EPIDEMIOLOGY AND ETIOPATHOGENY OF NECROTI ZING FASCIITIS DUE TO GROUP-A BETA-HEMOLYTIC STREPTOCOCCUS

A significant increase in the frequency of necrotizing fasciitis cause d by streptococci of group A has recently been noted. The disease usua lly appears in individuals without obvious risk factors. The initial l esion is often quite ordinary, and the evolution towards a toxic shock very swift. This evolution can be summarized as follows: 1) localized infection; 2) bacteraemia with circulating toxins and soft tissue nec rosis; 3) production of cytokines by the immune cells of the host, lea ding to a rapidly irreversible toxic shock Serotypes 1, 3, 12 and 28 o f group A streptococcus are usually involved. The virulence of some se rotypes might be explained by the acquisition of a toxic gene. The sen sitivity of the host is linked to the genetic expression of the V. bet a. elements on the surface of lymphocytes. Antibiotics cannot save the patient when necrotizing fasciitis is installed. Surgery must be mass ive and performed early.