[Streptococcus group A infections of skin, soft tissue and blood].
BACKGROUND
Group A streptococcus is one of the most common bacterial pathogens causing infections in tissue and organs, most frequently throat and skin. Since the late 1980s there have been reports from Scandinavia and many other countries documenting a resurgence of highly invasive infections such as puerperal fever, necrotizing fasciitis, myositis and sepsis.


METHODS
On the basis of relevant studies and reviews and a clinical study of 61 patients between 1992 and 1999 with necrotizing fasciitis and myositis at Haukeland University Hospital, Bergen, Norway, we present an overview of the prevalence, pathogenesis, clinical features and treatment of group A streptococcal infections in skin, soft tissue and blood.


CONCLUSIONS
The reason for the increase in severe group A streptococcal infections is unclear. The clinical features depend on the level of infection (superficial skin, subcutis, fascia and muscle): the deeper the initial infection, the more frequent development of bacteraemia and life-threatening disease. Serious infections are associated with shock and multiorgan failure, i.e. streptococcal toxic shock syndrome. Early surgical debridement is essential in necrotizing fasciitis and myositis. Penicillin is still the drug of choice for milder infections. The addition of clindamycin is recommended in cases of more invasive infection.
Chelsom
J
J
Medisinsk avdeling Diakonissehjemmets Sykehus 5009 Bergen. juch@haraldsplass.no
Halstensen
A
A
D000328:Adult; D015897:Comorbidity; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000473:pathology; D005260:Female; D006801:Humans; D007169:Impetigo / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009220:Myositis / Q000382:microbiology / Q000473:pathology; D015995:Prevalence; D018805:Sepsis / Q000382:microbiology*; D012874:Skin Diseases, Infectious / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology* / Q000473:pathology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D013297:Streptococcus pyogenes / Q000302:isolation & purification / Q000472:pathogenicity