Kallikrein-kinin system activation in streptococcal toxic shock syndrome

A retrospective analysis of 7 patients with streptococcal toxic shock revea led isolated prolongation of the activated partial thromboplastin time, whi ch returned to normal during recovery. Levels of factor XII were reduced in 2 patients who had single factor assays performed, consistent with activat ion of the kallikrein-kinin system, We speculate that bradykinin release fo llowing activation of the kallikrein-kinin system in streptococcal toxic sh ock may underlie the features of pain, capillary leaking, and severe hypote nsion characteristic of this syndrome.