title: Streptococcal toxic shock syndrome associated with marked gamma delta T cell expansion: case report.
abstract: Streptococcal toxic shock syndrome (strepTSS) has been associated with various streptococcal soft-tissue infections including cellulitis, necrotizing fasciitis, and peritonitis in adults. We describe a 40-year-old patient with pharyngitis and strepTSS. Throat swab cultures yielded a strain of Streptococcus pyogenes that produced large amounts of erythrogenic toxin A. Fluorescence-activated cell sorter analysis of the patient's peripheral blood lymphocytes revealed generally enhanced expression of the T cell activity markers CD25 and human leukocyte antigen-DR and a marked increase in the number of gamma delta T cells, largely of the V delta 1-bearing subpopulation. Two more analyses, which were performed 2 weeks and 9 months later, respectively, documented the course of normalization after the acute episode of strepTSS. The T cells of this patient were stimulated in vitro with supernatants of his streptococcal isolate, and they proliferated in a dose-dependent manner. These proliferating T cells were mainly alpha beta T cells.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases/Immunology, Free University of Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Arvand
authors.forename: T
authors.initials: T
authors.lastname: Schneider
authors.forename: H U
authors.initials: HU
authors.lastname: Jahn
authors.forename: H
authors.initials: H
authors.lastname: Hahn
mesh_terms: D000328:Adult; D001426:Bacterial Proteins; D005098:Exotoxins / Q000032:analysis; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D008213:Lymphocyte Activation; D008297:Male; D008565:Membrane Proteins; D010612:Pharyngitis / Q000276:immunology / Q000382:microbiology*; D016692:Receptors, Antigen, T-Cell, gamma-delta / Q000032:analysis*; D015375:Receptors, Interleukin-2 / Q000032:analysis; D012772:Shock, Septic / Q000276:immunology* / Q000382:microbiology; D013290:Streptococcal Infections / Q000276:immunology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013601:T-Lymphocytes / Q000276:immunology*
chemical_list: D001426:Bacterial Proteins; D005098:Exotoxins; D006684:HLA-DR Antigens; D008565:Membrane Proteins; D016692:Receptors, Antigen, T-Cell, gamma-delta; D015375:Receptors, Interleukin-2; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin