title: Severe group a streptococcal soft-tissue infections in Ontario: 1992-1996.
abstract: A prospective, population-based, surveillance study of invasive soft-tissue infections due to group A streptococci was conducted in Ontario, Canada, from 1992 through 1996. Demographic and clinical information was obtained by patient interview and chart review. Isolates were characterized by M protein and T agglutination typing. The incidence of necrotizing fasciitis (NF) increased from 0.08 cases per 100,000 population in 1992 to 0.49 cases per 100,000 population in 1995. The case-fatality rate was 13% (68 of 520 patients died). Hypotension and multiorgan dysfunction complicated 64 cases (12%), and NF complicated 119 cases (23%). Underlying diabetes, alcohol abuse, cancer, and cardiac and pulmonary disease increased the risk of disease. Prior use of nonsteroidal anti-inflammatory agents did not influence disease severity. All 197 patients without NF, underlying illness, and hypotension at presentation survived, as did 95 (99%) of 96 normotensive patients who were <65 years old but who had underlying chronic illness. Previously healthy patients without hypotension or NF may be considered for outpatient treatment.
authors.affiliation: Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada M5G 1X5.
authors.forename: Abdu
authors.initials: A
authors.lastname: Sharkawy
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
authors.forename: Raphael
authors.initials: R
authors.lastname: Saginur
authors.forename: Daniel
authors.initials: D
authors.lastname: Gregson
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schwartz
authors.forename: Peter
authors.initials: P
authors.lastname: Jessamine
authors.forename: Karen
authors.initials: K
authors.lastname: Green
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors; D018461:Soft Tissue Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013297:Streptococcus pyogenes