Canadian Journal of Anaesthesia

, Volume 47, Issue 11, pp 1129–1140 | Cite as

Severe group a streptococcal infection and streptococcal toxic shock syndrome

Review Article

Abstract

Purpose: To review the literature on group A streptococcal toxic shock syndrome, (STSS).

Data source: Medline and EMBASE searches were conducted using the key words group A streptococcal toxic shock syndrome, alone and in combination with anesthesia; and septic shock, combined with anesthesia. Medline was also searched using key words intravenous immunoglobulin, (IVIG) and group A streptococcus, (GAS); and group A streptococcus and antibiotic therapy. Other references were included in this review if they addressed the history, microbiology, pathophysiology, incidence, mortality, presentation and management of invasive GAS infections. Relevant references from the papers reviewed were also considered. Articles on the foregoing topics were included regardless of study design. Non-English language studies were excluded. Literature on the efficacy of IVIG and optimal antibiotic therapy was specifically searched.

Principal findings: Reports of invasive GAS infections have recently increased. Invasive GAS infection is associated with a toxic shock syndrome, (STSS), in 8 – 14% of cases. The STSS characteristically results in shock and multi-organ failure soon after the onset of symptoms, and is associated with a mortality of 33 – 81%. Many of these patients will require extensive soft tissue debridement or amputation in the operating room, on an emergency basis. The extent of tissue debridement required is often underestimated before skin incision.

Conclusions: Management of STSS requires volume resuscitation, vasopressor/inotrope infusion, antibiotic therapy and supportive care in an intensive care unit, usually including mechanical ventilation. Intravenous immunoglobulin infusion has been recommended. Further studies are needed to define the role of IVIG in STSS management and to determine optimal anesthetic management of patients with septic shock.

Keywords

Septic Shock Myositis Necrotizing Fasciitis Streptococcal Infection Toxic Shock Syndrome 

Résumé

Objectif: Passer en revue la documentation sur le syndrome de choc toxique streptococcique de groupe A (SCTS).

Sources: Des recherches ont été menées dans Medline et EMBASE en utilisant les mots-clés:group A streptococcal toxic shock syndrome, seul et en combinaison avecanesthesia; septic shock, combiné avecanesthesia. Dans Medline, nous avons aussi utilisé les entréesintravenous immunoglobulin (immunoblobuline intraveineuse, IGIV) etgroup A streptococcus (streptocoque du groupe A, SGA) etantibiotic therapy. Nous avons retenu d’autres références qui concernaient l’histoire, la microbiologie, la physiopathologie, l’incidence, la mortalité, la présentation et le traitement des infections invasives de SGA. Les références pertinentes provenant des articles révisés ont aussi été conservées. Les articles concernant les sujets déjà cités ont été retenus sans tenir compte du type d’étude. On a exclu les études d’autres langues que l’anglais. La documentation sur l’efficacité de l’IGIV et sur l’antibiothérapie optimale a été spécialement recherchée.

Constatations principales: Les articles sur les infections envahissantes de SGA ont récemment augmenté. L’infection invasive de SGA est associée au syndrome de choc toxique (SCTS) dans 13–14 % des cas. Le SCTS cause, de façon caractéristique, un choc et une défaillance multiorganique peu après l’apparition des symptômes. Il s’accompagne d’un taux de mortalité de 33–81 %. Nombre des patients atteints auront besoin, de manière urgente, d’un débridement considérable du tissu mou ou d’une amputation. L’étendue du débridement tissulaire requis est souvent sous-estimée avant l’incision cutanée.

Conclusion: Le traitement du SCTS exige la restauration de la masse sanguine, des perfusions de vasopresseurs/inotropes, une antibiothérapie et des soins de soutien, incluant habituellement une ventilation mécanique, à l’unité des soins intensifs. La perfusion intraveineuse d’immunoglobuline est recommandée. D’autres études sont nécessaires pour définir le rôle de l’IGIV dans le traitement du SCTS et déterminer la ligne de conduite anesthésique la plus avantageuse pour les patients en choc septique.

