Original Articles

Virulence Genes Encoding for Panton Valentine Leucocidin and Toxic Shock Syndrome Toxin in Methicillin Resistant Staphylococcus aureus

Abstract

Background:   The outcome of Staphylococcal infections ranging from mild skin infection to fatal necrotising pneumonia is determined by the co-presence of virulence factors such as enzymes, toxins (Panton valentine leucocidin & toxic shock syndrome toxin) and methicillin resistance. In this study the association of toxin genes encoding for PVL and TSST was seen with drug resistance.

Methods:   Staphylococcus aureus isolates collected from clinical samples (pus, tracheal aspirate, wound swabs and blood) from inpatients of the tertiary care hospital. The isolates were analysed for presence of toxin genes and drug resistance. DNA extraction was done by boiling method and target genes were identified by PCR and gel electrophoresis. The data was analysed using Microsoft excel. Chi-square test was used for comparison of qualitative data. Unpaired t test was used for comparison of quantitative data. P value less than 0.05 was taken as significant.

Results:   Methicillin resistance was seen in 54.8% (108/197) of the staphylococcal isolates. There was no significant difference in MRSA and MSSA distribution amongst hospitalized or outpatients. The PVL and TSST gene was present in 123 (62.4%) and 29 (14.7%) isolates respectively. The presence of both the PVL and TSST were significantly higher in MRSA (P≤0.05).

Conclusion:   There was significantly higher association of virulence markers such as PVL and TSST in MRSA. The presence of toxins should be investigated from cases of non-resolving MRSA infections to initiate treatment effective against toxins for patient management.

1. Tong SY, Davis JS, Eichenberger E, et al. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev 2015; 28(3):603-61.
2. Archer GL. Staphylococcus aureus : A Well–Armed Pathogen. Clin Infect Dis 1998; 26: 1179-81.
3. Dinges MM, Orwin PM, Schlievert PM. Exotoxins of Staphylococcus aureus. Clin Microbiol Rev 2000; 13:16-34.
4. Panton PN, Valentine FCO. Staphylococcal Toxin. Lancet 1932; 219: 506-8.
5. Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying panton-valentine leukocidin genes: Worldwide emergence. Emerg Infect Dis 2003;9: 978-84.
6. Patil NR, Ghorpade MV, Roy S, et al. Evaluation of panton-valentine leukocidin gene by polymerase chain reaction in community-acquired methicillin resistant Staphylococcus aureus. Int J Recent Sci Res 2016; 7:8132-5.
7. Shallcross LJ, Fragaszy E, Johnson AM, et al. The role of the Panton-Valentine leucocidin toxin in staphylococcal disease: A systematic review and meta-analysis. Lancet Infect Dis 2013; 13:43-54.
8. Gillet Y, Issartel B, Vanhems P, et al. Association between Staphylococcus aureus strains carrying gene for panton-valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet 2002; 359:753-9.
9. Lina G, Piémont Y, Godail-Gamot F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis 1999; 29:1128-32.
10. Holmes A, Ganner M, McGuane S, et al. Staphylococcus aureus isolates carrying panton-valentine leucocidin genes in England and Wales: Frequency, characterization, and association with clinical disease. J Clin Microbiol 2005; 43:2384-90.
11. Becker K, Friedrich AW, Lubritz G, et al. Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens. J Clin Microbiol 2003; 41:1434-39.
12. Hodille E, Rose W, Diep BA, et al. The role of antibiotics in modulating virulence in Staphylococcus aureus. Clin Microbiol Rev 2017; 30(4):887-917.
13. Fitzgerald JR, Sturdevant DE, Mackie SM, et al. Evolutionary genomics of Staphylococcus aureus: Insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic. PNAS 2001; 98: 8821-6.
14. Indian Network for Surveillance of Antimicrobial Resistance (INSAR) group, India. Methicillin resistant Staphylococcus aureus (MRSA) in India: prevalence & susceptibility pattern. Indian J Med Res 2013 ; 137(2):363-9.
15. Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31(4):e00020-18.
16. Siberry GK, Tekle T, Carroll K, et al. Failure of Clindamycin treatment of methicillin-resistant Staphylococcus aureus expressing inducible clindamycin resistance in vitro. Clin Infect Dis 2003; 37:1257-60.
17. Mohanty S, Kapil A, Dhawan B, et al. Bacteriological and antimicrobial susceptibility profile of soft tissue infections from Northern India. Indian J Med Sci 2004; 58(1):10-15.
18. Moussa I, Shibl AM. Molecular characterization of methicillin-resistant Staphylococcus aureus recovered from outpatient clinics in Riyadh, Saudi Arabia. Saudi Med J 2009; 30(5):611-7.
19. Afroz S, Kobayashi N, Nagashima S, et al. Genetic characterization of Staphylococcus aureus isolates carrying Panton-Valentine leukocidin genes in Bangladesh. Jpn J Infect Dis 2008, 61:393-6.
20. Aires-de-Sousa M, Conceição T, De Lencastre H. Unusually high prevalence of nosocomial panton-valentine leukocidin-positive Staphylococcus aureus isolates in cape verde islands. J Clin Microbiol 2006; 44:3790-3.
21. Todd J, Fishaut M, Kapral F, et al. Toxic-shock syndrome associated with phage-group-i staphylococci. Lancet 1978; 312:1116-8.
22. El-Ghodban A, Ghenghesh KS, Márialigeti K, et al. PCR detection of toxic shock syndrome toxin of Staphylococcus aureus from Tripoli, Libya. J Med Microbiol 2006; 55:179-82.
23. Schlebusch S, Schooneveldt JM, Huygens F, et al. Prevalence of Staphylococcus aureus strains in an Australian cohort, 1989-2003: Evidence for the low prevalence of the toxic shock toxin and Panton-Valentine leukocidin genes. Eur J Clin Microbiol Infect Dis 2009, 28:1183-9.
24. Peck KR, Baek JY, Song JH, et al. Comparison of genotypes and enterotoxin genes between Staphylococcus aureus isolates from blood and nasal colonizers in a Korean hospital. J Korean Med Sci 2009; 24(4):585-91.
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IssueVol 13 No 2 (2025) QRcode
SectionOriginal Articles
DOI https://doi.org/10.18502/jmb.v13i2.18653
Keywords
Methicillin resistance Panton valentine leucocidin toxin Toxic shock syndrome toxin.
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How to Cite
1.
Jain M, Parida A, Rani V, Gaind R. Virulence Genes Encoding for Panton Valentine Leucocidin and Toxic Shock Syndrome Toxin in Methicillin Resistant Staphylococcus aureus. J Med Bacteriol. 2025;13(2):23-30.