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Septic scarlet fever due to Streptococcus pyogenes cellulitis

S Shaunak1, J Wendon, M Monteil

  • 1Medway Hospital, Gillingham, Kent.

Insights

Severe Streptococcus pyogenes Group A infections caused septic scarlet fever and cellulitis in three healthy adults. Despite prompt antibiotic treatment, two patients died, highlighting a rare and aggressive post-antibiotic era presentation.

Area of Science:

  • Infectious Diseases
  • Bacteriology
  • Clinical Medicine

Background:

  • Streptococcus pyogenes (Group A Streptococcus) is a significant human pathogen.
  • Scarlet fever and cellulitis are common Streptococcus pyogenes infections.
  • Septic presentations are typically associated with specific risk factors.

Observation:

  • Three healthy young adults presented with severe cellulitis.
  • The cellulitis was associated with scarlet fever and signs of severe toxaemia.
  • Blood cultures were positive for Streptococcus pyogenes Group A (serotype M1/T1/OF-).

Findings:

  • Two of the three patients experienced fatal outcomes despite prompt antibiotic therapy.
  • This represents a rare and aggressive clinical presentation of Streptococcus pyogenes infection.
  • Such severe cases of cellulitis with scarlet fever, toxaemia, and septicaemia are unreported in the post-antibiotic era.

Implications:

  • This case series underscores the potential for severe, life-threatening Streptococcus pyogenes infections even in healthy individuals.
  • It highlights the need for heightened clinical suspicion for aggressive disease in patients presenting with cellulitis and scarlet fever.
  • Further research into the virulence factors of specific Streptococcus pyogenes strains (e.g., M1/T1/OF-) may be warranted.

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