Streptococcal toxic shock syndrome secondary to a deep neck space infection presenting with no throat or neck symptoms (original) (raw)
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Fulminant streptococcal toxic shock syndrome
Journal of the Royal College of Physicians of Edinburgh, 2018
We present a case of a previously healthy 37-year-old male who developed fever, nausea, vomiting, diarrhoea, and hypovolaemia. Within 5.5 h he presented with tachycardia, tachypnoea, became hypotensive and displayed a diffuse erythematous rash. In the following hours he developed persistent hypotension, acute respiratory distress syndrome, liver failure, kidney failure and disseminated intravascular coagulation. A diagnosis of toxic shock syndrome was made, but despite antibiotic therapy, immunoglobulin administration, and supportive measures, the patient died 50 h after presentation. Streptococcus pyogenes was isolated from blood cultures.
Streptococcal toxic shock syndrome
Clinical Microbiology and Infection, 2002
Perhaps more noteworthy than the emergence of Streptococcal toxic shock syndrome (StrepTSS) is its persistence for a period of more than 15 years in most geographical areas and an actual increase in incidence in some regions. Early diagnosis remains a problem, and aggressive surgery often cannot be avoided. The continuing rates of mortality and morbidity indicate the need for novel approaches to diagnosis and treatment.
Streptococcus agalactiae Toxic Shock-Like Syndrome
Medicine, 2013
We present 2 patients with Streptococcus agalactiae toxic shock-like syndrome and review another 11 well-reported cases from the literature. Streptococcal toxic shock-like syndrome is a devastating illness with a high mortality rate, therefore we stress the importance of early supportive management, antimicrobial therapy, and surgical intervention. Toxic shock-like syndrome is likely to be underestimated in patients with invasive Streptococcus agalactiae infection who present with shock. Early diagnosis requires high suspicion of the illness, along with a thorough mucocutaneous examination. Streptococcus agalactiae produces uncharacterized pyrogenic toxins, which explains the ability of the organism to cause toxic shock-like syndrome.
Acta Paediatrica, 2007
Streptococcal toxic shock syndrome is a fulminant, highly fatal disease characterized by evidence of group A b-haemolytic streptococcus infection and early shock with consecutive organ failure. In adults, affected individuals usually have preceding skin or soft tissue infection. However, in paediatric patients, except for varicella, the background focus is usually respiratory tract infection, and early diagnosis of streptococcal toxic shock syndrome in such patients is difficult. We report four previously healthy children with streptococcal toxic shock syndrome. Pharyngitis was identified in three cases. All of them had constitutional symptoms such as fever, vomiting, diarrhoea, abdominal pain and physical findings of tachycardia and diffuse abdominal tenderness, but no concomitant skin infection.
International Congress Series, 2006
Streptococcal toxic shock syndrome (STSS) is an uncommon but important complication of invasive group A streptococcal (GAS) disease. A number of clinical risk factors and molecular markers have been linked with STSS. We report here a case controlled review looking specifically at cases of STSS from North Queensland, between 1996 and 2005. All isolates obtained were cultured from sterile sites. Of these, there were 25 cases which fulfilled the criteria for STSS. These were matched for age, sex and ethnicity with 31 cases of invasive GAS without STSS. Indigenous patients represented 16% of the group. Mortality was significantly higher (28%) in the STSS group. Necrotising fasciitis and an elevated serum creatinine on admission were significantly associated with STSS. There was no significant difference in the presence of risk factors or mean total white cell count in both groups. There was also no significant difference in the presence of streptococcal pyrogenic exotoxins a, c, g, h and ssa, prtF1, mean internalization efficiency, biotypes or emm types, in isolates involved. Although not statistically significant, there was a trend for prtF2 to be associated with STSS.
Clinical Infectious Diseases, 1998
In a retrospective study of invasive infections due to group A Streptococcus (GAS) in Stockholm during 1987 to 1995, the average incidence per 100,000 residents per year was 2.3, varying between 3.7 per 100,000 (in 1988) and 1.3 per 100,000 (in 1993). Incidence was 1.8 in the age group of 0 -4 years but otherwise increased by age, from 0.48 in the age group of 5 -14 years to 6.1 among those over 65 years of age. A review of 151 invasive episodes occurring in 1983 -1995 showed cyclic increases of infections due to T1M1-serotype strains during 1986 -1990 and 1993 -1995. The T1M1 serotype accounted for 27 (20%) of 135 available GAS strains. Streptococcal toxic shock syndrome (STSS) developed in 19 (13%) of the 151 episodes. The case fatality rate was 11% overall but 47% among patients with STSS. In a multivariate logistic regression model, STSS was associated with a history of alcohol abuse (odds ratio [OR], 6.3; P Å .004) and infection with a T1M1 strain (OR, 6.7; P Å .007). Case fatality was associated with age (OR, 14.5; P Å .08), immunosuppression (OR, 4.7; P Å .02), and STSS (OR, 21.5; P õ .0001) but not with T1M1 infection. Hypotension was significantly associated with a fatal outcome, regardless of whether STSS developed (P õ .0001).