Panton Valentine Leucocidin

PVL for short.

Cytotoxin associated with Staph SCCmec type IV (this is the cassette that contains mecA), which is the one sensitive to most non-beta lactam antibiotics, but in the US many MRSA too.

Causes lysis of neutrophils and macrophages.  But clinical effects probably through immune dysregulation.

Associated with higher virulence eg necrotizing, multifocal disease eg osteomyelitis, sepsis, multiorgan failure.

Should be treated with combination of beta lactam and protein synthesis blocking antibiotic (clindamycin, linezolid, rifampicin or gentamycin).  Some evidence to support addition of daptomycin.

Surgery often required to remove foci of infection in necrotic tissue.

Decolonisation therapy with chlorhexidine body wash and mupirocin nasal cream recommended.