Necrotizing group a streptococcal infections associated with streptococcal toxic shock syndrome

Background Group A streptococci (GAS) cause a variety of life-threatening infectious complications, including necrotizing fasciitis (NF), purpura fulminans (PF), and Streptococcal toxic shock syndrome (strepTSS), in which bacteremia is associated with shock and organ failure. Methods We reviewed our experience in the management of patients with necrotizing GAS infections from 1991 to 1995. Results Eight adult patients (6 NF, 2 PF) were identified. Patients presented with fever, leukocytosis, and severe pain, and rapidly developed shock and organ dysfunction. The diagnosis of strepTSS was confirmed in 6 cases. A total of 54 surgical procedures were required, including widespread debridements and amputations. Two patients died (25%). Conclusions Recognition of the need for aggressive diagnosis and surgical treatment of this most rapidly progressive surgical infection is necessary for successful management.