Toxic shock-like syndrome with flu-like prodrome: a possible role of 'enhancing tissue focus' for streptococcal toxic shock

We describe three patients with invasive group A streptococcal infection, a dmitted during the 3 months between November 1996 and February 1997, All pa tients were previously healthy Japanese women who developed a profound shoc k, with a rapidly fatal outcome, after experiencing flu-like symptoms. All cases conformed to the case definition of toxic shock-like syndrome (TSLS). Currently, the pathogenic mechanism of TSLS remains unclear. Known microbia l virulence factors can not sufficiently explain the occurrence of TSLS, an d it has been generally considered that host factors may be contributory. O n pathological examination, each patient had one organ or tissue that was m ost severely involved: Case 1 a non-penetrating trauma; Case 2 a pregnant u terus; and Case 3 a pulmonary lesion reminiscent of lymphocytic interstitia l pneumonia, On the basis of clinicopathological features of these cases, w e propose that the coexistence of 'enhancing tissue focus' may be one of ho st factors for the progression of TSLS in patients infected with non-invasi ve GAS. (C) 2001 The British Infection Society.