Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment

Emerg Infect Dis. Jul-Sep 1995;1(3):69-78. doi: 10.3201/eid0103.950301.

Abstract

Since the 1980s there has been a marked increase in the recognition and reporting of highly invasive group A streptococcal infections with or without necrotizing fasciitis associated with shock and organ failure. Such dramatic cases have been defined as streptococcal toxic-shock syndrome. Strains of group A streptococci isolated from patients with invasive disease have been predominantly M types 1 and 3 that produce pyrogenic exotoxin A or B or both. In this paper, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared to those of streptococcal toxic-shock syndrome. Current concepts in the pathogenesis of invasive streptococcal infection are also presented, with emphasis on the interaction between group A Streptococcus virulence factors and host defense mechanisms. Finally, new concepts in the treatment of streptococcal toxic-shock syndrome are discussed.

Publication types

  • Comparative Study
  • Review

MeSH terms

  • Animals
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / etiology
  • Bacteremia / microbiology
  • Clindamycin / therapeutic use
  • Clostridium / pathogenicity
  • Clostridium perfringens / pathogenicity
  • Debridement
  • Drug Resistance, Microbial
  • Endotoxins / adverse effects
  • Exotoxins / adverse effects
  • Fasciitis, Necrotizing / etiology
  • Fasciitis, Necrotizing / microbiology
  • Humans
  • Mice
  • Myositis / etiology
  • Myositis / microbiology
  • Penicillin Resistance
  • Penicillins / therapeutic use
  • Shock, Septic / drug therapy
  • Shock, Septic / etiology
  • Shock, Septic / microbiology*
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / etiology
  • Streptococcal Infections / microbiology*
  • Streptococcal Infections / therapy
  • Streptococcus pyogenes / drug effects
  • Streptococcus pyogenes / metabolism
  • Streptococcus pyogenes / pathogenicity*
  • Virulence

Substances

  • Anti-Bacterial Agents
  • Endotoxins
  • Exotoxins
  • Penicillins
  • Clindamycin