Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome

Arthur L Forni; Edward L Kaplan; Patrick M Schlievert; Richard B Roberts

doi:10.1093/clinids/21.2.333

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Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome

Journal article

Open access

Peer reviewed

Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome

Arthur L Forni, Edward L Kaplan, Patrick M Schlievert and Richard B Roberts

Clinical infectious diseases, Vol.21(2), pp.333-340

08/1995

DOI: 10.1093/clinids/21.2.333

PMID: 8562741

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Abstract

We have monitored all cases of invasive group A streptococcus (GAS) infection that have occurred at the New York Hospital (New York) since 1989. Five cases of GAS infection and shock were identified between 1990 and 1991, and an additional case was recently identified at an affiliated hospital. Five of the six patients met the case definition for streptococcal toxic shock syndrome (strep TSS). Three were bacteremic, and four had aggressive soft-tissue infections. Patients with shock, for whom the mortality was higher, had fewer underlying illnesses than did patients who had GAS bacteremia without shock. Although the M1 serotype and production of streptococcal pyrogenic exotoxin A were more common in patients with GAS infection and shock, several patients with strep TSS were infected with a nontypable strain of GAS that produced only streptococcal pyrogenic exotoxin B. In addition, we observed a distinctive early hemodynamic profile for patients with strep TSS that was unlike that for patients who had typical gram-negative septic shock; this profile was consistent with toxic cardiomyopathy (i.e., relatively low cardiac output, low-to-normal systemic vascular resistance, and striking reduction in ventricular performance.

Hemodynamics

Humans

Middle Aged

Male

Shock, Septic - diagnosis

Streptococcal Infections - mortality

Bacteremia - microbiology

Pyrogens - analysis

Aged, 80 and over

Adult

Female

Retrospective Studies

Exotoxins - analysis

Serotyping

Streptococcal Infections - microbiology

Bacteremia - diagnosis

Shock, Septic - mortality

Bacterial Proteins

Shock, Septic - microbiology

Membrane Proteins

Streptococcus pyogenes - isolation & purification

Cardiac Output, Low - microbiology

Streptococcal Infections - diagnosis

Cardiac Output, Low - diagnosis

Aged

Details

Title: Subtitle: Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome
Creators: Arthur L Forni - Department of Medicine, Cornell University Medical College, New York, New York 10021, USA
Edward L Kaplan
Patrick M Schlievert
Richard B Roberts
Resource Type: Journal article
Publication Details: Clinical infectious diseases, Vol.21(2), pp.333-340
DOI: 10.1093/clinids/21.2.333
PMID: 8562741
NLM abbreviation: Clin Infect Dis
ISSN: 1058-4838
eISSN: 1537-6591
Publisher: United States
Language: English
Date published: 08/1995
Academic Unit: Microbiology and Immunology; Internal Medicine
Record Identifier: 9984001221702771

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