Journal article
Severe Group A Streptococcal Infections Associated with a Toxic Shock-like Syndrome and Scarlet Fever Toxin A
The New England journal of medicine, Vol.321(1), pp.1-7
07/06/1989
DOI: 10.1056/NEJM198907063210101
PMID: 2659990
Abstract
There is concern that group A streptococci, which have caused less serious infections in developed countries in recent decades, may be acquiring greater virulence. We describe 20 patients from the Rocky Mountain region who had group A streptococcal infections from 1986 to 1988 that were remarkable for the severity of local tissue destruction and life-threatening systemic toxicity.
Among the 20 patients (median age, 36), necrotizing fasciitis with or without myositis was the most common soft-tissue infection (55 percent). Nineteen patients (95 percent) had shock, 16 (80 percent) had renal impairment, and 11 (55 percent) had acute respiratory distress syndrome. The mortality rate was 30 percent. All patients but 1 had positive tissue cultures for Streptococcus pyogenes; 12 had positive blood cultures. Most of the patients had no underlying disease; 2 used intravenous drugs. Strains of group A beta-hemolytic streptococci isolated from 10 patients were not of a single M or T type; however, 8 of the 10 strains produced pyrogenic exotoxin A (scarlet fever toxin A, a classic erythrogenic toxin), which has rarely been observed in recent years.
From our study of this cluster of severe streptococcal infections with a toxic shock-like syndrome, we conclude that in our region, more virulent group A streptococci have reappeared that produce the pyrogenic toxin A associated with scarlet fever. (N Engl J Med 1989; 321:1–7.)
Dramatic declines in the prevalence of both rheumatic fever and serious infection caused by group A streptococci have been observed throughout the 20th century in much of the Western world.
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The decline has been thought by some
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to be related in part to improved socioeconomic conditions, timely treatment of streptococcal pharyngitis with antibiotics, and secondary prophylaxis for rheumatic fever.
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Stollerman
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has argued that this decline is a function of the changing potential of the organism to cause rheumatic fever and other major diseases. The recent outbreaks of acute rheumatic fever reported in middle-class children in Utah
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as well as in . . .
Details
- Title: Subtitle
- Severe Group A Streptococcal Infections Associated with a Toxic Shock-like Syndrome and Scarlet Fever Toxin A
- Creators
- Dennis L StevensMartha H TannerJay WinshipRaymond SwartsKristen M RiesPatrick M SchlievertEdward Kaplan
- Resource Type
- Journal article
- Publication Details
- The New England journal of medicine, Vol.321(1), pp.1-7
- Publisher
- Massachusetts Medical Society
- DOI
- 10.1056/NEJM198907063210101
- PMID
- 2659990
- ISSN
- 0028-4793
- eISSN
- 1533-4406
- Language
- English
- Date published
- 07/06/1989
- Academic Unit
- Microbiology and Immunology; Internal Medicine
- Record Identifier
- 9984001218402771
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