References

  1. 1.
    Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a toxic shock — like syndrome and scarlet fever toxin A. N Engl J Med 1989; 321: 1–7.PubMedGoogle Scholar
  2. 2.
    Cone LA, Woodard DR, Schlievert PM, Tomory GS. Clinical and bacteriologic observations of a toxic shock — like syndrome due to streptococcus pyogenes. N Engl J Med 1987; 317: 146–9.PubMedGoogle Scholar
  3. 3.
    Chapnick EK, Gradon JD, Lutwick LI, et al. Streptococcal toxic shock syndrome due to noninvasive pharyngitis. Clin Infect Dis 1992; 14: 1074–7.PubMedGoogle Scholar
  4. 4.
    Donaldson PMW, Naylor B, Lowe JW, Gouldesbrough DR. Rapidly fatal necrotizing fasciitis caused by streptococcus pyogenes. J Clin Pathol 1993; 46: 617–20.PubMedCrossRefGoogle Scholar
  5. 5.
    Case 21-1995. Case records of the Massachusetts General Hospital. N Engl J Med 1995; 333: 113–9.Google Scholar
  6. 6.
    Floret D, Stamm D, Cochat P, Delmas Ph, Kohler W. Streptococcal toxic shock syndrome in children. Intensive Care Med 1992; 18: 175–6.PubMedCrossRefGoogle Scholar
  7. 7.
    Wheeler MC, Roe MH, Kaplan EL, Schlievert PM, Todd JK. Outbreaks of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates. JAMA 1991; 266: 533–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Soravia C, Romand J-A, Herrmann M, Chevrolet J-C, Ricou B, Suter PM. Group A beta-haemolytic streptococcus septicemia: the toxic shock syndrome. Intensive Care Med 1993; 19: 53–6.PubMedCrossRefGoogle Scholar
  9. 9.
    Chelsom J, Halstensen A, Haga T, Høiby EA. Necrotizing fasciitis due to group A streptococci in western Norway: incidence and clinical features. Lancet 1994; 344: 1111–5.PubMedCrossRefGoogle Scholar
  10. 10.
    Drabick JJ, Lennox JL. Group A streptococcal infections and a toxic shock — like syndrome (Letter). N Engl J Med 1989; 321: 1545.Google Scholar
  11. 11.
    Demers B, Simor AE, Velland H, et al. Severe invasive group A streptococcal infections in Ontario, Canada: 1987 – 1991. Clin Infect Dis 1993; 16: 792–800.PubMedGoogle Scholar
  12. 12.
    The Working Group on Severe Streptococcal Infections. Defining the group A streptococcal toxic shock syndrome: rationale and consensus definition. JAMA 1993; 269: 390–1.CrossRefGoogle Scholar
  13. 13.
    Bartter T, Dascal A, Carroll K, Curley FJ. “Toxic strep syndrome.” A manifestation of group A streptococcal infection. Arch Intern Med 1988; 148: 1421–4.PubMedCrossRefGoogle Scholar
  14. 14.
    Cook DJ, Guyatt GH, Laupacis A, Sackett DL, Goldberg RJ. Clinical recommendations using levels of evidence for antithrombotic agents. Chest 1995; 108: 227s-30.PubMedCrossRefGoogle Scholar
  15. 15.
    Katz AR, Morens DM. Severe streptococcal infections in historical perspective. Clin Infect Dis 1992; 14: 298–307.PubMedGoogle Scholar
  16. 16.
    Krause RM. Dynamics of emergence. J Infect Dis 1994; 170: 265–71.PubMedGoogle Scholar
  17. 17.
    Wannamaker LW, Rammelkamp CH Jr,Denny FW, et al. Prophylaxis of acute rheumatic fever by treatment of preceding streptococcal infection with various amounts of depot penicillin. Am J Med 1951; 10: 673–95.PubMedCrossRefGoogle Scholar
  18. 18.
    Dillon HC Jr. Impetigo contagiosa: suppurative and non-suppurative complications. I. Clinical, bacteriologic and epidemiologic characteristics of impetigo. Am J Dis Child 1968; 115: 530–41.PubMedGoogle Scholar
  19. 19.
    Meleney FL, Zau Z-D, Zaytzeff H, Harvey HD. Epidemiological and bacteriological investigation of the Sloane Hospital epidemic of hemolytic streptococcus puerperal fever in 1927. Am J Obstet Gynecol 1928; 16: 180–94.Google Scholar
