11/47. waterhouse-friderichsen syndrome after infection with group A streptococcus.We report a case of waterhouse-friderichsen syndrome associated with group A streptococcus (GAS) toxic shock syndrome in a previously healthy man. The patient presented with neck pain and fevers of 2 days' duration. Computed tomography of the neck revealed a mass in the retropharyngeal space, suggesting an abscess. Despite prompt treatment with appropriate antibiotics, the patient experienced a fulminant course and died within 8 hours of presentation. Antemortem blood cultures grew GAS positive for exotoxins A, B, and C. Postmortem examination revealed bilateral adrenal hemorrhage, consistent with waterhouse-friderichsen syndrome. Immunohistochemical analysis of the adrenal glands revealed the presence of GAS antigens. However, no disseminated intravascular coagulation was evident. This case demonstrates that adrenal hemorrhage can occur without associated coagulopathy and may result directly from the action of bacterial toxins.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
12/47. streptococcus pyogenes pyomyositis.Group A beta-hemolytic Streptococcus pyomyositis continues to be an uncommon disease. We present a case of a 7-year-old boy with an M protein type 1, streptococcal pyrogenic exotoxin A and B, streptococcus pyogenes pyomyositis and streptococcal toxic shock syndrome.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
13/47. Invasive group a streptococcus associated with an intrauterine device and oral sex.BACKGROUND: peritonitis due to group A Streptococcus (GAS) and toxic shock syndrome occurred in a previously healthy 45-year-old woman with an intrauterine device. The intrauterine device was believed to be the portal of entry. In addition, her husband was found to be an asymptomatic carrier of GAS in his oropharynx. GOAL: The goal was to increase physicians' awareness of oral sex as a risk factor for transmission of invasive GAS disease. STUDY DESIGN: This is a case report of the development of GAS peritonitis and toxic shock syndrome in a woman after acquisition of the organism through oral sex. RESULTS: The GAS strains isolated from the patient and her husband were identical in their M-type, T-type, and exotoxin gene pattern. CONCLUSION: Because the couple practices oral sex, it was postulated that this was the mode of transmission of the GAS.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
14/47. A 10-year case report and current clinical review of chronic beta-hemolytic streptococcal keratoconjunctivitis.BACKGROUND: Streptococcus is a common source of bacterial keratoconjunctivitis in adults. Affected patients often report decreased vision, foreign body sensation, redness, and a mucous discharge. Clinical signs reveal diffuse conjunctival injection, a conjunctival papillary response, corneal superficial punctate keratitis, and a mucopurulent discharge with corresponding visual acuity decrease. Culturing is mandatory in hyperacute cases and broad-spectrum treatment is advised until culture results are definitive. Recurrent cases may change in clinical appearance. Bacterial exotoxins may induce a severe inflammatory response as well. CASE REPORT: A case of bilateral recurrent bacterial keratoconjunctivitis in a 61-year-old man is reported, as well as a current clinical review of the literature. Aerobic culture yielded streptococcus pyogenes, a beta-hemolytic group A streptococcus. After unsuccessful broad-spectrum antibiotic treatment with several agents, culture and sensitivity testing confirmed the diagnosis and adjustment of the treatment plan accordingly was successful. During the following 10 years, there were six episodes in the left eye and three episodes in the right eye with resultant inflammation and comeal pannus. Recent repeat culture and sensitivity testing showed that the streptococcus had changed to an atypical presentation. The university laboratory reported the findings to the State Department of public health, as this was a nonrespiratory isolate of group A streptococcus. CONCLUSION: Although culture is indicated in hyperacute bacterial keratoconjunctivitis, consider sensitivity testing in non-responsive cases. If the condition is recurrent and the clinical presentation appears different from previous episodes, suspect that the initial pathogen may be changing. Severe secondary inflammation may occur due to bacterial exotoxin reactions. Identification of the underlying causes is advised.- - - - - - - - - - ranking = 2keywords = exotoxin (Clic here for more details about this article) |
15/47. Fulminant liver failure in a child with invasive group A streptococcal infection.Liver involvement is mentioned in streptococcal toxic shock syndrome, but never as fulminant liver failure (FLF). We report the case of a 2-year-old child who developed isolated FLF secondary to invasive group A streptococcal infection without shock due to a M1T1-type strain expressing speA, speB and speC toxin genes. On antibiotics, he recovered rapidly without liver transplantation. CONCLUSION: A streptococcal pyrogenic exotoxin likely constituted the initial insult leading to FLF. This etiology can be included in the differential diagnosis of FLF and would support early introduction of antibiotics.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
16/47. Emergence of invasive group A streptococcal disease among young children.Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
17/47. First reported case of streptococcus pyogenes infection with toxic shock-like syndrome in italy.A 43-year-old male who sustained a superficial hand injury developed streptococcal toxic shock-like syndrome and died within 48 hours. The clinical course of the illness in this previously well patient was rapid and fulminant. The organism responsible was a group A beta-hemolytic streptococcus which was identified as opacity factor negative, M serotype 1, T type 1. The organism produced streptococcal pyrogenic exotoxins B and C, but no detectable exotoxin A although it carried speA, the gene for exotoxin A. This is the first case reported in italy, and further emphasizes the virulence of these organisms and the rapidity with which the illness can progress.- - - - - - - - - - ranking = 3keywords = exotoxin (Clic here for more details about this article) |
18/47. Pediatric streptococcal toxic shock syndrome.Two children who presented with fever, rash, and hypotension were found to have group A beta hemolytic streptococcal toxic shock syndrome. These cases are reported to remind physicians who care for acutely ill children that exotoxin-producing streptococci can produce clinical features and multisystem failure similar to staphylococcal toxic shock syndrome.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
19/47. Group A Streptococcus septicemia and an infected, ruptured abdominal aortic aneurysm associated with pharyngitis.A 65-year-old man had a 3-day history of sore throat, fever, rigors, back pain, abdominal discomfort, nausea, vomiting, and diarrhea. The patient's daughter had group A streptococcus pharyngitis. The patient was found to have a ruptured abdominal aortic aneurysm. He underwent resection of the aneurysm and right axillary femoro-femoral bypass graft. The patient died 40 hours after admission. Gram stain of the aneurysm showed numerous gram-positive cocci. Group A streptococcus grew from cultures of blood, throat, and aneurysm. The group A streptococcus was M type 3, T type 3 and produced streptococcal pyrogenic exotoxin A. This case is a very rare fatal complication of group A streptococcus pharyngitis.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
20/47. Streptococcal necrotizing fasciitis with toxic shock syndrome following cervical adenitis.In the recent years an increase of serious invasive infections due to Group A Streptococcus have been reported. Necrotizing fasciitis is a rapidly progressive soft tissue infection characterized by necrosis of the subcutaneous tissues and superficial fascia. We report a case of necrotizing fasciitis and toxic shock syndrome following cervical adenitis in a previously healthy 11-month-old boy. Cultures from blood and the necrotic lymph node grew Group A Streptococcus. Group A Streptococcus belonging to M1 serotype and producing streptococcal pyrogenic exotoxin, SPE A was identified. Full recovery was achieved by aggressive treatment, which included intensive care support, extensive surgical debridement of necrotic lesions and antibiotic treatment with the combination of penicillin and clindamycin.- - - - - - - - - - ranking = 1keywords = exotoxin (Clic here for more details about this article) |
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