title: Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group.
abstract: Twenty-one consecutive patients with streptococcal toxic shock syndrome (TSS) between December 1994 and April 1995 were treated with a median dose of 2 g of intravenous immunoglobulin (IVIG)/kg (cases) and were compared with 32 patients with streptococcal TSS between 1992 and 1995 who did not receive IVIG therapy (controls). The outcome measure was 30-day survival. Patient plasma was tested for its ability to inhibit T cell activation induced by the infecting strain. The proportion of cases with 30-day survival was higher than that of the controls with 30-day survival (67% vs. 34%, respectively; P = .02). Multivariate analysis revealed that IVIG administration and a lower Acute Physiology and Chronic Health Evaluation II score were associated with survival; the odds ratio for survival associated with IVIG therapy was 8.1 (95% confidence interval, 1.6-45; P = .009). IVIG therapy enhanced the ability of patient plasma to neutralize bacterial mitogenicity and reduced T cell production of interleukin-6 and tumor necrosis factor alpha. IVIG may be an effective adjunctive therapy for streptococcal TSS, possibly because of its ability to neutralize bacterial exotoxins.
authors.affiliation: Department of Microbiology, Mount Sinai and Princess Margaret Hospitals, Toronto, Ontario, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Kaul
authors.forename: A
authors.initials: A
authors.lastname: McGeer
authors.forename: A
authors.initials: A
authors.lastname: Norrby-Teglund
authors.forename: M
authors.initials: M
authors.lastname: Kotb
authors.forename: B
authors.initials: B
authors.lastname: Schwartz
authors.forename: K
authors.initials: K
authors.lastname: O'Rourke
authors.forename: J
authors.initials: J
authors.lastname: Talbot
authors.forename: D E
authors.initials: DE
authors.lastname: Low
mesh_terms: D018806:APACHE; D000704:Analysis of Variance; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D008934:Mitogens / Q000502:physiology; D009500:Neutralization Tests; D012772:Shock, Septic / Q000188:drug therapy* / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D016756:Immunoglobulins, Intravenous; D008934:Mitogens