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[Streptococcus group A infections of skin, soft tissue and blood]
1Medisinsk avdeling Diakonissehjemmets Sykehus 5009 Bergen. juch@haraldsplass.no
Background:
Group A streptococcus is one of the most common bacterial pathogens causing infections in tissue and organs, most frequently throat and skin. Since the late 1980s there have been reports from Scandinavia and many other countries documenting a resurgence of highly invasive infections such as puerperal fever, necrotizing fasciitis, myositis and sepsis.
Material And Methods:
On the basis of relevant studies and reviews and a clinical study of 61 patients between 1992 and 1999 with necrotizing fasciitis and myositis at Haukeland University Hospital, Bergen, Norway, we present an overview of the prevalence, pathogenesis, clinical features and treatment of group A streptococcal infections in skin, soft tissue and blood.
Results And Interpretation:
The reason for the increase in severe group A streptococcal infections is unclear. The clinical features depend on the level of infection (superficial skin, subcutis, fascia and muscle): the deeper the initial infection, the more frequent development of bacteraemia and life-threatening disease. Serious infections are associated with shock and multiorgan failure, i.e. streptococcal toxic shock syndrome. Early surgical debridement is essential in necrotizing fasciitis and myositis. Penicillin is still the drug of choice for milder infections. The addition of clindamycin is recommended in cases of more invasive infection.
Insights
Severe group A streptococcus infections are increasing, with deeper infections leading to more severe disease. Early surgical debridement and appropriate antibiotics like clindamycin are crucial for invasive cases.
Area of Science:
- Bacteriology
- Infectious Diseases
- Clinical Medicine
Context:
- Group A Streptococcus (GAS) is a common bacterial pathogen causing throat and skin infections.
- A resurgence of highly invasive GAS infections, including necrotizing fasciitis and sepsis, has been reported globally since the late 1980s.
Purpose:
- To provide an overview of the prevalence, pathogenesis, clinical features, and treatment of GAS infections in skin, soft tissue, and blood.
- To analyze a clinical study of 61 patients with necrotizing fasciitis and myositis.
Summary:
- The increasing incidence of severe GAS infections lacks a clear explanation.
- Clinical presentation varies with infection depth; deeper infections correlate with increased risk of bacteremia and life-threatening conditions.
- Severe cases can lead to shock and multiorgan failure, characteristic of streptococcal toxic shock syndrome.
Impact:
- Early surgical debridement is critical for managing necrotizing fasciitis and myositis.
- Penicillin remains the primary treatment for milder GAS infections.
- Clindamycin is recommended as an adjunct therapy for more invasive GAS infections.