Association of exotoxin-producing group A streptococci and severe disease in children

Pediatr Infect Dis J. 1991 May;10(5):351-4. doi: 10.1097/00006454-199105000-00001.


Clinical features and microbiologic data on all cases of serious (hospitalized) Group A streptococcal infections in children managed at our institution between 1985 and 1988 are presented. All 6 cases were caused by toxin-producing strains. Four of 6 were toxin A-producing strains whereas none of 58 community-acquired (Group A streptococcal) pharyngeal isolates in the same period was a toxin A producer. A review of the literature on the incidence of toxin A-producing strains provides information suggesting a resurgence of such strains in the late 1980s after a relative disappearance of toxin B production in isolates from these patients was also significantly greater than in the isolates acquired from the community in uncomplicated pharyngitis. These findings suggest a role for exotoxin in severe manifestations of Group A streptococcal disease in children.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Cellulitis / etiology
  • Child
  • Child, Preschool
  • Disseminated Intravascular Coagulation / etiology
  • Exotoxins / biosynthesis*
  • Female
  • Gangrene / etiology
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Minnesota / epidemiology
  • Prevalence
  • Sepsis / microbiology
  • Streptococcal Infections / complications*
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / isolation & purification*


  • Exotoxins