Clinical Usefulness of Intravenous Human Immunoglobulins in Invasive Group A Streptococcal Infections: Case Report and Review

Abstract

The spectrum of invasive Streptococcus pyogenes (group A streptococcus) infections includes bacteremia, toxic shock syndrome, and necrotizing fasciitis or myositis. We report the successful use of intravenous immunoglobulins in conjunction with antibiotics and surgery in a case of necrotizing myositis, toxic shock, and bacteremia. A literature review revealed that three other patients with invasive group A streptococcal infections had been treated with immunoglobulins: one adult patient had toxic shock syndrome, one had necrotizing fasciitis, and one child had septic arthritis. On the basis of this report and the review, we suggest that intravenous immunoglobulins may be useful in the treatment of all forms of invasive group A streptococcal infections associated with toxic shock syndrome.

Group A Streptococcal Toxic Shock Syndrome Developing inthe Third Trimester of Pregnancy

“…Case-control studies show a reduction of mortality from 67 to 34% 36 . Although a randomized clinical trial has never been conducted, most experts advocate the use of IVIG -preferably early in the disease course -for patients with shock due to invasive GAS infections [37][38][39] . This case represents the first report utilizing IVIG in GAS TSS occurring in the puerperium and reminds clinicians to include invasive GAS in the differential diagnosis of a puerperal infection when a patient presents with the rapid onset of septic shock.…”

Severe Invasive Group a Streptococcal Infections

“…Several case reports have demonstrated clinical improvement after IVIG therapy of patients with severe invasive GAS infections including STSS, NF, and necrotizing myositis (Barry et al, 1992;Cawley et al, 1999;Chiu et al, 1997;Lamothe et al, 1995;Mahieu et al, 1995;Nadal et al, 1993;Perez et al, 1997;Stegmayr et al, 1992;Yong, 1994).…”

Passive Immunity in Prevention and Treatment of Infectious Diseases

“…Several reports (99,135) suggest its clinical benefit in invasive streptococcal disease when given in large doses (1 to 2 g/kg), in addition to antimicrobial and supportive therapy.…”