NECROTIZING GROUP-A STREPTOCOCCAL INFECTIONS ASSOCIATED WITH STREPTOCOCCAL TOXIC SHOCK SYNDROME

BACKGROUND: Group A streptococci (GAS) cause a variety of life-threate ning infectious complications, including necrotizing fasciitis (NF), p urpura fulminans (PF), and streptococcal toxic shock syndrome (strepTS S), in which bacteremia is associated with shock and organ failure. ME THODS: We reviewed our experience in the management of patients with n ecrotizing GAS infections from 1991 to 1995. RESULTS: Eight adult pati ents (6 NF, 2 PF) were identified. Patients presented with fever, leuk ocytosis, and severe pain, and rapidly developed shock and organ dysfu nction, The diagnosis of strepTSS was confirmed in 6 cases, A total of 54 surgical procedures were required, including; widespread debrideme nts and amputations. Two patients died (25%). CONCLUSIONS: Recognition of the need for aggressive diagnosis and surgical treatment of this m ost rapidly progressive surgical infection is necessary for successful management. (C) 1996 by Excerpta Medica, Inc.