Skip to main content
SpringerLink
Log in

Streptococcus pyogenes Induced Necrosis and Ulcers of the Skin: The Possible Role of Streptococcal Exotoxins

  • Conference paper
Wound Healing and Skin Physiology

  • 548 Accesses

Abstract

Infections with β-hemolytic streptococci may be harmful to the skin in different ways. Milder forms may cause a contagious superficial pyogenic infection of the skin characterized by blisters and erosions (impetigo contagiosa), an inflammation of the dermis and upper subcutaneous tissue without necrosis (erysipelas), or a pyogenic infection of the skin characterized by the formation of adherent crusts, beneath which ulceration occurs (ecthyma). Acute ulcers, often on the legs and feet, are one of the more frequent forms of streptococcal pyoderma under humid tropical conditions [2]. Chronic ulcers of streptococcal origin may follow insect bites or abrasions. They may persist for many months but heal rapidly with antibiotic treatment [21].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Aitken DR, Mackett MCT, Smith LL (1982) The changing pattern of hemolytic streptococcal gangrene. Arch Surg 117:561–567.

    Article  PubMed  CAS  Google Scholar 

  2. Allen AM, Taplin D, Twigg L (1971) Cutaneous streptococcal infections in Vietnam. Arch Dermatol 104:271–280.

    Article  PubMed  CAS  Google Scholar 

  3. Alouf JE, Knöll H, Köhler W (1991) The family of mitogenic, shock-inducing and superantigenic toxins from staphylococci and streptococci. In: Alouf JE, Freer JH (eds) Sourcebook of bacterial protein toxins. Academic, London, pp 367–414.

    Google Scholar 

  4. Ambalov IM, Kovalenko AP, Usatkin AV, Khomchenko LN (1991) The pathogenetic and prognostic significance of the level of class-E immunoglobulins in erysipelas. Vrach Delo 9:76–79.

    PubMed  Google Scholar 

  5. Barker FG, Leppard BJ, Seal DV (1987) Streptococcal necrotizing fasciitis: comparison between histological and clinical features. J Clin Pathol 40:335–341.

    Article  PubMed  CAS  Google Scholar 

  6. Bierhaug K (1925) Toxin-production by the Streptococcus erysipelatis. Proc Soc Exp Biol Med 23.

    Google Scholar 

  7. Buslau M, Hoffmann G (1993) Hyperbaric oxygenation in the treatment of skin diseases. In: Fuchs J, Packer L (eds) Oxidative stress in dermatopathology. Dekker, New York, pp 457–485.

    Google Scholar 

  8. Buslau M, Hoffmann G (1993) Die hyperbare Oxygenation (HBO) — eine adjuvante Therapie akuter und chronischer Wundheilungsstörungen. Dermatol Monatsschr 179:39–54.

    Google Scholar 

  9. Buslau M, Kappus R, Gerlach D, Köhler W (1993) Interleukin 2, soluble interleukin 2 receptor, and interferon-gamma in suction blister fluids from erysipelas. Br J Dermatol (submitted).

    Google Scholar 

  10. Buslau M, Kappus R, Gerlach D, Köhler W, Diehl S, Holzmann H (1993) Streptococcal and staphylococcal superantigens (ETA, SEB): presentation by human epidermal cells and induction of autologous T cell proliferation in vitro. Acta Derm Venereol (Stockh) 73:94–96.

    CAS  Google Scholar 

  11. Cherkasov VL, Beletskaia LV, Anokhina GI, Samotolkin KN, Boldyrev NV (1989) The immunopathological mechanisms of the skin lesion in erysipelas patients. Zh Mikrobiol Epidemiol Immunobiol 11:64–67.

    PubMed  Google Scholar 

  12. Cone LA, Voodard DR, Schlievert PM, Tomory GS (1987) Clinical and bacteriological observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med 317:146–149.

