Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated

Bacteraemia with Streptococcus pyogenes (Group A haemolytic streptococci) was reviewed in patients admitted to University Hospital, Nottingham over a period of 7 years. Altogether, 40 cases were encountered, representing 2% of all cases of bacteraemia. Mortality was 35%. Most cases were community-acquired and 28% of patients were less than 40 years of age. A third of the patients were previously fit. The most common sources of bacteraemia were the skin and soft tissue (23 patients) and the respiratory tract (eight patients). Shock was recorded in 40% of cases and carried a 60% mortality. This feature of streptococcal bacteremia has not received sufficient attention in the past. Despite its unique susceptibility to penicillin, S. pyogenes continues to pose a challenge to the physician.