The Shock of Strep: Rapid Deaths Due to Group a Streptococcus

Abstract

Streptococcus pyogenes, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease. Why certain individuals contract severe infections is not known, but many strains of Streptococcus pyogenes are known to produce toxins and superantigens. Invasive Streptococcus pyogenes infections have been shown to cause significant morbidity and rapid mortality. In many cases, patients expire before full antemortem testing can be performed, causing physicians and families to look to forensic pathologists for answers. Understanding the pathogenesis of invasive group A strep infections, relevant gross and microscopic findings, and proper culturing techniques is critical for forensic pathologists to diagnosis this condition and assist in the education and protection of the communities they serve.

Pathogenesis, epidemiology and control of Group A Streptococcus infection

“…Taken together, these findings implicate MAIT cells in the pathogenesis of pharyngitis, invasive GAS and ARF (Fig. 2), and although it remains hypothetical, it is tempting to speculate that therapies which selectively impair MAIT cell activity might have broad applicability as treatments for GAS diseases, particularly for STSS where mortality remains unacceptably high 117 . Although MAIT celldirected immunotherapies are yet to enter the market, interventions against MAIT cells as treatments for other inflammatory diseases are under development 118 .…”

Fatal Pediatric Streptococcal Infection: A Clinico—Pathological Study

“…In two cases of meningitis, the likely origin of infection was otitis media, confirmed by microbiologic and histologic examination of the middle ear. Sampling the center and edges of any abnormal skin lesion for microbiology and histological assessment is also recommended 35 as skin is the most common portal of entry in iGAS. 4,22 Virology testing is advised in sudden death in infants and children.…”

Bacterial cholesterol-dependent cytolysins and their interaction with the human immune response

“…Group A Streptococcus (GAS; Streptococcus pyogenes) is a major human pathogen accounting for 700 million cases of disease worldwide annually and of those 1.8 million severe infections occur with a mortality rate of 25% [27][28][29]. GAS is responsible for a broad variety of infections ranging from acute pharyngitis and impetigo to invasive and deadly diseases like streptococcal toxic shock syndrome, necrotizing fasciitis, and bacteremia, as well as postinfectious autoimmune disorders [27,30,31].…”