  20. 20.
    Watson BP. An outbreak of puerperal sepsis in New York City. Am J Obstet Gynecol 1928; 16: 157–79.Google Scholar
  21. 21.
    Meleney FL. Hemolytic streptococcus gangrene. Arch Surg 1924; 9: 317–64.Google Scholar
  22. 22.
    Pollack MM, Schisgall RM. Overwhelming postoperative streptococcal infection. J Ped Surg 1978; 13: 527–8.CrossRefGoogle Scholar
  23. 23.
    Henkel JS, Armstrong D, Blevins A, Moody MD. Group A β-hemolytic streptococcus bacteremia in a cancer hospital. JAMA 1970; 211: 983–6.PubMedCrossRefGoogle Scholar
  24. 24.
    Black PH, Swartz MN, Sharp JT, Kunz LJ, Stokes J III,MacFarland RB. Severe streptococcal disease. Observations of an epidemic occurring in southern England 1958–1959. N Engl J Med 1961; 264:898–903.CrossRefGoogle Scholar
  25. 25.
    Beathard GA, Guckian JC. Necrotizing fasciitis due to group A β-hemolytic streptococci. Arch Int Med 1967; 120: 63–7.CrossRefGoogle Scholar
  26. 26.
    Edwards JD, Schofield PM. Myocardial depression in streptococcal cellulitis. BMJ 1984; 288: 816–7.PubMedGoogle Scholar
  27. 27.
    Bisno AL. Group A streptococcal infections and acute rheumatic fever. N Engl J Med 1991; 325: 783–93.PubMedGoogle Scholar
  28. 28.
    Bisno AL. Streptococcus pyogenes.In: Mandell GL, Bennett JE, Dolin R (Eds.). Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, 4th ed. New York: Churchill-Livingston, 1995: 1786–99.Google Scholar
  29. 29.
    Schlievert PM. Role of superantigens in human disease. J Infect Dis 1993; 167: 997–1002.PubMedGoogle Scholar
  30. 30.
    Musser JM. Clinical relevance of streptococcal pyrogenic exotoxins in streptococcal toxic shock — like syndrome and other severe invasive infections. Ped Ann 1992; 21: 821–8.Google Scholar
  31. 31.
    Bannan J, Visvanathan K, Zabriskie JB. Structure and function of streptococcal and staphylococcal superantigens in septic shock. Infect Dis Clin North Am 1999; 13: 387–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Norrby-Teglund A, Kaul R, Low DE, et al. Plasma from patients with severe invasive group A streptococcal infections treated with normal polyspecific IgG inhibits streptococcal superantigen — induced T cell proliferation and cytokine production. J Immunol 1996; 156: 3057–64.PubMedGoogle Scholar
  33. 33.
    Davies HD, McGeer A, Schwartz B, et al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med 1996; 335: 547–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeil EM, Englender SJ. The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. JAMA 1993; 269: 384–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Eriksson BKG, Andersson J, Holm SE, Norgren M. Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis 1998; 27: 1428–36.PubMedCrossRefGoogle Scholar
  36. 36.
    Zurawski CA, Bardsley MS, Beall B, et al. Invasive group A streptococcal disease in Metropolitan Atlanta: a population-based assessment. Clin Infect Dis 1998; 27: 150–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Mahieu LM, Holm SE, Goossens HJ, Van Acker KJ. Congenital streptococcal toxic shock syndrome with absence of antibodies against streptococcal pyrogenic exotoxins. J Pediatr 1995; 127: 987–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Begovac J, Kuzmanovi N, Bejuk D. Comparison of clinical characteristics of group A streptococcal bacteremia in children and adults. Clin Infect Dis 1996; 23: 97–100.PubMedGoogle Scholar
  39. 39.
