FATAL GROUP-A STREPTOCOCCAL INFECTION WITH TOXIC SHOCK SYNDROME - COMPLICATING MINOR ORTHOPEDIC TRAUMA

Since 1987, reports have appeared of a streptococcal toxic shock syndr ome in various clinical settings. None have appeared in the orthopaedi c literature. Between 1989 and 1991 at our institution three patients with relatively minor orthopaedic injuries or procedures died of group A streptococcal infections complicated by toxic shock syndrome. The m anifestations of this syndrome included rapid progression of systemic sepsis, necrotizing soft-tissue infections, acute renal failure, adult respiratory distress syndrome, and coagulopathy. All three patients d ied despite aggressive resuscitative measures and surgical debridement . Optimal treatment of this life-threatening process requires early re cognition, aggressive surgical debridement, appropriate antibiotic man agement, and intensive care unit support.