Summary
We describe two female patients presenting with spontaneous peritonitis and fulminant Streptococcus pyogenes (Strep. pyogenes) septicemia and shock. Both patients recovered completely upon immediate antibiotic therapy, initially with broad range combination therapy effective againstStrep. pyogenes, which was switched to penicillin G when culture results became available. The isolated strain in case 1 was M-type 28, which is the M-type most often isolated from vaginal swabs (as commensal) and from blood from patients with puerperal sepsis. Patient 1 had signs and symptoms of a toxic shock-like syndrome, including rapid onset of fever and shock, skin rash, desquamation of palms and soles, and multisystem involvement with vomiting, diarrhea, myalgia, renal failure, and severe disorientation without focal neurological deficits.
Similar content being viewed by others
Abbreviations
- Strep. pyogenes :
-
Streptococcus pyogenes (=group A beta-hemolytic streptococcus)
References
Adams EM, Gudmundsson SS, Yocum DE (1985) Streptococcal myositis. Arch Intern Med 145:1020–1023
Barg NL, Kish MA, Kauffman CA, Supena RB (1985) Group A streptococcal bacteremia in intravenous drug abusers. Am J Med 78:569–574
Bartter T, Dascal A, Carroll K, Curley FJ (1988) «Toxic strep syndrome»: a manifestation of group A streptococcal infection. Arch Intern Med 148:1421–1424
Braman SS, Donat WE (1986) Explosive pleuritis: manifestation of group A beta-hemolytic streptococcal infection. Am J Med 81:723–726
Cone LA, Woodard DR, Schlievert PM, Tomory GS (1987) Clinical and bacteriologic observations of a toxic shock-like syndrome due toStreptococcus pyogenes. N Engl J Med 317:146–149
Cruickshank JG, Hart RJC, George M, Feest TG (1981) Fatal streptococcal septicaemia. Br Med J 282:1944–1945
Eagle H (1952) Experimental approach to the problem of treatment failure with penicillin I. Group A streptococcal infection in mice. Am J Med 13:389–399
Francis J, Warren RE (1988)Streptococcus pyogenes bacteraemia in Cambridge — a review of 67 episodes. Q J Med 68 (256):603–613
Gaworzewska E, Colman G (1988) Changes in the pattern of infection caused byStreptococcus pyogenes. Epidemiol Infect 100:257–269
Goepel JR, Richards DG, Harris DM, Henry L (1980) FulminantStreptococcus pyogenes infection. Br med J 281:1412
Henkel JS, Armstrong D, Blevins A, Moddy MD (1970) Group A beta-hemolytic streptococcus bacteremia in a cancer hospital. JAMA 211:983–986
Hribalova V (1988)Streptococcus pyogenes and the toxic shock syndrome. Ann Intern Med 108:772
Ispahani P, Donal FE, Aveline AJ (1988)Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated. J Infect 16:37–46
Johnson LP, L'Italien JJ, Schlievert PM (1986) Streptococcal pyrogenic exotoxin type A (scarlet fever toxin) is related toStaphylococcus aureus enterotoxin B. MGG 203:354–356
Kilton LF, Fossieck BE, Cohen MH, Parker RH (1979) Bacteremia due to gram-positive cocci in patients with neoplastic diseases. Am J Med 66:596–601
Reingold AL, Hargrett NT, Dan BB, Shands KN, Strickland BY, Bloome CV (1982) Nonmenstrual toxic shock syndrome: a review of 130 cases. Ann Intern Med 96:871–874
Ruben FL, Norden CW, Heisler B, Korica Y (1984) An outbreak ofStreptococcus pyogenes infections in a nursing home. Ann Intern Med 101:494–496
Shands KN, Schmid GP, Dan BB et al. (1980) Toxic-shock syndrome in menstruating women: association with tampon use andStaphylococcus aureus and the clinical features in 52 cases. N Engl J Med 303:1436–1442
Shievert PM, Bettin KM, Watson DW (1979) Production of pyrogenic exotoxin by groups of streptococci: association with group A. J Infect Dis 140:676–681
Schievert PM, Bettin KM, Watson DW (1979) Reinterpretation of the Dick test: role of group a streptococcal pyrogenic exotoxin. Infect Immunol 26:467–472
Schlievert PM (1986) Staphylococcal enterotoxin B and toxic-shock syndrome toxin-1 are significantly associated with non-menstrual TSS. Lancet 1:1149–1150
Stevens DL, Gibbson AE, Bergstrom R, Winn V (1988) The Eagle effect revisited: efficacy of clindamycin, erythomycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis 158:23–28
Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schievert PM, Kaplan E (1989) Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 321:1–7
Todd J, Fishaut M, Kapral F, Welch T (1978) Toxic-shock syndrome associated with phage-group-I staphylococci. Lancet 2:1116–1118
Vlasveld LT, Hogewind BL (1986) Streptococcal myositis. Arch Intern Med 146:1017
Willoughby R, Greenberg R (1983) The toxic shock syndrome and streptococcal pyrogenic exotoxins (letter). Ann Intern Med 98:559
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Christen, R.D., Moser, R., Schlup, P. et al. Fulminant group A streptococcal infections. Klin Wochenschr 68, 427–430 (1990). https://doi.org/10.1007/BF01648585
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01648585