Ann Clin Microbiol.  2014 Sep;17(3):91-94. 10.5145/ACM.2014.17.3.91.

Group B Streptococcal Toxic Shock-like Syndrome: A Case Report and Review of the Literature

• Son BR
• Shin KS

• KMID: 1971101
• DOI: http://doi.org/10.5145/ACM.2014.17.3.91

Abstract

Toxic shock syndrome is an acute and febrile illness that rapidly progress to shock and multi-organ failure, and it is caused by toxin-producing strains of Staphylococcus aureus or Streptococcus species. Streptococcal toxic shock syndrome (STSS) is usually caused by group A streptococci, but non-group A STSS is rare. In this study, we describe a case of STSS caused by Streptococcus agalactiae(group B streptococci) in a patient with alcoholic liver cirrhosis. At arrival in our hospital, the patient had a decreased mental status with hemorrhagic bullae on four extremities, and he progressed to a fatal outcome within 4 days in spite of antibiotic treatment.

Keyword

Liver cirrhosis; Streptococcus agalactiae; Toxic shock syndrome

MeSH Terms

Extremities
Fatal Outcome
Humans
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Shock
Shock, Septic
Staphylococcus aureus
Streptococcus
Streptococcus agalactiae

Reference

1.Lappin E., Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009. 9:281–90.

2.Cone LA., Woodard DR., Schlievert PM., Tomory GS. Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med. 1987. 317:146–9.

3.Kwon HJ., Kim MY., Park YM., Kim HO., Kim YR., Kang MW. A case of streptococcal toxic shock syndrome clinically presenting with purpura fulminans. Korean J Dermatol. 2006. 44:315–7.

4.Lee S., Yun NR., Kim KH., Jeon JH., Kang YM., Kim G, et al. A case of group g streptococcal toxic shock syndrome. Infect Chemother. 2010. 42:187–9.

5.Suh YS., Cheon YH., Kim MK., Ahn JH., Lee SS., Lim MH, et al. Two cases of streptococcal toxic shock syndrome caused by Streptococcus agalactiae and Streptococcus dysagalactiae. Infect Chemother. 2011. 43:429–31.

6.Farley MM. Group B streptococcal infection in older patients. Spectrum of disease and management strategies. Drugs Aging. 1995. 6:293–300.

7.Stevens DL. The toxic shock syndromes. Infect Dis Clin North Am. 1996. 10:727–46.

8.Gardam MA., Low DE., Saginur R., Miller MA. Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults. Arch Intern Med. 1998. 158:1704–8.

9.Tang WM., Ho PL., Yau WP., Wong JW., Yip DK. Report of 2 fatal cases of adult necrotizing fasciitis and toxic shock syndrome caused by Streptococcus agalactiae. Clin Infect Dis. 2000. 31:E15–7.

10.Cunningham MW. Pathogenesis of group A streptococcal infections. Clin Microbiol Rev. 2000. 13:470–511.

11.Sendi P., Johansson L., Norrby-Teglund A. Invasive group B Streptococcal disease in non-pregnant adults: a review with emphasis on skin and soft-tissue infections. Infection. 2008. 36:100–11.

12.Defining the group A streptococcal toxic shock syndrome. Rati-onale and consensus definition. The Working Group on Severe Streptococcal Infections. JAMA. 1993. 269:390–1.

13.Reich HL., Crawford GH., Pelle MT., James WD. Group B streptococcal toxic shock-like syndrome. Arch Dermatol. 2004. 140:163–6.

14.Thomas S., Cunha BA. Group B streptococcal toxic shock-like syndrome with fulminant cellulitis. Heart Lung. 1996. 25:497–9.

15.Murdoch DR., Reller LB. Antimicrobial susceptibilities of group B streptococci isolated from patients with invasive disease: 10-year perspective. Antimicrob Agents Chemother. 2001. 45:3623–4.

16.Wong CH., Kurup A., Tan KC. Group B Streptococcus necrotizing fasciitis: an emerging disease? Eur J Clin Microbiol Infect Dis. 2004. 23:573–5.

17.Mascini EM., Jansze M., Schouls LM., Verhoef J., Van Dijk H. Penicillin and clindamycin differentially inhibit the production of pyrogenic exotoxins A and B by group A streptococci. Int J Antimicrob Agents. 2001. 18:395–8.

18.Norrby-Teglund A., Stevens DL. Novel therapies in streptococcal toxic shock syndrome: attenuation of virulence factor expression and modulation of the host response. Curr Opin Infect Dis. 1998. 11:285–91.