[Toxic shock syndrome in group A streptococcal infection]

Three new cases of toxic shock syndrome due to infection with group A beta-hemolytic streptococci are described and similar cases in the literature are reviewed. The typical features of this disease include rapid development of multiorgan failure with renal impairment and, in many patients, also the respiratory distress syndrome. Cardiac dysfunction with myocardial depression is a prominent feature which is most reasonably explained by an effect of the septicaemia per se but may also be toxic cardiomyopathy mediated by circulating toxins. Other major findings include exanthema--often with the development of haemorrhagic bullae as part of toxic epidermal necrolysis. In patients with initial soft tissue infection this is rapidly progressive and often associated with necrotizing fasciitis and myositis, which may give rise to a compartment syndrome with rhabdomyolysis. In addition to conventional therapy with antibiotics, fluid replacement and inotropics, most patients with extensive soft tissue infection also require surgical intervention with debridement and occasionally fasciotomy.