Related Experiment Videos
[Toxic shock syndrome caused by Streptococcus pyogenes]
H Hohn1, A Kaufhold, J Schoenemann
1Medizinische Abteilung, St.-Elisabeth-Krankenhauses Köln-Hohenlind.
Abstract:
Four days after being bitten by an insect a 35-year-old woman without any serious underlying disease developed an extensive phlegmonous inflammation of the left eyelid which soon spread to the entire left half of her face. Streptococcus pyogenes serotype M1, which produced the erythrogenic toxin A in vitro, was isolated from two blood cultures. The course of the illness was characterized by high fever, diarrhoea, vomiting, circulatory failure, consumption coagulopathy, abnormal renal functions and a generalized exanthem with desquamation of the skin, exhibiting the full-blown picture of a toxic shock syndrome caused by S. pyogenes. She eventually recovered completely under intensive care involving administration of catecholamines, fresh frozen plasma and antithrombin III substitution, as well as antibiotic treatment with clindamycin (600 mg three times daily), ampicillin/sulbactam (4 g three times daily)--after 3 days replaced by imipenem (0.5 g four times daily)--and gentamycin (80 mg three times daily) for two weeks. Extensive necroses later required plastic surgery to the left eyelid, cheek and temporal region.
Insights
A severe Streptococcus pyogenes infection mimicked toxic shock syndrome after an insect bite. Prompt intensive care and antibiotics led to the patient's complete recovery, though plastic surgery was needed for tissue damage.
Area of Science:
- Infectious Diseases
- Toxicology
- Dermatology
Background:
- Streptococcus pyogenes (S. pyogenes) can cause severe invasive infections.
- Toxic Shock Syndrome (TSS) is a life-threatening condition characterized by multi-organ failure.
Observation:
- A 35-year-old woman developed extensive facial phlegmonous inflammation post-insect bite.
- S. pyogenes serotype M1 was isolated from blood cultures.
- The patient presented with symptoms consistent with S. pyogenes-induced toxic shock syndrome.
Findings:
- The patient experienced high fever, diarrhea, vomiting, circulatory failure, consumption coagulopathy, renal dysfunction, and a generalized exanthem with desquamation.
- Successful treatment involved intensive care, catecholamines, plasma, antithrombin III, and a multi-antibiotic regimen including clindamycin, ampicillin/sulbactam, imipenem, and gentamicin.
- Extensive necroses necessitated reconstructive plastic surgery.
Implications:
- This case highlights the potential for S. pyogenes to cause severe TSS mimicking other conditions.
- Early recognition and aggressive multi-modal treatment are crucial for patient survival.
- Understanding the pathogenesis of S. pyogenes toxins is vital for developing targeted therapies.