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PVL Staphylococcus Aureus Osteomyelitis Complicating Septic Arthritis in a Uk Soldier Serving in Iraq
  1. Surg Lt Cdr Jowan G Penn-Barwell, MRCS RN1,
  2. S Finnikin2,
  3. I Sargeant, Consultant Orthopaedic Surgeon3 and
  4. K Porter, Professor of Clinical Traumatology4
  1. 1ST2 Trauma and Orthopaedics, West Midlands Deanery
  2. 2FY2West Midlands Deanery
  3. 3Royal Centre for Defence Medicine
  4. 4all University Hospitals Birmingham, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD, UK
  1. c/o Trauma Coordinator, Selly Oak Hospital, Raddlebarn Road, Selly Oak, Birmingham B29 6JD 07810 867555 Jowan{at}doctors.net.uk

Abstract

Musculoskeletal infections caused by Panton-Valentine Leukocidin (PVL) secreting Stapylocccus 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.

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