CLINICAL AND MICROBIOLOGICAL CHARACTERISTICS OF SEVERE GROUP-A STREPTOCOCCUS INFECTIONS AND STREPTOCOCCAL TOXIC SHOCK SYNDROME

We have monitored all cases of invasive group A streptococcus (GAS) in fection that have occurred at the New York Hospital (New York) since 1 989. Five cases of GAS infection and shock were identified between 199 0 and 1991, and an additional case was recently identified at an affil iated hospital. Five of the six patients met the case definition for s treptococcal toxic shock syndrome (strep TSS). Three were bacteremic, and four had aggressive soft-tissue infections, Patients with shock, f or whom the mortality was higher, had fewer underlying illnesses than did patients who had GAS bacteremia without shock, Although the M1 ser otype and production of streptococcal pyrogenic exotoxin A were more c ommon in patients with GAS infection and shock, several patients with strep TSS were infected with a nontypable strain of GAS that produced only streptococcal pyrogenic exotoxin B. In addition, we observed a di stinctive early hemodynamic profile for patients with strep TSS that w as unlike that for patients who had typical gram-negative septic shock ; this profile was consistent with toxic cardiomyopathy (i.e., relativ ely low cardiac output, low-to-normal systemic vascular resistance, an d striking reduction in ventricular performance).