[Toxic shock-like syndrome caused by streptococci]

Since the mid-eighties an increase of severe infections with invasive group A streptococci (GAS) has been noticed throughout the world, not only in the elderly but in healthy adults as well. The acute presenting infection starts with fever, enanthema, generalised erythema, rapidly progressing into shock and multiorgan failure, and is called streptococcal toxic shock syndrome (STSS). Despite surgical and antibiotic therapy with penicillin and clindamycin the mortality is high. There are as yet insufficient data in patients with STSS to decide between penicillin en clindamycin. Intravenous administration of high dose gammaglobulin, advocated in the USA, might neutralize the exotoxins, but the effectiveness of this therapy has not been established yet.