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      Streptococcal Toxic Shock Syndrome Caused by Group G Streptococcus, United Kingdom

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          Abstract

          We describe successful management of 3 patients with streptococcal toxic shock syndrome (STSS) attributable to group G Streptococcus infection. This small series supports recognition of group G Streptococcus in the etiology of STSS. We propose intravenous immunoglobulin be used in treatment as it is for STSS caused by group A Streptococcus.

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          Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial.

          N Ihendyane, Sven Haidl, Jan Sjölin … (2003)
          The efficacy and safety of high-dose intravenous polyspecific immunoglobulin G (IVIG) as adjunctive therapy in streptococcal toxic shock syndrome (STSS) were evaluated in a multicenter, randomized, double-blind, placebo-controlled trial. The trial was prematurely terminated because of slow patient recruitment, and results were obtained from 21 enrolled patients (10 IVIG recipients and 11 placebo recipients). The primary end point was mortality at 28 days, and a 3.6-fold higher mortality rate was found in the placebo group. A significant decrease in the sepsis-related organ failure assessment score at days 2 (P=.02) and 3 (P=.04) was noted in the IVIG group. Furthermore, a significant increase in plasma neutralizing activity against superantigens expressed by autologous isolates was noted in the IVIG group after treatment (P=.03). Although statistical significance was not reached in the primary end point, the trial provides further support for IVIG as an efficacious adjunctive therapy in STSS.
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            Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome--a comparative observational study. The Canadian Streptococcal Study Group.

            Austin Schwartz, A McGeer, D Low … (1999)
            Twenty-one consecutive patients with streptococcal toxic shock syndrome (TSS) between December 1994 and April 1995 were treated with a median dose of 2 g of intravenous immunoglobulin (IVIG)/kg (cases) and were compared with 32 patients with streptococcal TSS between 1992 and 1995 who did not receive IVIG therapy (controls). The outcome measure was 30-day survival. Patient plasma was tested for its ability to inhibit T cell activation induced by the infecting strain. The proportion of cases with 30-day survival was higher than that of the controls with 30-day survival (67% vs. 34%, respectively; P = .02). Multivariate analysis revealed that IVIG administration and a lower Acute Physiology and Chronic Health Evaluation II score were associated with survival; the odds ratio for survival associated with IVIG therapy was 8.1 (95% confidence interval, 1.6-45; P = .009). IVIG therapy enhanced the ability of patient plasma to neutralize bacterial mitogenicity and reduced T cell production of interleukin-6 and tumor necrosis factor alpha. IVIG may be an effective adjunctive therapy for streptococcal TSS, possibly because of its ability to neutralize bacterial exotoxins.
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              Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections.

              RR Facklam, RF Breiman, PM Schlievert … (1993)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (iso-abbrev): Emerging Infect. Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): January 2017
                Volume: 23
                Issue: 1
                Pages: 127-129
                Affiliations
                [1]Royal Devon and Exeter National Health Service Foundation Trust, Devon, United Kingdom
                Author notes
                Address for correspondence: Melissa Baxter, Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon EX3 5DW, UK; email: melissabaxter1@ 123456nhs.net
                Article
                Publisher ID: 16-1009
                DOI: 10.3201/eid2301.161009
                PMC ID: 5176243
                PubMed ID: 27983491
                SO-VID: 3784af85-9b65-4c7c-8130-fa47fc7f0862
                History
                Categories
                Subject: Dispatch
                Subject: Dispatch
                Subject: Streptococcal Toxic Shock Syndrome Caused by Group G Streptococcus, United Kingdom

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: streptococcal toxic shock syndrome,stss,streptococcus,bacteria,bacterial infections,group g streptococcus,intravenous immunoglobulin,ivig,streptococci
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: streptococcal toxic shock syndrome, stss, streptococcus, bacteria, bacterial infections, group g streptococcus, intravenous immunoglobulin, ivig, streptococci

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