title: Streptococcal toxic shock syndrome from necrotizing soft-tissue infection of the breast caused by a mucoid type strain.
abstract: Streptococcal toxic shock syndrome is a severe infectious disease. We report a Japanese case of Streptococcal toxic shock syndrome caused by a highly mucoid strain of Streptococcus pyogenes. A 31-year old female with shock vital sign presented at a tertiary medical center. Her left breast was necrotizing and S. pyogenes was detected by Immunochromatographic rapid diagnostic kits. Intensive care, including administration of antibiotics and skin debridement, was performed. After 53 days in our hospital, she was discharged. The blood cultures and skin swab cultures all grew S. pyogenes which displayed a highly mucoid morphology on culture media. In her course of the disease, the Streptococcus strain had infected two other family members. All of the strains possessed the T1 and M1 antigens, as well as the emm1.0 gene. As for fever genes, the strains were all positive for speA, speB, and speF, but negative for speC. All of the strains exhibited and the same pattern in PFGE with the SfiI restriction enzyme. The strain might have spread in the local area by the data from the Japanese Infectious Disease Surveillance Center. Immunochromatographic rapid diagnostic kits are very useful for detecting S. pyogenes. However, they can not be used to diagnose severe streptococcul disease by highly mucoid strain alone. Careful observation of patients and colony morphology are useful methods for diagnosing severe streptococcal disease by highly mucoid strain.
authors.affiliation: Department of Clinical Laboratory, National Hospital Organization Disaster Medical Center, Tachikawa, Japan. Electronic address: kahedon@mac.com.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Kohayagawa
authors.affiliation: Department of Critical Care and Emergency Medicine, Shimane Prefectural Central Hospital, Izumo, Japan. Electronic address: natsu_k725@hotmail.com.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Ishitobi
authors.affiliation: Department of Critical Care and Emergency Medicine, Shimane Prefectural Central Hospital, Izumo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamori
authors.affiliation: Department of Clinical Laboratory, Shimane Prefectural Central Hospital, Izumo, Japan.
authors.forename: Miho
authors.initials: M
authors.lastname: Wakuri
authors.affiliation: Department of Microbiology, School of Medicine, Shimane University, Izumo, Japan.
authors.forename: Chiaki
authors.initials: C
authors.lastname: Sano
authors.affiliation: Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Tominaga
authors.affiliation: Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Ikebe
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001940:Breast / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D001941:Breast Diseases / Q000378:metabolism* / Q000473:pathology; D003646:Debridement; D005260:Female; D006801:Humans; D009336:Necrosis; D012772:Shock, Septic / Q000382:microbiology* / Q000473:pathology; D018461:Soft Tissue Infections / Q000382:microbiology* / Q000473:pathology; D013290:Streptococcal Infections / Q000382:microbiology* / Q000473:pathology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Breast; Familial infection; Mucoid type strain; Streptococcal toxic shock syndrome; Streptococcus pyogenes