title: Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features.
abstract: During November, 1992, to May, 1994, 13 patients were treated at Haukeland University Hospital, Norway, for necrotising fasciitis due to group A beta-haemolytic streptococci. 3 patients died, 1 before admission. Mucoid group A streptococci were isolated from affected tissue (12 patients) and/or blood (5). Strains from 11 patients were serotype M-1 (5 patients), M-3 (2), M-6 (2), M-28 (1), and M-untypable (T-1, opacity factor negative) (1). For the 12 patients admitted alive, the following preoperative events were recorded: 8 had clinical signs of shock with systolic blood pressure of 90 mm Hg or less, 8 had impaired renal function, and 7 had biochemical markers of disseminated intravascular coagulation. At least 6 patients fulfilled the criteria for streptococcal toxic shock syndrome. Preoperative C-reactive protein was substantially raised ( > 200 mg/L) in 10 patients. The 12 patients were given high doses of antibiotics and were operated on with aggressive debridement of necrotic skin and fascia, 7 of them within 24 h of admission. The increasing incidence of necrotising fasciitis in western Norway reflects the resurgence of invasive group A streptococcal infections documented in Scandinavia since 1987. The high case-fatality rate can be reduced by early diagnosis and aggressive surgery combined with adequate antibiotic therapy.
authors.affiliation: Medical Department B, Gade Institute, Oslo, Norway.
authors.forename: J
authors.initials: J
authors.lastname: Chelsom
authors.forename: A
authors.initials: A
authors.lastname: Halstensen
authors.forename: T
authors.initials: T
authors.lastname: Haga
authors.forename: E A
authors.initials: EA
authors.lastname: Høiby
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000032:analysis; D003646:Debridement; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D005208:Fasciitis / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D009664:Norway / Q000453:epidemiology; D012769:Shock / Q000209:etiology; D012772:Shock, Septic / Q000209:etiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D002097:C-Reactive Protein