    Doctor A, Harper MB, Fleisher GR. Group A β-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella. Pediatrics 1995; 96: 428–33.PubMedGoogle Scholar
  40. 40.
    Stevens DL. Could nonsteroidal antiinflammatory drugs (NSAIDS) enhance the progression of bacterial infections to toxic shock syndrome? Clin Infect Dis 1995; 21: 977–80.PubMedGoogle Scholar
  41. 41.
    Cockerill FR III,Thompson RL, Musser JM, et al. Molecular, serological, and clinical features of 16 consecutive cases of invasive streptococcal disease. Clin Infect Dis 1998; 26: 1448–58.PubMedCrossRefGoogle Scholar
  42. 42.
    Zerr DM, Alexander ER, Duchin JS, Koutsky LA, Rubens CE. A case-control study of necrotizing fasciitis during primary varicella. Pediatrics 1999; 103: 783–90.PubMedCrossRefGoogle Scholar
  43. 43.
    Parillo JE. Pathogenetic mechanisms of septic shock. N Engl J Med 1993; 328: 1471–7.CrossRefGoogle Scholar
  44. 44.
    Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997; 112: 235–43.PubMedCrossRefGoogle Scholar
  45. 45.
    Wheeler AP, Bernard GR. Treating patients with severe sepsis. N Engl J Med 1999; 340: 207–14.PubMedCrossRefGoogle Scholar
  46. 46.
    Sriskandan S, Cohen J. Gram positive sepsis. Mechanisms and differences from gram negative sepsis. Infect Dis Clin North Am 1999; 13: 397–412.PubMedCrossRefGoogle Scholar
  47. 47.
    Bone RC. Gram — positive organisms and sepsis. Arch Int Med 1994; 154: 26–34.CrossRefGoogle Scholar
  48. 48.
    Zumla A. Superantigens, T cells and microbes. Clin Infect Dis 1992; 15: 313–20.PubMedGoogle Scholar
  49. 49.
    Arad G, Levy R, Hillman D, Kaempfer R. Superantigen antagonist protects against lethal shock and defines a new domain for T — cell activation. Nat Med 2000; 6: 414–21.PubMedCrossRefGoogle Scholar
  50. 50.
    Fast DJ, Schlievert PM, Nelson RD. Toxic shock syndrome — associated staphylococcal and streptococcal pyrogenic toxins are potent inducers of tumor necrosis factor production. Inf Immun 1989; 57: 291–4.Google Scholar
  51. 51.
    Hackett SP, Stevens DL. Streptococcal toxic shock syndrome: synthesis of Tumor necrosis factor and interleukin — 1 by monocytes stimulated with pyrogenic exotoxin A and streptolysin O. J Infect Dis 1992; 165: 879–85.PubMedGoogle Scholar
  52. 52.
    Stevens DL, Bryant AE, Hackett SP, et al. Group A streptococcal bacteremia: the role of tumor necrosis factor in shock and organ failure. J Infect Dis 1996; 173: 619–26.PubMedGoogle Scholar
  53. 53.
    Basma H, Norrby-Teglund A, Guedez Y, et al. Risk factors in the pathogenesis of invasive group A streptococcal infections: role of protective humoral immunity. Inf Immun 1999; 67: 1871–7.Google Scholar
  54. 54.
    Kaplan EL. Recent epidemiology of group A streptococcal infections in North America and abroad: an overview. Pediatrics 1996; 97: 945–8.PubMedGoogle Scholar
  55. 55.
    Eriksson BKG, Andersson J, Holm SE, Norgren M. Invasive group A streptococcal infections: T1M1 isolates expressing pyrogenic exotoxins A and B in combination with selective lack of toxin — neutralizing antibodies are associated with increased risk of streptococcal toxic shock syndrome. J Infect Dis 1999; 180: 410–8.PubMedCrossRefGoogle Scholar
  56. 56.
    Johnson DR, Stevens DL, Kaplan EL. Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. J Infect Dis 1992; 166: 374–82.PubMedGoogle Scholar
  57. 57.
    Chausee MS, Liu J, Stevens DL, Ferretti JJ. Genetic and phenotypic diversity among isolates of streptococcus pyogenes from invasive infections. J Infect Dis 1996; 173: 901–8.Google Scholar
  58. 58.
    Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996; 334: 240–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Urschel J. Necrotizing soft tissue infections. Postgrad Med J 1999; 75: 645–9.PubMedCrossRefGoogle Scholar
  60. 60.
    Devin B, McCarthy A, Mehran R, Auger C Necrotizing fasciitis of the retroperitoneum: an unusual presentation of group A streptococcus infection. Can J Surg 1998; 41: 156–60.PubMedGoogle Scholar
  61. 61.
    Stevens DL. Invasive group A streptococcus infections. Clin Inf Dis 1992; 14: 2–13.Google Scholar
  62. 62.
    Stevens DL. The flesh-eating bacterium: what’s next? J Infect Dis 1999; 179(Suppl 2): S366–74.PubMedCrossRefGoogle Scholar
  63. 63.
    Sellers BJ, Woods ML, Morris SE, Saffle JR. Necrotizing group A streptococcal infections associated with streptococcal toxic shock syndrome. Am J Surg 1996; 172: 523–8.PubMedCrossRefGoogle Scholar
  64. 64.
    Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996; 110: 219–29.PubMedCrossRefGoogle Scholar
  65. 65.
    The Working Group on Prevention of Invasive Group A Streptococcal Infections. Prevention of invasive group A streptococcal disease among household contacts of case — patients. Is prophylaxis warranted? JAMA 1998; 279: 1206–10.CrossRefGoogle Scholar
  66. 66.
    Elloitt DC, Kufera JA, Myers RAM. Necrotizing soft tissue infections. Risk factors for mortality and strategies for management. Ann Surg 1996; 224: 672–83.CrossRefGoogle Scholar
  67. 67.
    Moss RL, Musemeche CA, Kosloske AM. Necrotizing fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 1996; 31: 1142–6.PubMedCrossRefGoogle Scholar
  68. 68.
    Kaul R, McGeer A, Low DE, et al. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Am J Med 1997; 103: 18–24.PubMedCrossRefGoogle Scholar
  69. 69.
    Stamenkovic I, Lew PD. Early recognition of potentially fatal necrotizing fasciitis. The use of frozen section biopsy. N Engl J Med 1984; 310: 1689–93.PubMedGoogle Scholar
  70. 70.
    Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg 1998; 64: 397–401.PubMedGoogle Scholar
  71. 71.
    McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing softtissue infections. Ann Surg 1995; 221: 558–65.PubMedCrossRefGoogle Scholar
  72. 72.
    Weiss KA, Laverdière M. Group A streptococcus invasive infections: a review. Can J Surg 1997; 40: 18–25.PubMedGoogle Scholar
  73. 73.
    Stegmayr B, Björck S, Holm S, Nisell J, Rydvall A, Settergren B. Septic shock induced by group A streptococcal infection: clinical and therapeutic aspects. Scand J Infect Dis 1992; 24: 589–97.PubMedCrossRefGoogle Scholar
  74. 74.
    Forni AL, Kaplan EL, Schlievert PM, Roberts RB. Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome. Clin Infect Dis 1995; 21: 333–40.PubMedGoogle Scholar
  75. 75.
    Stevens DL, Yau S, Bryant AE. Penicillin — binding protein expression at different growth stages determines penicillin efficacy in vitro and in vivo: an explanation for the inoculum effect. J Infect Dis 1993; 167: 1401–5.PubMedGoogle Scholar
  76. 76.
    Stevens DL, Maier KA, Mitten JE. Effect of antibiotics on toxin production and viability of clostridium perfringens. Antimicrob Agents Chemother 1987; 31: 213–8.PubMedGoogle Scholar
  77. 77.
    Gemmell CG, Peterson PK, Schmeling D, et al. Potentiation of opsonization and phagocytosis of streptococcus pyogenes following growth in the presence of Clindamycin. J Clin Invest 1981; 67: 1249–56.PubMedCrossRefGoogle Scholar
  78. 78.
    Stevens DL, Bryant AE, Hackett SP. Antibiotic effects on bacterial viability, toxin production and host response. Clin Infect Dis 1995; 20(Suppl2): S154–7.PubMedGoogle Scholar