    Article  PubMed  CAS  Google Scholar 

  13. Dochez AR, Stevens FA (1927) Studies on biology of streptococcus-allergic reactions with strains from erysipelas. J Exp Med 46:487.

    Article  PubMed  CAS  Google Scholar 

  14. Fast DJ, Schlievert PM, Nelson RD (1989) Toxic shock syndrome-associated staphylococcal and streptococcal pyrogenic toxins are potent inducers of tumor necrosis factor production. Infect Immun 57:291–294.

    PubMed  CAS  Google Scholar 

  15. Fleischer B (1991) T-lymphocyte-stimulating microbial toxins as “superantigens”. Med Microbiol Immunol 180:53–58.

    Article  PubMed  CAS  Google Scholar 

  16. Fleischer B, Schmidt K-H, Gerlach D, Köhler W (1993) Separation of T cell stimulating activity from streptococcal M protein. Infect Immun 60:1767–1770.

    Google Scholar 

  17. Fournier AJ (1883) Gangrène foudroyante de la verge. Sem Med 3:334–346.

    Google Scholar 

  18. Frolov VM, Boichenko PK, Peresadin NA (1990) The diagnostic and prognostic significance of the level of circulating immune complexes in patients with recurrent erysipelas. Vrach Delo 6:116–118.

    PubMed  Google Scholar 

  19. Gerlach D, Moravek L, Knöll H, Köhler W, Pavlik M (1990) Relationship between low molecular weight protein mitogen LMP-10k, erythrogenic toxin D and phosphocarrier protein from Staphylococcus aureus. XIth Lancefield international symposium on streptococci and streptococcal diseases, Siena, 10–14 Sept, p 100 (abstract).

    Google Scholar 

  20. Giuliano A, Lewis F, Hadley K et al. (1977) Bacteriology of necrotizing fasciitis. Am J Surg 134:52–56.

    Article  PubMed  CAS  Google Scholar 

  21. Goodman MH (1938) Chronic streptococcic ulcer of the skin. J Am Med Assoc 111:1427.

    Article  Google Scholar 

  22. Hammar H, Wanger L (1977) Erysipelas and necrotizing fasciitis. Br J Dermatol 96:409–419.

    Article  PubMed  CAS  Google Scholar 

  23. Iushchuk ND, Frolov VM, Gaidash IS, Peresadin NA (1991) The immunogenetic aspects of erysipelas infection. Zh Mikrobiol Epidemiol Immunobiol 3:57–59.

    PubMed  Google Scholar 

  24. Keroack MA (1991) Invasive group A streptococcal infection and streptococcal toxic shock syndrome. Curr Opin Infect Dis 4:621–627.

    Article  Google Scholar 

  25. Köhler W (1990) Streptococcal toxic shock syndrome. Zentralbl Bakteriol 272:257–264.

    Article  PubMed  Google Scholar 

  26. Köhler W (1992) Epidemiology and pathogenesis of streptococcal infections. Immun Infect 20:92–98.

    Google Scholar 

  27. Köhler W, Gerlach D, Knöll H (1987) Streptococcal outbreaks and erythrogenic toxin type A. Zentralbl Bakteriol Hyg [A] 266:104–115.

    Google Scholar 

  28. Köhler W, Nestler J, Schneider J, Schau HP (1989) Streptococcal Toxic Shock Syndrome. Z Gesamte Inn Med 44:725–731.

    PubMed  Google Scholar 

  29. Krifuks OI, Tsoi IG, Sagimbaeva GE (1990) The functional characteristics of the peripheral blood granulocytes in erysipelatous inflammation. Zh Mikrobiol Epidemiol Immunobiol 6:67–71.

    PubMed  Google Scholar 

  30. Le Frock JL, Molavi A (1982) Necrotizing skin and subcutaneous infections. J Antimicrob Chemother 9[Suppl A]: 183–192.

