Acute Deaths in Nonpregnant Adults Due to Invasive Streptococcal Infections

Abstract

Streptococcal organisms, part of the normal human bacterial flora, occasionally become infectious pathogens responsible for a wide array of clinical syndromes, ranging from mild pharyngitis to death. Notably, infections due to group A and group B beta-hemolytic strains are well known for causing invasive disease leading to death. These deaths, while often suspected clinically, occasionally are not diagnosed until autopsy. We present 3 rapid deaths, with very different presentations, due to streptococcal infection. Two decedents experienced sudden deaths due to pneumonia and severe meningoencephalitis caused by group B beta-hemolytic streptococcal infection, a common cause of neonatal meningitis but only rarely reported in nonpregnant adults. The final case involves a 69-year-old male who presented to the emergency room with a complaint of shoulder pain but over the next several hours developed signs of necrotizing fasciitis, became septic, and died. While antemortem cultures were negative, owing to antibiotic administration, postmortem cultures of bone and deep soft tissue were positive for group A beta-hemolytic Streptococcus sp. Acute and sudden deaths due to infectious etiology represent an uncommon yet well-documented occurrence. The importance of appropriate postmortem cultures in these situations and a review of the literature will be discussed.

Sudden adult death

“…Acute death can occur from infection [408,409]. Viral infection can be established using molecular techniques [408], but a postmortem diagnosis of bacterial infection may be difficult to establish [410][411][412].…”

Autopsy cases of fulminant‐type bacterial infection with necrotizing fasciitis: Group A (beta) hemolytic Streptococcus pyogenes versus Vibrio vulnificus infection

“…first reported the wound infection type in 1978 14 . Recently, autopsies have been performed to determine the specific cause of death 15–20 . But there are few reports of the clinicopathological findings.…”

“…14 Recently, autopsies have been performed to determine the specific cause of death. [15][16][17][18][19][20] But there are few reports of the clinicopathological findings. We present the cases of two patients who had a similar sudden onset of toxic shock-like syndrome with necrotizing fasciitis.…”

Two Fatal Cases of Hidden Pneumonia in Young People*

“…The patient was admitted to the intensive care unit with severe leukopenia, but he got worse and after few hours died. Two postmortem blood cultures were positive for group A beta‐hemolytic Streptococcus which is well known for causing invasive disease leading to death even though diagnosis is not always made in life, as in this case (19). No other pathogenous agents were present.…”