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[Fatal streptococcus A shock after thoracic surgery]

O Theissen1, P Ocquidant, J P Loeb

  • 1Service d'Anesthésie-Réanimation Chirurgicale, Centre Hospitalier Louis-Pasteur, Colmar.

Annales Francaises D'Anesthesie Et De Reanimation
|January 1, 1993
PubMed
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A patient developed toxic shock-like syndrome after surgery for pneumothorax. Group A Streptococcus was identified as the cause, highlighting the need for precise bacterial diagnosis and broad-spectrum antibiotics.

Area of Science:

  • Medicine
  • Infectious Diseases
  • Critical Care

Background:

  • Pneumothorax is a condition where air enters the space between the lungs and chest wall.
  • Surgical interventions like bullae removal and pleural abrasion are common treatments for recurrent pneumothorax.

Observation:

  • A 23-year-old male presented with shock, tachypnea, oliguria, and erythema 48 hours post-surgery for pneumothorax.
  • Initial investigations suggested septic shock, but no clear source of infection was identified.
  • Despite broad-spectrum antibiotics, the patient's condition deteriorated, with fever and abdominal tenderness.

Findings:

  • Exploratory laparotomy did not reveal a septic focus.
  • A large pyothorax was discovered upon thoracic cavity aspiration, yielding Gram-positive cocci.

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  • Blood and pus cultures confirmed Group A Streptococcus as the causative agent of this severe infection.

    • Implications:

    • Group A Streptococcus can cause severe, multi-organ failure syndromes, termed toxic shock-like syndrome.
    • The clinical presentation mimics staphylococcal toxic shock, necessitating accurate bacteriological diagnosis.
    • Prompt and appropriate antibiotic therapy targeting both streptococcal and staphylococcal pathogens is crucial for patient survival.