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Streptococcal toxic shock syndrome in children
1Unité de Réanimation Pédiatrique, Hopital Edouard Herriot, Lyon, France.
Insights
Two children developed toxic shock-like syndrome from Streptococcus pyogenes infections. Strains producing erythrogenic toxin B, not A, were implicated, suggesting regional differences in toxin involvement.
Area of Science:
- Microbiology
- Infectious Diseases
- Toxicology
Background:
- Toxic shock-like syndrome (TSLS) is a severe condition often associated with bacterial toxins.
- Group A Streptococcus (GAS) is a known pathogen capable of causing TSLS.
- Erythrogenic toxins (ETs) produced by GAS are implicated in the pathogenesis of TSLS.
Observation:
- Two pediatric cases of TSLS secondary to soft tissue streptococcal infections are presented.
- One of the two cases was fatal.
- Blood cultures identified Streptococcus pyogenes in both children.
Findings:
- The isolated Streptococcus pyogenes strains produced significant quantities of erythrogenic toxin B (ET B) and smaller amounts of ET C.
- Notably, these strains did not produce erythrogenic toxin A (ET A).
- This contrasts with many reported US cases where ET A is considered the primary toxin.
Implications:
- This study reinforces the role of Streptococcus pyogenes in TSLS.
- The findings suggest that strains producing high levels of ET B may be more prevalent in TSLS cases observed in Europe.
- Understanding regional variations in ET production is crucial for accurate diagnosis and treatment of streptococcal TSLS.
Abstract:
Two children with toxic shock-like syndrome due to streptococcal infection are reported. In both cases (one fatal) the site of infection was in the soft tissues. Both strains of group A hemolytic streptococci isolated from blood culture produced large amounts of erythrogenic toxin B (ET B) small amounts of ET C but no ET A. This report confirms the implication of Streptococcus pyogenes in toxic shock like syndromes. When ET A seems to be responsible for most cases observed in the USA, our cases and others observed in Europe could be related to strains producing large amounts of ET B.