Streptococcal Disease
Basics
Description
Description
- Increase in frequency of aggressive streptococcal necrotizing skin infection noted in 1980s and dubbed “flesh-eating bacteria”
- Affects otherwise healthy patients aged 20–50 yr who did not have underlying predisposing diseases
- Rapid progression of shock and multiorgan dysfunction, with death occurring within 1–2 d
- Incidence is 3–4 per 100,000 in industrialized countries
- Invasive infections caused by group A Streptococcus (GAS) include:
- Necrotizing fasciitis (NF):
- Progressive, rapidly spreading soft tissue infection located within the deep fascia and subcutaneous fat
- Streptococcal toxic shock syndrome (STSS):
- May occur in patients with GAS-associated NF
- Portals of entry for streptococci include vagina, pharynx, mucosa, and skin
- Unknown cause in 50% of cases
- “Other” invasive disease defined as isolation of GAS from a normally sterile body site (i.e., sepsis, bacteremic pneumonia, septic arthritis, etc.)
- Necrotizing fasciitis (NF):
- Occurs sporadically, with occasional outbreaks in long-term care facilities and hospitals
- Rate of invasive GAS disease 6 times the annual incidence of meningococcal disease
STSS Case Definition
- Isolation of GAS from sterile or nonsterile body site
- Hypotension
- 2 or more of the following:
- Renal impairment
- Coagulopathy
- Liver abnormalities
- Acute respiratory distress
- Extensive tissue necrosis (NF)
- Erythematous rash
Etiology
Etiology
- NF:
- GAS is causative in 10% of cases. Blunt trauma is risk factor
- Mixed anaerobic and aerobic organisms are found in 70% of cases
- Staphylococcus aureus, Clostridium species, and other enteric organisms
- STSS:
- Occurs when susceptible host is infected with virulent strain
- M protein types 1, 3, and 28 are most common
- Pyrogenic exotoxins (e.g., A, B, and C) produce fever and shock via activation of tumor necrosis factor and interleukins
- Nonsteroidal anti-inflammatory drugs appear to mask or predispose patients
- Risk factors:
- Age <10 or >60 yr
- Cancer
- Renal failure
- Leukemia
- Severe burns
- Corticosteroids
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Citation
Schaider, Jeffrey J., et al., editors. "Streptococcal Disease." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307068/all/Streptococcal_Disease.
Streptococcal Disease. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307068/all/Streptococcal_Disease. Accessed October 13, 2024.
Streptococcal Disease. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307068/all/Streptococcal_Disease
Streptococcal Disease [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 13]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307068/all/Streptococcal_Disease.
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