    Article  Google Scholar 

  31. Meade JW, Mueller CB (1968) Necrotizing infections of subcutaneous tissue and fascia. Ann Surg 168:274–280.

    Article  PubMed  CAS  Google Scholar 

  32. Meleney FL (1924) Hemolytic streptococcus gangrene. Arch Surg 9:317–364.

    Article  Google Scholar 

  33. Movat HZ, Burrowes CE, Cybulski MI, Dinarello CA (1987) Acute inflammation and a Shwartzman-like reaction induced by interleukin-1 and tumor necrosis factor: synergistic action of the cytokines in the induction of inflammation and microvascular injury. Am J Pathol 129:463–466.

    PubMed  CAS  Google Scholar 

  34. Musser JM, Hauser AR, Kim MH, Schlievert PM, Nelson K, Seiander RK (1991) Streptococcus pyogenes causing toxic-shock like syndrome and other invasive diseases: clonal diversity and pyrogenic exotoxin expression. Proc Natl Acad Sci USA 88:2668–2672.

    Article  PubMed  CAS  Google Scholar 

  35. Nagoev BS, Kanukoeva MIU (1990) Leukocyte intracellular metabolism and phagocytic activity in patients with an erysipelatous inflammation. Ter Arkh 62:50–53.

    PubMed  CAS  Google Scholar 

  36. Patel A, Ramsey JW, Whitfield HN (1991) Fournier’s gangrene of the scotum following day case vasectomy. J R Soc Med 84:49–50.

    PubMed  CAS  Google Scholar 

  37. Podbielski A, Kaufhold A, Lütticken R (1992) Das Vir-Regulon von Streptococcus pyogenes: Koordinierte Expression wichtiger Virulenzfaktoren. Immun Infect 20:161–168.

    CAS  Google Scholar 

  38. Quintiliani R, Engh GA (1971) Overwhelming sepsis associated with group A beta hemolytic streptococci. J Bone Joint Surg 53:1391–1399.

    PubMed  CAS  Google Scholar 

  39. Rathore MH, Barton LL, Kaplan EL (1992) Suppurative group A βhemolytic streptococcal infections in children. Pediatrics 89:743–746.

    PubMed  CAS  Google Scholar 

  40. Rea WJ, Wyrick WJJ (1970) Necrotizing fasciitis. Ann Surg 172:957–964.

    Article  PubMed  CAS  Google Scholar 

  41. Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS (1990) Hyperbaric oxygen therapy for necrotizing fasciitis and the need for débridements. Surgery 108:847–850.

    PubMed  CAS  Google Scholar 

  42. Sachs MK (1991) Cutaneous cellulitis. Arch Dermatol 127:493–496.

    Article  PubMed  CAS  Google Scholar 

  43. Saijo S, Kuramoto Y, Yoshinari M, Tagami H (1990) Extremely extended Fournier’s gangrene. Dermatologica 181:228–232.

    Article  PubMed  CAS  Google Scholar 

  44. Sawyer MD, Dunn DL (1991) Deep soft tissue infections. Curr Opin Infect Dis 4:649–654.

    Article  Google Scholar 

  45. Schneider I (1985) Klinisches Bild, Immunologie und Pathogenese des rezidivierenden Erysipels. Z Hautkr 61:431–435.

    Google Scholar 

  46. Schneider I, Somos Z, Battyani Z (1989) Study of granulocyte function of peripheral blood in recurrent erysipelas. Dermatol Monatsschr 175:681–684.

    PubMed  CAS  Google Scholar 

  47. Schröder-Kolb B, Geiger J (1988) Fournier’s gangrene in a dialysis patient with renal insufficiency. Akt Dermatol 14:249–252.

    Google Scholar 

  48. Scriba S, Wagner B, Wagner M (1986) Receptors for erythrogenic toxin A of Streptococcus pyogenes on human peripheral blood lymphocytes and other blood cells. Acta Histochemica XXXIII [Suppl]: 17–22.

    Google Scholar 

  49. Stephenson H, Dotters DJ, Katz V, Droegemueller W (1992) Necrotizing fasciitis of the vulva. Am J Obstet Gynecol 166:1324–1327.

