Toxic shock syndrome

The pyrogenic exotoxins, previously known as erythrogenic toxins, cause the rash of scarlet fever. Since the mid-1980s, pyrogenic exotoxin-producing strains of group A Streptococcus have been linked to unusually severe invasive infections, including necrotizing fasciitis and a systemic syndrome termed the streptococcal toxic shock syndrome. A streptococcal infections associated with shock and multisystem organ failure. This syndrome has been called the streptococcal toxic shock syndrome because it shares certain features with staphylococcal toxic shock syndrome.

Several extracellular products stimulate specific antibody responses useful in the serodiagnosis of recent streptococcal infection. Tests for these antibodies are used primarily for the detection of preceding streptococcal infection in cases of suspected acute rheumatic fever or poststreptococcal glomerulonephritis.

Symptoms include sore throat, fever and chills, malaise, and sometimes abdominal complaints and vomiting, particularly in children. Both symptoms and signs are quite variable, ranging from mild throat discomfort with minimal physical findings to high fever and severe sore throat associated with intense erythema and swelling of the pharyngeal mucosa and the presence of purulent exudate over the posterior pharyngeal wall and tonsillar pillars.

In the usual course of uncomplicated streptococcal pharyngitis, symptoms resolve after 3 to 5 days. The course is shortened little by treatment, which is given primarily to prevent suppurative complications and rheumatic fever. Patients should be given aggressive supportive care in the form of fluid resuscitation, pressors, and mechanical ventilation in addition to antimicrobial therapy and, in cases associated with necrotizing fasciitis, surgical debridement. In contrast to those with staphylococcal toxic shock, the majority of patients with the streptococcal syndrome are bacteremic.