  79. 79.
    Stevens DL. Streptococcal toxic-shock syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis 1995; 1: 69–78.PubMedGoogle Scholar
  80. 80.
    Stevens DL, Gibbons AE, Bergstrom R, Winn V. The Eagle effect revisited: efficacy of clindamycin, erythromycin and penicillin in the treatment of streptococcal myositis. J Infect Dis 1998; 158: 23–8.Google Scholar
  81. 81.
    Zimbelman J, Palmer A, Todd J. Improved outcome of clindamycin compared with beta — lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999; 18: 1096–100.PubMedCrossRefGoogle Scholar
  82. 82.
    Hauser AR. Another toxic shock syndrome. Streptococcal infection is even more dangerous than the staphylococcal form. Postgrad Med 1998; 104: 31–44.PubMedGoogle Scholar
  83. 83.
    Norrby-Teglund A, Kaul R, Low DE, et al. Evidence for the presence of streptococcal-superantigen- neutralizing antibodies in normal polyspecific immunoglobulin G. Infect Immun 1996; 64: 5395–8.PubMedGoogle Scholar
  84. 84.
    Norrby-Teglund A, Basma H, Andersson J, McGeer A, Low DE, Koth M. Varying titers of neutralizing antibodies to streptococcal superantigens in different preparations of normal polyspecific immunoglobulin G: implications for therapeutic efficacy. Clin Infect Dis 1998; 26: 631–8.PubMedCrossRefGoogle Scholar
  85. 85.
    Barry W, Hudgins L, Donta ST, Pesanti EL. Intravenous immunoglobulin therapy for toxic shock syndrome. JAMA 1992; 267: 3315–6.PubMedCrossRefGoogle Scholar
  86. 86.
    Nadal J, Lauener RP, Braegger CP, et al. T cell activation and cytokine release in streptococcal toxic shock-like syndrome. J Pediatr 1993; 122: 727–9.PubMedCrossRefGoogle Scholar
  87. 87.
    Perez CM, Kubak BM, Cryer HG, Salehmugodam S, Vespa P, Farmer D. Adjunctive treatment of streptococcal toxic shock syndrome using intravenous immunoglobulin: case report and review. Am J Med 1997; 102: 111–3.PubMedCrossRefGoogle Scholar
  88. 88.
    Yong JM. Necrotizing fascitis (Letter). Lancet 1994; 343: 1427.PubMedCrossRefGoogle Scholar
  89. 89.
    Lamothe F, D’Amico P, Ghosn P, Tremblay C, Braidy J, Patenaude J-V. Clinical usefulness of intravenous human immunoglobulins in invasive group A streptococcal infections: case report and review. Clin Infect Dis 1995; 21: 1469–70.PubMedGoogle Scholar
  90. 90.
    Chiu CH, Ou JT, Chang KSS, Lin TY. Successful treatment of severe streptococcal toxic shock syndrome with a combination of intravenous immunoglobulin, dexamethasone and antibiotics (Letter). Infection 1997; 25: 47–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Cawley MJ, Briggs M, Haith LR Jr,et al. Intravenous immunoglobulin as adjunctive treatment for streptococcal toxic shock syndrome associated with necrotizing fasciitis: case report and review. Pharmacotherapy 1999; 19: 1094–8.PubMedCrossRefGoogle Scholar
  92. 92.
    Kaul R, McGeer A, Norrby-Teglund A, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome — a comparative observational study. Clin Infect Dis 1999; 28: 800–7.PubMedCrossRefGoogle Scholar
  93. 93.
    Stevens DL. Editorial response: rationale for the use of intravenous gamma globulin in the treatment of streptococcal toxic shock syndrome (Editorial). Clin Infect Dis 1998; 26: 639–41.PubMedCrossRefGoogle Scholar
  94. 94.
    Dellinger RP. Current therapy for sepsis. Infect Dis Clin North Am 1999; 13: 495–509.PubMedCrossRefGoogle Scholar
  95. 95.
    Carcillo JA, Cunnion RE. Septic shock. Crit Care Clin 1997; 13: 553–74.PubMedCrossRefGoogle Scholar