    PubMed  CAS  Google Scholar 

  50. Stevens DL (1992) Invasive group A Streptococcus infections. Clin Infect Dis 14:2–13.

    Article  PubMed  CAS  Google Scholar 

  51. Stevens DL, Tanner MH, Winship J et al. (1989) Severe group A streptococcus infections associated with a toxic-shock-like syndrome and scarlet fever toxin. N Engl J Med 321:1–6.

    Article  PubMed  CAS  Google Scholar 

  52. Stone L, Codere F (1991) Streptococcal lid necrosis in previously healthy children. Can J Ophthalmol 26:386–390.

    PubMed  CAS  Google Scholar 

  53. Sudarsky LA, Laschinger JC, Coppa GF, Spencer FC (1987) Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg 206:661–665.

    Article  PubMed  CAS  Google Scholar 

  54. Tharakaram S, Keczkes K (1988) Necrotizing fasciitis-a report of five patients. Int J Dermatol 27:585–588.

    Article  PubMed  CAS  Google Scholar 

  55. Umbert IJ, Winkelmann RK, Oliver GF, Peters MS (1989) Necrotizing fasciitis: a clinical, microbiologic, and histopathologic study of 14 patients. J Am Acad Dermatol 20:774–781.

    Article  PubMed  CAS  Google Scholar 

  56. Unna PG (1894) Die Histopathologie der Hautkrankheiten, vol 1. Hirschwald, Berlin, p 401.

    Google Scholar 

  57. Van der Meer JB, van der Wal T, Bos WH et al. (1990) Fournier’s gangrene: the human counterpart of local Shwartzman phenomenon?. Arch Dermatol 126:1376–1377.

    Article  PubMed  Google Scholar 

  58. Wagner B, Buslau M, Gerlach D, Ramirez-Bosca A, Stracke R, Wagner M (1992) Binding of the erythrogenic toxin A of Streptococcus pyogenes to OKT6-positive and OKT6-negative human epidermal cells and to dermal fibroblasts. Arbeitsgemeinschaft Dermatologische Forschung (ADF) in cooperation with “Deutsche Dermatologische Gesellschaft” (DDG), XXth annual meeting, 13–15 Nov 1992, Mainz, Germany, p 119 (abstract).

    Google Scholar 

  59. Willoughby R, Greenberg RN (1987) The toxic shock syndrome and streptococcal pyrogenic exotoxins. Intern Med 98:559.

    Google Scholar 

  60. Wilson B (1952) Necrotizing fasciitis. Am Surg 18:416–431.

    PubMed  CAS  Google Scholar 

  61. Zhidkikh VN (1991) The functional activity of neutrophilic granulocytes in patients with erysipelas. Lab Delo 9:32–34.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology and Venereology, Johann-Wolfgang-Goethe-University, Theodor-Stern-Kai-7, 60596, Frankfurt/Main, Germany

    M. Buslau & P. Schmidt

Authors
  1. M. Buslau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Schmidt
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Dermatologische Klinik im St. Josef-Hospital, Ruhr-Universität, Gudrunstr. 56, 44791, Bochum, Germany

    Peter Altmeyer , Klaus Hoffmann  & Stephan el Gammal ,  & 

  2. ConvaTec Wound Healing Institute, Deeside, Clwyd, CH5 2NU, UK

    Jerry Hutchinson

Rights and permissions

Reprints and permissions

Copyright information

© 1995 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Buslau, M., Schmidt, P. (1995). Streptococcus pyogenes Induced Necrosis and Ulcers of the Skin: The Possible Role of Streptococcal Exotoxins. In: Altmeyer, P., Hoffmann, K., el Gammal, S., Hutchinson, J. (eds) Wound Healing and Skin Physiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77882-7_40

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-77882-7_40

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-56124-8

  • Online ISBN: 978-3-642-77882-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation