Virulence determinants of community-acquired methicillin-resistant Staphylococcus aureus
- Franklin D Lowy, MD
Franklin D Lowy, MD
- Professor of Medicine and Pathology & Cell Biology (in Epidemiology)
- Columbia University, College of Physicians and Surgeons
The virulence and rapid transmission of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have raised interest in understanding the pathogenesis of this organism . The most prevalent strain in the United States, USA300, is now among the most common causes of skin and soft tissue infections in urban emergency departments across the United States [2,3]. Up to 10 percent of these infections are invasive infections such as sepsis, meningitis, osteomyelitis, and necrotizing pneumonia [4,5].
Issues related to evolution and virulence determinants that appear to be specific to the emergence of these epidemic CA-MRSA clones will be reviewed here. Issues related to the microbiology of MRSA are discussed in detail separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology".)
EVOLUTION OF CA-MRSA
Several of the emergent community-acquired methicillin-resistant S. aureus (CA-MRSA) strain sequences demonstrate striking similarity to other clonal MRSA strains [6,7]. The genetic persistence of these strains over time suggests they have core genomic determinants that facilitate their survival and virulence. A limited number of clones are responsible for most MRSA infections. The original methicillin-resistant isolate is strikingly similar in nucleotide sequence to the epidemic strain USA300 . In addition, the southwest Pacific strain that has caused infections in Australia and other countries in the region is a descendent of the phage 80/81 strain that has caused outbreaks in newborn nurseries in the 1960s .
The genetic sequence of USA300 revealed that these strains contained a unique mobile element that includes the methicillin-resistance gene staphylococcal cassette chromosome mec (SCCmec) IVa, the arginine catabolic mobile element, enterotoxins Seq and Sek, and a prophage containing the leukocidin, Panton-Valentine leukocidin .
VIRULENCE DETERMINANTS AND THEIR REGULATION
The enhanced virulence of the community-acquired methicillin-resistant S. aureus (CA-MRSA) strains is not fully understood but appears to result from several contributing factors (figure 1), including:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- EVOLUTION OF CA-MRSA
- VIRULENCE DETERMINANTS AND THEIR REGULATION
- Panton-Valentine leukocidin
- Phenol soluble modulins (PSMs)
- Arginine catabolic mobile element (ACME)
- Accessory gene regulator
- Serologic response to infection
- Transmission and survival in the environment