Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment.
Since the 1980s there has been a marked increase in the recognition and reporting of highly invasive group A streptococcal infections with or without necrotizing fasciitis associated with shock and organ failure. Such dramatic cases have been defined as streptococcal toxic-shock syndrome. Strains of group A streptococci isolated from patients with invasive disease have been predominantly M types 1 and 3 that produce pyrogenic exotoxin A or B or both. In this paper, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared to those of streptococcal toxic-shock syndrome. Current concepts in the pathogenesis of invasive streptococcal infection are also presented, with emphasis on the interaction between group A Streptococcus virulence factors and host defense mechanisms. Finally, new concepts in the treatment of streptococcal toxic-shock syndrome are discussed.
University of Washington School of Medicine, Seattle, Washington, USA.
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Stevens
D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000209:etiology / Q000382:microbiology; D002981:Clindamycin / Q000627:therapeutic use; D003013:Clostridium / Q000472:pathogenicity; D003016:Clostridium perfringens / Q000472:pathogenicity; D003646:Debridement; D004352:Drug Resistance, Microbial; D004731:Endotoxins / Q000009:adverse effects; D005098:Exotoxins / Q000009:adverse effects; D019115:Fasciitis, Necrotizing / Q000209:etiology / Q000382:microbiology; D006801:Humans; D051379:Mice; D009220:Myositis / Q000209:etiology / Q000382:microbiology; D010403:Penicillin Resistance; D010406:Penicillins / Q000627:therapeutic use; D012772:Shock, Septic / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000378:metabolism / Q000472:pathogenicity*; D014774:Virulence
D000900:Anti-Bacterial Agents; D004731:Endotoxins; D005098:Exotoxins; D010406:Penicillins; D002981:Clindamycin