Severe invasive group A streptococcal disease: Clinical description and mechanisms of pathogenesis

Schlievert, Patrick M.; Assimacopoulos, A.; Cleary, P. Patrick

doi:10.1016/s0022-2143(96)90161-4

Cited by 92 publications

(66 citation statements)

References 29 publications

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“…It is also interesting to note that streptococcal TSS associated with throat infections is less common than illness associated with infection of skin breaks, despite the presence of the organism and SPEA production (28). For example, in a recent outbreak of streptococcal TSS in southeast Minnesota (7), a large number of children attending the local school had the causative SPEA-positive M3 streptococci in the throat, yet the children did not develop TSS as a consequence of the infection.…”

Section: Discussionmentioning

confidence: 99%

Pyrogenic Toxin Superantigen Site Specificity in Toxic Shock Syndrome and Food Poisoning in Animals

Schlievert¹,

Jabloński

Roggiani³

et al. 2000

Infect Immun

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Staphylococcus aureus and Streptococcus pyogenes express pyrogenic toxin superantigens (PTSAgs) that are associated with toxic shock syndrome (TSS) and staphylococcal food poisoning (SFP). Most PTSAgs cause TSS in deep-tissue infections, whereas only TSS toxin 1 (TSST-1) is associated with menstrual, vaginal TSS. In contrast, SFP has been linked only with staphylococcal enterotoxins (SEs). Because of the differential abilities of PTSAgs to cause systemic or localized symptoms in a site-dependent manner, the present study was undertaken to assess the toxins' abilities to cross mucosal barriers. The activity of three PTSAgs when delivered orally, vaginally, or intravenously to rabbits and orally to monkeys was investigated. TSST-1 induced shock via all three routes in rabbits. Although active when administered intravenously, SEC1 and streptococcal pyrogenic exotoxin A (SPEA) did not cause symptoms when administered orally or vaginally. Only SEC1 induced emesis in the monkey feeding assay. TSST-1, albeit less stable than SEC1 and SPEA to pepsin, induced diarrhea in monkeys. Our results may explain the unique association of TSST-1 with menstrual TSS and why SPEA is only rarely associated with TSS after pharyngitis, despite being highly associated with TSS after subcutaneous infections. Finally, our studies indicate that enterotoxicity in SFP is not the result of superantigenicity.

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Section: Discussionmentioning

confidence: 99%

Pyrogenic Toxin Superantigen Site Specificity in Toxic Shock Syndrome and Food Poisoning in Animals

Schlievert¹,

Jabloński

Roggiani³

et al. 2000

Infect Immun

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“…Various bacterial strains may dominate different wounds, but essentially necrotizing fasciitis may be categorized into three types according to the causative organism. (1) In cool and temperate climates it tends to be associated with group A beta hemolytic streptococci (Streptococcus pyogenes) alone or with Staphylococcus aureus [6]. (2) In upto 60% cases the necrotizing fasciitis may be polymicrobial, including one or more obligate anaerobes (Peptostreptococcus, Provetella) [7][8][9].…”

Section: Discussion Microbiologymentioning

confidence: 99%

Necrotizing cervical fasciitis: a case report and review of literature

Lingaraj

Rao

Kotrashetti

et al. 2010

J. Maxillofac. Oral Surg.

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Necrotizing cervical fasciitis is a rare, fulminating infection causing extensive necrosis of the subcutaneous tissue and fascial planes with resultant skin gangrene. To reduce the morbitity and mortality from this condition, it requires early recognition and aggressive surgical debridment with appropriate antibiotic therapy. The origin is generally odontogenic and presents more often in immunocompromised patients. This article presents a case with typical clinical features and appropriate management of this condition. An review of literature was carried out for microbiology, pathogenesis, clinical features, diagnosis, management and prognosis of this condition.

