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Volume 14, Number 8—August 2008

Letter

Pediatric Pneumonia Death Caused by Community-acquired Methicillin-Resistant Staphylococcus aureus, Japan

Takashi Ito*, Makiko Iijima*, Takayoshi Fukushima*, Masato Nonoyama*, Masahiro Ishii*, Tatiana Baranovich†, Taketo Otsuka†, Tomomi Takano†, and Tatsuo Yamamoto†
Author affiliations: *Kitasato University School of Medicine, Kanagawa, Japan; †Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan;

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Table

Characteristics of PVL-positive MRSA strains reported in Japan since 2000*

Type, gene, or resistancePVL-positive MRSA
Present strain
Previous strains
NN32NN1NN12, NN31EB 00449DB 00319
TypesCC3030303030
ST30303030765
spa1919191943
agr33333
SCCmecIVaIVcIVcIVcIVx*

Coagulase
IV

IV
IV
IV
IV
Toxins
LeukocidinslukS-PV, lukF-PV†+++++
lukE-lukD, lukM
Hemolysinshla, hlg, hld+++++
hlb+
hlg–v
Staphylococcal enterotoxinssea+
tst, seb, sec, 
sed, see, seh, 
sej, sek, sep
egc‡+++++
seu+++++
Exfoliative toxinseta, etb, etd
Othersset+++++

edin






Adhesins
icaA, sdrD, sdrE

icaD, cna,§
eno, fnbA,
fnbB, ebpS,clfA, clfB, fib, 
sdrC, bbp¶
+

+
+
+
+
Drug resistance and penicillinase plasmidAminoglycosidesGEN#
KAN#*GEN**
KAN**
STR**
MacrolidesERY**
LincosamidesCLI**
TetracyclineTET#
Penicillinase plasmid (kb)+ 
(33)+ 
(33)+ 
(33)+ 
(33)+ 
(40)**

*PVL, Panton-Valentine leukocidin; MRSA, methicillin-resistant Staphylococcus aureus; SCCmec IVx, staphylococcal cassette chromosome mec type IV with unknown subtypes; +, positive; ­­–, negative; GEN, gentamicin; KAN, kanamycin; STR, streptomycin; ERY, erythromycin; CLI, clindamycin; TET, tetracycline.
†GenBank accession nos. for the PVL gene sequences from strains NN32 and NN1 are AB286959 and AB186917, respectively.
egc, enterotoxin gene cluster, including seg, sei, sem, sen, and seo genes.
§cna, gene encoding for collagen binding protein (adhesin).
bbp, gene encoding for bone sialoprotein binding protein (adhesin).
#Drug resistance encoded by a conjugative drug resistance plasmid (pGKT1) (8).
**Multidrug-resistant penicillinase plasmid encoding for resistance to GEN, KAN, STR, ERY, and CLI, in addition to penicillin resistance (9).

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