Intravenous Immunoglobulin Therapy for Streptococcal Toxic Shock Syndrome--A Comparative Observational Study. The Canadian Streptococcal Study Group

Clin Infect Dis. 1999 Apr;28(4):800-7. doi: 10.1086/515199.


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.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Analysis of Variance
  • Case-Control Studies
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Male
  • Middle Aged
  • Mitogens / physiology
  • Neutralization Tests
  • Shock, Septic / drug therapy*
  • Shock, Septic / microbiology
  • Streptococcal Infections / drug therapy*
  • Streptococcal Infections / microbiology
  • Streptococcus pyogenes* / immunology
  • Treatment Outcome


  • Immunoglobulins, Intravenous
  • Mitogens