Invasive Group a Streptococcal Soft Tissue Infection and the Streptococcal Toxic Shock Like Syndrome

Abstract

A recent increase in the number of patients with severe group a streptococcal soft tissue infections and the streptococcal toxic shock like syndrome (stsls) in Edmonton sparked the interest to review eight cases that occurred between March 1991 and December 1993, including two patients after cosmetic surgery. These cases were felt to be sporadic and not linked. Four of the eight patients (age range 25 to 64 years), including one patient following upper blepharoplasties, developed invasive infection without shock. These patients presented one to seven days after the initiating event with only mild fever, but severe pain and localized erythema and swelling in the affected area which progressed quickly with the formation of bullae. Two streptococcal specimens were serotyped as M1 and contained streptococcal pyrogenic exotoxins (spe) a and B. Management included surgical debridement, penicillin, and clindamycin (interferes with M-protein and toxin production). All four patients recovered. The other four patients, including one patient following rhytidectomy, (age range 45 to 83 years) were much more ill and developed stsls. They rapidly developed septic shock within 12 to 24 h and progressed to multiorgan involvement despite surgical debridement. One streptococcal specimen was serotyped as M1 and positive for spe a and B, another specimen as M12 and positive for spe B, and another specimen as M-nontypable and positive for spe B. Two patients died within five days of presentation. The other two patients recovered following lengthy hospitalization, reconstructive surgery and rehabilitation.