Abstract • Three patients presented with multisystem disease that shared many of the features of toxic shock syndrome. Bacteriologic and serologic evidence strongly suggested that group A β-hemolytic Streptococcus had caused the illnesses. Group A streptococcal infection may be an underdiagnosed cause of a toxic streptococcal syndrome, a syndrome of multisystem disease apparently mediated by toxins. (Arch Intern Med 1988;148:1421-1424) References 1. Bisno AL: Streptococcus pyogenes , in Mandel GL, Douglas RG Jr, Bennett JE (eds): Principles and Practice of Infectious Diseases , ed 2. New York, John Wiley & Sons Inc, 1985, pp 1124-1132. 2. Bisno AL; Nonsuppurative poststreptococcal sequelae: Rheumatic fever and glomerulonephritis , in Mandel GL, Douglas RG Jr, Bennett JE (eds): Principles and Practice of Infectious Diseases , ed 2. New York, John Wiley & Sons Inc, 1985, pp 1133-1142. 3. Adams EM, Gudmundsson S, Yocum DE, et al: Streptococcal myositis. Arch Intern Med 1985;145:1020-1023.Crossref 4. Vlasveld LT, Hogewind BL: Streptococcal myositis. Arch Intern Med 1986;146:1017.Crossref 5. Braman SS, Donat WE: Explosive pleuritis: Manifestation of group A beta-hemolytic streptococcal infection. Am J Med 1986;81:723-726.Crossref 6. Todd J, Fishaut M, Kapral F, et al: Toxic shock syndrome associated with phage-group-1 staphylococci. Lancet 1978;2:1116-1118.Crossref 7. Reingold AL, Hargrett NT, Shands KN, et al: Toxic shock syndrome surveillance in the United States 1980 to 1981. Ann Intern Med 1982;96:875-880.Crossref 8. Farmer S: Immunology of bacterial infections , in Manual of Clinical Microbiology , ed 4. Washington, DC, American Society of Microbiology, 1985, pp 898-904. 9. Basiliere JL, Bistrong HW, Spence WF: Streptococcal pneumonia: Recent outbreaks in military recruits. Am J Med 1968;44:580-589.Crossref 10. Ginsberg I: Mechanisms of cell and tissue injury induced by group A streptococci: Relation to poststreptococcal sequelae. J Infect Dis 1972;126:294-334, 419-450.Crossref 11. Wannamaker LW: Streptococcal toxins. Rev Infect Dis 1983;5( (suppl 4) ):S723-S732.Crossref 12. Schlievert PM, Bettin KM, Watson DW: Production of pyrogenic exotoxin by groups of streptococci: Association with group A. J Infect Dis 1979;140:676-681.Crossref 13. Johnson LP, L'Italien JJ, Schlievert PM: Streptococcal pyrogenic exotoxin type A (scarlet fever toxin) is related to Staphylococcus aureus enterotoxin B. MGG 1986;203:354-356.Crossref 14. Swartz WN, Weinberg AN: Infections due to gram-positive bacteria , in Fitzpatrick TB, Eisen AZ, Wolff K, et al (eds): Dermatology in General Medicine , ed 3. New York, McGraw-Hill International Book Co, 1987, pp 2108-2111. 15. Brezis M, Rosen S, Epstein FH: Acute renal failure , in Brenner BM, Rector FC Jr (eds): The Kidney . Philadelphia, WB Saunders Co, 1986, pp 735-799. 16. Cone LA, Woodard DR, Shlievert PM, et al: Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med 1987;317:146-149.Crossref
Archives of Internal Medicine – American Medical Association
Published: Jun 1, 1988
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