we report 2 patients infected with panton - valentine leukocidin ( pvl)positive mrsa t034 . each patient had a medical history typical of that reported for community - acquired mrsa of other lineages , which in most cases are pvl positive ( 8) . the first patient , a previously healthy 36-year - old male physiotherapist , sought medical care in march 2006 for a small abscess in his axilla . culture of the abscess grew mrsa .
presence of meca gene was confirmed by pcr ( 9 ) . during the next 2 months ,
his youngest child , adopted from china , had been found to be mrsa positive ( throat , perineum , and a small wound ) a month earlier during routine screening for adopted children . during subsequent screening of the family , the older sister , adopted from south korea ,
both parents were negative for mrsa at that time , which suggests that the father was newly infected when his abscess developed and that he had not acquired the strain abroad .
also , spa typing indicated that the children carried different strains from that of the father and from each other ( t286 , t1434 ) ( 10 ) .
subsequent screening of family members for mrsa on several occasions found only the father to be repeatedly positive .
the second patient , a 43-year - old male clerk , also previously healthy , sought medical attention during the summer of 2007 for a mrsa - infected elbow wound .
follow - up examination determined that he carried mrsa also in the perineum and in a chronic external otitis eczema .
the patients lived in geographically distinct areas in the western part of sweden and had no connection to each other . no animal contact
( e.g. , pets , farming ) was reported by the 2 patients , their family members , or other close contacts . both patient strains carried pvl , confirmed by identification of the luks - lukf genes ( 11 ) , and were resistant to digestion with restriction endonuclease smai when typing by pfge was attempted .
they produced -hemolysin according to phenotypic detection methods that used rabbit blood agar with hot  cold analysis , which further indicated their animal origin ( 12 ) .
their drug - susceptibility profiles differed ; 1 was resistant to doxycycline and the other was resistant to ciprofloxacin , erythromycin , and clindamycin .
these strains carry pvl , a toxin partly responsible for the increased virulence of several of the mrsa clones in the community ( 8) . despite several recent publications concerning st398 mrsa ,
few have reported pvl in this lineage , which is believed to be of animal origin ( 2,4,6,13 ) .
most previous reports have described asymptomatic carriage in persons exposed to occupational hazards ( e.g. , veterinary personal and pig farmers ) ( 1,2,7 ) . however , severe clinical infections have been described ( 46 ) . in our patients these strains caused repeated infections that needed medical attention , even hospitalization .
since neither patient had even a remote connection to animals and we found no common source of infection , these strains may already be more common in our region than we had thought .
these case reports suggest that strains of this lineage may impose a threat in the community , even to patients with no obvious animal contact .
 panton - valentine leukocidin ( pvl)positive methicillin - resistant staphylococcus aureus ( mrsa ) , sequence type 398 is believed to be of animal origin . 
 we report 2 cases of infection due to pvl  positive mrsa , spa type t034 , in patients in sweden who had had no animal contact . 
The Cases
Conclusions