Severe group a streptococcal infection and streptococcal toxic shock syndrome

Abstract

Purpose: To review the literature on group A streptococcal toxic shock syndrome, (STSS). Data source: Medline and EMBASE searches were conducted using the key words group A streptococcal toxic shock syndrome, alone and in combination with anesthesia; and septic shock, combined with anesthesia. Medline was also searched using key words intravenous immunoglobulin, (IVIG) and group A streptococcus, (GAS); and group A streptococcus and antibiotic therapy. Other references were included in this review if they addressed the history, microbiology, pathophysiology, incidence, mortality, presentation and management of invasive GAS infections. Relevant references from the papers reviewed were also considered. Articles on the foregoing topics were included regardless of study design. Non-English language studies were excluded. Literature on the efficacy of IVIG and optimal antibiotic therapy was specifically searched. Principal findings: Reports of invasive GAS infections have recently increased. Invasive GAS infection is associated with a toxic shock syndrome, (STSS), in 8 -14% of cases. The STSS characteristically results in shock and multi-organ failure soon after the onset of symptoms, and is associated with a mortality of 33 -81%. Many of these patients will require extensive soft tissue debridement or amputation in the operating room, on an emergency basis. The extent of tissue debridement required is often underestimated before skin incision. Conclusions: Management of STSS requires volume resuscitation, vasopressor/inotrope infusion, antibiotic therapy and supportive care in an intensive care unit, usually including mechanical ventilation. Intravenous immunoglobulin infusion has been recommended. Further studies are needed to define the role of IVIG in STSS management and to determine optimal anesthetic management of patients with septic shock.Objectif: Passer en revue la documentation sur le syndrome de choc toxique streptococcique de groupe A (SCTS). Sources: Des recherches ont été menées dans Medline et EMBASE en utilisant les mots-clés: group A streptococcal toxic shock syndrome, seul et en combinaison avec anesthesia; septic shock, combiné avec anesthesia. Dans Medline, nous avons aussi utilisé les entrées intravenous immunoglobulin (immunoblobuline intraveineuse, IGIV) et group A streptococcus (streptocoque du groupe A, SGA) et antibiotic therapy. Nous avons retenu d'autres références qui concernaient l'histoire, la microbiologie, la physiopathologie, l'incidence, la mortalité, la présenta-tion et le traitement des infections invasives de SGA. Les références pertinentes provenant des articles révisés ont aussi été conservées. Les articles concernant les sujets déjà cités ont été retenus sans tenir compte du type d'é-tude. On a exclu les études d'autres langues que l'anglais. La documentation sur l'efficacité de l'IGIV et sur l'antibiothérapie optimale a été spécialement recherchée. Constatations principales : Les articles sur les infections envahissantes de SGA ont récemment augmenté. L'infection invasive de ...

Group A streptococcal toxic shock syndrome associated with pelvic peritonitis following diagnostic hysteroscopy in a healthy woman: a case report and review

“…Invasive GAS infection is associated with toxic shock syndrome in 8-14% cases, resulting in shock and multi-organ failure soon after onset of symptoms, and is associated with a mortality of 33% despite antibiotics and supportive therapy [1,7]. It has been reported that over the last two decades there has been an increase in the incidence of invasive GAS disease.…”

Influenza A Virus-Infected Hosts Boost an Invasive Type ofStreptococcus pyogenesInfection in Mice

“…In addition, a number of severe invasive GAS infections have been reported in North America, Europe, and Japan (2,18,30,34,36). These infections comprise a wide range of diverse diseases, including acute respiratory distress syndrome, renal failure, toxic shocklike syndrome (TSLS), sepsis, and cellulitis (2,18,35). Since infection can occasionally progress within hours to necrosis of an entire limb and lethal shock (2,18,35), GAS has become known as the "flesh-eating bug."…”

“…These infections comprise a wide range of diverse diseases, including acute respiratory distress syndrome, renal failure, toxic shocklike syndrome (TSLS), sepsis, and cellulitis (2,18,35). Since infection can occasionally progress within hours to necrosis of an entire limb and lethal shock (2,18,35), GAS has become known as the "flesh-eating bug." It has been reported that many invasive GAS isolates are of the M1 or M3 serotype, which produce streptococcal pyrogenic exotoxin A (SPEA) (6,10,16).…”

Liver cirrhosis as a real risk factor for necrotising fasciitis: a three-year population-based follow-up study

“…(10)(11)(12) In a large survey of Canadian children, Eneli and Davies found that the incidence of NF caused by Group A streptococci was 0.21 per 100,000 children, while that of NF caused by non-Group A streptococci was 0.08 per 100,000 children. (13) In the present study, we found that, in addition to the incidence of NF in cirrhotic patients (0.7%), the occurrence rate of NF in non-cirrhotic patients (0.4%) was also much higher than reported in the literature.…”