Toxic Shock—like Syndrome Caused by Non—Group A ß-Hemolytic Streptococci

Abstract

Two patients with rapidly developing shock, multisystem organ failure, and destructive soft-tissue infection caused by groups G and C streptococci are described. Both patients died rapidly despite aggressive treatment. The clinical characteristics cannot be distinguished from those of toxic shock-like syndrome, but Streptococcus pyogenes was not recovered. These strains did not produce any previously identified type of streptococcal pyrogenic exotoxins. These findings suggest that toxic shock-like syndrome can be caused not only by group A but also groups G and C streptococci. The causative strains of toxic shock-like syndrome may have something in common with unknown virulent factors for this syndrome.

Clinical Characteristics of Necrotizing Fasciitis Caused by Group G Streptococcus: Case Report and Review of the Literature

“…Comorbid conditions were present in 4 patients (44.4%), including diabetes mellitus (n¾ 2), rheumatoid arthritis on steroid treatment (n¾ 1) and syringomyelia (n ¾ 1). Antecedent trauma was reported in 3 cases (33.3%): a skin injury of the toe while trimming a toenail, minor burns on the ngers and hands while cooking and surgical amputation of an infected toe (11,16, this report).…”

“…Other organisms that have only rarely been implicated in monobacterial infections include Serratia marcescens, F lavobacterium odoratum, Ochrobactrum anthropi and Vibrio vulni cus (6 -8). G roup G Streptococcus has been incriminated in rare instances but the characteristics of this infection have not been thoroughly described (9)(10)(11)(12)(13)(14)(15)(16)(17). We report a case of Scand J Infect Dis Downloaded from informahealthcare.com by University of Otago on 07/28/15…”

“…A M EDLINE literature review from 1966 onwards revealed 8 previously reported cases of necrotizing fasciitis, 1 of which involved myonecrosis, secondary to group G Streptococcus (9)(10)(11)(12)(13)(14)(15)(16)(17). A single case was excluded because of mixed group G Streptococcus and Staphylococcus aureus infections (13).…”

“…Of the 6 cases with available clinical information, the most common signs and symptoms were swelling with redness (n ¾ 6; 100%), pain (n¾ 5; 83.3%) and blister formation (n¾ 5; 88.3%). The blisters were noted during initial assessment in 3 instances (14)(15)(16) and developed a few days later in the remainder (11,13). The site of involvement was the leg in nearly all cases (n ¾ 8) and the arm in 1 case; both legs were involved in 1 patient (16).…”

Toxic-shock-like-Syndrom durch β-hämolysierende Streptokokken der Gruppe G bei einem multimorbiden Patienten mit Erysipel

“…This unusual and fulminant case emphasizes the importance of considering Streptococcus dysgalactiae as a causative agent in septicemia with multiple predisposing factors and soft-tissue infections. (6,7,8,12,14). Allerdings sind in der Literatur auch fulminante Verläufe bei gesunden Patienten beschrieben (12).…”