色葡萄球菌（PVL-SA）菌株常与健康年轻个体中反复发作的大脓肿有关。其典型临床表现、推荐的诊断评估和治疗方法尚未被广泛了解。
方法
本综述基于在 PubMed 中进行选择性检索得到的相关文献，特别关注国际推荐意见。
结果
PVL-SA 可通过特定的细胞壁孔形成导致白细胞溶解和皮肤坏死。与其他类型的脓疱病不同，PVL-SA 引起的这些病症没有特定的好发部位。在德国，252/411（61.3%）例金黄色葡萄球菌引起的皮肤和软组织感染可检测到 PVL 基因。与 PVL 阴性金黄色葡萄球菌引起的皮肤和软组织感染相比，PVL-SA 引起的感染复发频率高 3 倍。通过从伤口拭子和鼻/咽拭子中培养金黄色葡萄球菌，并结合基因检测 PCR 进行诊断。皮肤脓肿的急性治疗包括引流，如果需要，还可进行抗菌治疗。重要的二级预防措施包括使用莫匹罗星鼻用软膏进行局部清洁以及使用氯己定或奥替尼啶进行全身清洗。关于 PVL-SA 的有限证据（IIb 级）主要来源于非随机队列研究和实验分析。
结论
针对病史采集和诊断评估，PVL-SA 皮肤感染很容易与其他皮肤病区分开来。
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