Transmission of Streptococcus pyogenes causing toxic shock-like syndrome among family members and confirmation by DNA macrorestriction analysis

Streptococcus pyogenes can cause severe infections, such as toxic shock-like syndrome (TSLS). The transmission and pathogenesis of TSLS are poorly understood, and information is needed to develop prevention strategies. Four cases were identified in which the organism was transmitted among patients with TSLS and their family members. DNA macrorestriction endonuclease analysis using pulsed-field gel electrophoresis demonstrated the spread of S. pyogenes clones that caused TSLS among the family members. Although 14 persons related to the case-patients experienced only colonization or self-limited disease, 3 developed invasive infections (pneumonia, severe pharyngitis requiring hospitalization, and puerperal sepsis). These findings indicate that antimicrobial prophylaxis for close contacts of patients with TSLS should be considered and reinforce the need for further studies on epidemic control of TSLS.