  96. 96.
    Baxter F. Septic shock. Can J Anaesth 1997; 44: 59–72.PubMedGoogle Scholar
  97. 97.
    Levy B, Bollaert P-E, Charpentier C, et al. Comparison of norepinephrine and dobutamine to epinephrine for hemodynamics, lactate metabolism and gastric tonometric variables in septic shock: a prospective, randomized study. Intensive Care Med 1997; 23: 282–7.PubMedCrossRefGoogle Scholar
  98. 98.
    Marik PE, Mohedin M. The contrasting effects of dopamine and norepinephrine on systemic and splanchnic oxygen utilization in hyperdynamic sepsis. JAMA 1994; 272: 1354–7.PubMedCrossRefGoogle Scholar
  99. 99.
    Meier - Hellman A, Reinhart K, Bredle DL, Specht M, Spies CD, Hannemann L. Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 1997; 25: 399–404.CrossRefGoogle Scholar
  100. 100.
    Cronin L, Cook DJ, Carlet J, et al. Corticosteroid treatment for sepsis: a critical appraisal and meta-analysis of the literature. Crit Care Med 1995; 23: 1430–9.PubMedCrossRefGoogle Scholar
  101. 101.
    Bollaert P-E, Charpentier C, Levy B, Debouverie M, Audibert G, Larcan A. Reversal of late septic shock with supraphysiological doses of hydrocortisone. Crit Care Med 1998; 26: 645–50.PubMedCrossRefGoogle Scholar
  102. 102.
    Briegel J, Forst H, Haller M, et al. Stress doses of hydrocortisone reverse hyperdynamic septic shock: a prospective, randomized, double-blind, single center study. Crit Care Med 1999; 27:723–32.PubMedCrossRefGoogle Scholar
  103. 103.
    Rutishauser J, Funke G, Lütticken CR, Luef C. Streptococcal toxic shock syndrome in two patients infected by a colonized surgeon. Infection 1999; 27: 259–60.PubMedCrossRefGoogle Scholar
  104. 104.
    Valenzuela TD, Hooton TM, Kaplan EL, Schlievert P. Transmission of “toxic strep” syndrome from an infected child to a firefighter during CPR. Ann Emerg Med 1991; 20: 90–2.PubMedCrossRefGoogle Scholar
  105. 105.
    DiPersio JR, File TM Jr,Stevens DL, Gardner WG, Petropoulos G, Dinsa K. Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers. Clin Infect Dis 1996; 22: 490–5.PubMedGoogle Scholar
  106. 106.
    Takala J. Determinants of splanchnic blood flow. Br J Anaesth 1996; 77: 50–8.PubMedGoogle Scholar
  107. 107.
    Kay J. Anesthesia for emergency surgery in the patient with sepsis.In: Donegan J (Ed.). Manual of Anesthesia For Emergency Surgery. New York: Churchill Livingston Inc., 1987: 311–5.Google Scholar
  108. 108.
    Gill R, Martin C, McKinnon T, Lam C, Cunningham D, Sibbald WJ. Sepsis reduces isoflurane MAC in a normotensive animal model of sepsis. Can J Anaesth 1995; 42: 631–5.PubMedCrossRefGoogle Scholar
  109. 109.
    Van der Linden P, Gilbart E, Engelman E, Schmartz D, de Rood M, Vincent J-L. Comparison of halothane, isoflurane, alfentanil, and ketamine in experimental septic shock. Anesth Analg 1990; 70: 608–17.PubMedGoogle Scholar
  110. 110.
    Yli - Hankala A, Kirvelä M, Randell T, Lindgren L. Ketamine anaesthesia in a patient with septic shock. Acta Anaesthesiol Scand 1992; 36: 483–5.PubMedCrossRefGoogle Scholar
  111. 111.
    Liu K, Yen-Hsiang H. The anesthetic management of a patient with streptococcal toxic shock-like syndrome. A case report. Acta Anaesthesiol Sin 1995; 33: 195–8.PubMedGoogle Scholar

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© Canadian Anesthesiologists 2000

Authors and Affiliations

  1. 1.From the Departments of Anaesthesiology and Critical CareMcMaster University, St. Joseph’s HospitalHamiltonCanada

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