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“…The normative CPP data are based on a longitudinal study in 63 normal pregnant women examined by the same research group. The normal data have obviously not been published in an original paper, as the authors refer to two abstracts of presentations at scienti®c meetings 2,3 . The abstract by Belfort et al 2 gives only the mean values of CPP on gestational age.…”

Section: Sirmentioning

confidence: 99%

“…The normal data have obviously not been published in an original paper, as the authors refer to two abstracts of presentations at scienti®c meetings 2,3 . The abstract by Belfort et al 2 gives only the mean values of CPP on gestational age. The abstract by West et al 3 does not give full background data on the group of normal pregnant women, however, a plot of all CPP values and the predicted means and 95% con®dence intervals are presented in a ®gure.…”

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confidence: 99%

Author's Reply

Belfort

2001

BJOG

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Sir,Belfort et al. 1 conclude in their paper that headache in women with pre-eclampsia is strongly associated with the presence of abnormal cerebral perfusion pressure (CPP). They suggest also that this information may be of use in clinical management. Unfortunately, their paper contains signi®cant errors, which do not allow the above conclusions to be drawn.One of the main results of the study by Belfort et al. 1 is the ®nding of more frequent abnormal CPP in pre-eclamptic women with headache (34/42; 88%) than in those without headache (18/ 37; 49%). The abnormal ± low or high ± CPP values were de®ned as being above the 95% or below 5% limits of the normative data, respectively. The normative CPP data are based on a longitudinal study in 63 normal pregnant women examined by the same research group. The normal data have obviously not been published in an original paper, as the authors refer to two abstracts of presentations at scienti®c meetings 2,3 . The abstract by Belfort et al. 2 gives only the mean values of CPP on gestational age. The abstract by West et al. 3 does not give full background data on the group of normal pregnant women, however, a plot of all CPP values and the predicted means and 95% con®dence intervals are presented in a ®gure. The discrepancy between the plotted individual CPP values in the abstract 3 and the normative data published in the British Journal of Obstetrics and Gynaecology 1 (Fig. 4) shows clearly that the authors have erroneously considered the con®dence limits of the estimated mean values to be the 5 th and 95 th percentiles of the normal population CPP values.According to the referred abstract 3 , 43 normal pregnant women were examined at 36 weeks of gestation, i.e., during the period of gestation in which the majority of pre-eclamptic women of the present paper were studied. For the normal women, a mean CPP value of 72.1 mm Hg was found with standard error of mean (SE) 2.9 mm Hg. This corresponds to one standard deviation (SD) of 19.02 mm Hg, mean 2 2 SD of 34.1 mm Hg and mean 1 2 SD of 110.1 mm Hg. For 16 weeks of gestation, following data are given: n 43, mean CPP 47.6 mm Hg and SE 3.0, giving SD of 19.67 mm Hg, mean 1 2 SD 86.9 mm Hg and mean 2 2 SD 8.3 mm Hg. Considering these normal limits, according to Fig. 4 in the paper, no CPP values of the pre-eclamptic women without headache had abnormal CPP (0/37; 0%). Of the 42 pre-eclamptic women with headache, approximately 4 had CPP values above the upper normal limit and one below the lower normal limit. (The numbers were estimated from Fig. 4.) Thus, in none of the pre-eclamptic women without headache abnormal CPP was found, which is not signi®-cantly different from the ®nding of abnormal CPP in 12% of preeclamptic women with headache (OR 0; 95% CI 0 to 1.22; P 0.12).Belfort et al. 1 did not ®nd any signi®cant difference between the CPP values of pre-eclamptic women with and without headache ( Table 2). This is not surprising considering the overlap of the CPP values shown in Fig. 4. By calculating the multiples of standar...

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Severe invasive group A streptococcal disease: Clinical description and mechanisms of pathogenesis

Cited by 92 publications

References 29 publications

Pyrogenic Toxin Superantigen Site Specificity in Toxic Shock Syndrome and Food Poisoning in Animals

Pyrogenic Toxin Superantigen Site Specificity in Toxic Shock Syndrome and Food Poisoning in Animals

Necrotizing cervical fasciitis: a case report and review of literature

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