title: Acute deaths in nonpregnant adults due to invasive streptococcal infections.
abstract: Streptococcal organisms, part of the normal human bacterial flora, occasionally become infectious pathogens responsible for a wide array of clinical syndromes, ranging from mild pharyngitis to death. Notably, infections due to group A and group B beta-hemolytic strains are well known for causing invasive disease leading to death. These deaths, while often suspected clinically, occasionally are not diagnosed until autopsy. We present 3 rapid deaths, with very different presentations, due to streptococcal infection. Two decedents experienced sudden deaths due to pneumonia and severe meningoencephalitis caused by group B beta-hemolytic streptococcal infection, a common cause of neonatal meningitis but only rarely reported in nonpregnant adults. The final case involves a 69-year-old male who presented to the emergency room with a complaint of shoulder pain but over the next several hours developed signs of necrotizing fasciitis, became septic, and died. While antemortem cultures were negative, owing to antibiotic administration, postmortem cultures of bone and deep soft tissue were positive for group A beta-hemolytic Streptococcus sp. Acute and sudden deaths due to infectious etiology represent an uncommon yet well-documented occurrence. The importance of appropriate postmortem cultures in these situations and a review of the literature will be discussed.
authors.affiliation: Medical University of South Carolina, Forensic Section, Charleston, South Carolina, USA. batalini@musc.edu
authors.forename: Nick I
authors.initials: NI
authors.lastname: Batalis
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Caplan
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Schandl
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology; D003645:Death, Sudden / Q000209:etiology*; D019115:Fasciitis, Necrotizing / Q000382:microbiology; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008590:Meningoencephalitis / Q000382:microbiology; D008875:Middle Aged; D010019:Osteomyelitis / Q000382:microbiology; D011014:Pneumonia / Q000382:microbiology; D018805:Sepsis / Q000382:microbiology; D018461:Soft Tissue Infections / Q000382:microbiology; D013290:Streptococcal Infections / Q000150:complications / Q000175:diagnosis*; D013292:Streptococcus agalactiae / Q000302:isolation & purification / Q000472:pathogenicity*; D013297:Streptococcus pyogenes / Q000302:isolation & purification / Q000472:pathogenicity*