Streptococcal toxic shock syndrome in two patients infected by a colonizedsurgeon

The incidence of severe invasive infections caused by Streptococcus pyogene s, a group A streptococcus (CAS), has increased in the past 10 years. Most cases occur outside of the hospital setting. We report on two patients with nosocomial streptococcal toxic shock syndrome (StrepTSS), In patient 1 the syndrome was associated with the development of necrotizing fasciitis foll owing inguinal hernia repair. Patient 2 suffered from StrepTSS shortly afte r receiving a tetanus vaccine in her left deltoid, Epidemiologic investigat ions of these cases, which were noted within 48 hours of each other, showed that the same surgeon performed the vaccination on patient 2 after assisti ng a colleague during the hernia repair procedure on patient 1, He was foun d to be a nasal carrier of GAS. All GAS isolates from the patients and the surgeon were indistinguishable by pulsed field gel electrophoresis. PCR ana lysis demonstrated the presence of streptococcal pyogenic exotoxins A and F , All strains were of the T-1 serotype and possessed the gene for M-protein 1. This report demonstrates that a virulent strain of CAS may be spread by asymptomatically colonized medical personnel via the air route.