Necrotizing group A streptococcal infections associated with streptococcal toxic shock syndrome

BACKGROUND: Group A streptococci (GAS) cause a variety of life-threatening infectious complications, including necrotizing fasciitis (NF), purpura fulminans (PF), and streptococcal toxic shock syndrome (strepTSS), in which bacteremia is associated with shock and organ failure. METHODS: We reviewed our experience in the management of patients with necrotizing GAS infections from 1991 to 1995. RESULTS: Eight adult patients (6 NF, 2 PF) were identified. Patients presented with fever, leukocytosis, and severe pain, and rapidly developed shock and organ dysfunction, The diagnosis of strepTSS was confirmed in 6 cases, A total of 54 surgical procedures were required, including; widespread debridements and amputations. Two patients died (25%). CONCLUSIONS: Recognition of the need for aggressive diagnosis and surgical treatment of this most rapidly progressive surgical infection is necessary for successful management. (C) 1996 by Excerpta Medica, Inc.