Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 26, Number 12—December 2020

Arthritis Caused by MRSA CC398 in a Patient without Animal Contact, Japan

Cite This Article

In Response: In our article (1), we hypothesized that the transmission route of the Panton-Valentine leukocidin (PVL)–positive sequence type (ST) 1232 (CC398) MRSA strain is not only from humans but also from imported edible meat for humans. However, in their letter, Larsen and Larsen (2) indicated that S. aureus CC398 includes 2 major MRSA variants with distinct genetic and epidemiologic properties; 1 being a highly transmissible and virulent human variant comprising both PVL-positive and PVL-negative strains, and the other being a more benign PVL-negative livestock-associated variant (3). The presence of PVL genes and immune evasion cluster (IEC) genes in CC398 strain provides supportive evidence for the association of human colonization or infections. Furthermore, they showed that most case-patients in Denmark who were colonized or infected with PVL-positive MRSA CC398 strains of the human variant have links to countries in mainland Asia (4).

Actually, we confirmed scn, chp, and sak of the IEC genes in the PVL-positive ST1232 strain. Hence, as Larsen and Larsen suggested, the ST1232 strain might be a human variant of CC398. We recently reported a second case of the ST1232 strain with characteristics similar to the previous patient in Japan (5). The data strongly suggest that the incidence of human variant of CC398 has been increasing in Japan. Therefore, I agree with their opinion that accurate discrimination of the human variant of MRSA CC398 from the livestock-associated variant is essential for maintaining effective MRSA infection control. I presume that detection of PVL and IEC genes might be a useful simplified marker for classification of the human variant of CC398.


Hidemasa NakaminamiComments to Author 
Author affiliation: Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan



  1. Nakaminami  H, Hirai  Y, Nishimura  H, Takadama  S, Noguchi  N. Arthritis caused by MRSA CC398 in a patient without animal contact, Japan. Emerg Infect Dis. 2020;26:7957. DOIPubMedGoogle Scholar
  2. Larsen  AR, Larsen  J. Arthritis caused by MRSA CC398 in a patient without animal contact, Japan. Emerg Infect Dis. 2020 Dec [cited 2020 Aug 10].
  3. Price  LB, Stegger  M, Hasman  H, Aziz  M, Larsen  J, Andersen  PS, et al. Staphylococcus aureus CC398: host adaptation and emergence of methicillin resistance in livestock. MBio. 2012;3:e0030511. DOIPubMedGoogle Scholar
  4. Møller  JK, Larsen  AR, Østergaard  C, Møller  CH, Kristensen  MA, Larsen  J. International travel as source of a hospital outbreak with an unusual meticillin-resistant Staphylococcus aureus clonal complex 398, Denmark, 2016. Euro Surveill. 2019;24:24. DOIPubMedGoogle Scholar
  5. Nakaminami  H, Kawasaki  H, Takadama  S, Kaneko  H, Suzuki  Y, Maruyama  H, et al. Threat of dissemination, Panton-Valentine leukocidin-positive livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) CC398 clone in Tokyo, Japan. Jpn J Infect Dis. 2020. DOIPubMedGoogle Scholar


Cite This Article

DOI: 10.3201/eid2612.203738

Original Publication Date: November 16, 2020

Related Links


Table of Contents – Volume 26, Number 12—December 2020


Please use the form below to submit correspondence to the authors or contact them at the following address:

Hidemasa Nakaminami, Department of Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan

Send To

10000 character(s) remaining.


Page created: October 22, 2020
Page updated: November 19, 2020
Page reviewed: November 19, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.