Abstract
Toxic shock syndrome and necrotizing fasciitis ("flesh-eating disease") are the most feared, lethal presentations of group A streptococcal (GAS) infection. The worst cases can manifest severe physiologic derangement and multiple organ failures. A generalized erythematous macular rash in a patient with signs of septic shock, or frank soft tissue necrosis or gangrene should raise suspicion of streptococcal toxic shock syndrome. In differentiating early necrotizing fasciitis from cellulitis and uncomplicated soft tissue injury, severe pain in the setting of a normal appearance or modest local changes may be the most distinguishing feature. Although supportive care is similar to that used for other severe infections, optimal treatment may require antibiotics such as clindamycin rather than those used in standard broad-spectrum regimens. The definitive test for GAS necrotizing fasciitis is tissue biopsy, and the mainstays of therapy are debridement and, if necessary, amputation.
| Original language | English |
|---|---|
| Pages (from-to) | 257-264 |
| Number of pages | 8 |
| Journal | Journal of Critical Illness |
| Volume | 17 |
| Issue number | 7 |
| State | Published - Jan 1 2002 |
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Keywords
- Case definition: TSS
- Clinical Conclusions
- Photographic evidence of gangrene
- Treatment options
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
Cite this
Group A streptococcal infections : Formidable foes in the ICU. Presenting signs can mask advanced disease. / Quartin, Andrew; Schein, Roland; Bisno, Alan L.
In: Journal of Critical Illness, Vol. 17, No. 7, 01.01.2002, p. 257-264.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Group A streptococcal infections
T2 - Formidable foes in the ICU. Presenting signs can mask advanced disease
AU - Quartin, Andrew
AU - Schein, Roland
AU - Bisno, Alan L.
PY - 2002/1/1
Y1 - 2002/1/1
N2 - Toxic shock syndrome and necrotizing fasciitis ("flesh-eating disease") are the most feared, lethal presentations of group A streptococcal (GAS) infection. The worst cases can manifest severe physiologic derangement and multiple organ failures. A generalized erythematous macular rash in a patient with signs of septic shock, or frank soft tissue necrosis or gangrene should raise suspicion of streptococcal toxic shock syndrome. In differentiating early necrotizing fasciitis from cellulitis and uncomplicated soft tissue injury, severe pain in the setting of a normal appearance or modest local changes may be the most distinguishing feature. Although supportive care is similar to that used for other severe infections, optimal treatment may require antibiotics such as clindamycin rather than those used in standard broad-spectrum regimens. The definitive test for GAS necrotizing fasciitis is tissue biopsy, and the mainstays of therapy are debridement and, if necessary, amputation.
AB - Toxic shock syndrome and necrotizing fasciitis ("flesh-eating disease") are the most feared, lethal presentations of group A streptococcal (GAS) infection. The worst cases can manifest severe physiologic derangement and multiple organ failures. A generalized erythematous macular rash in a patient with signs of septic shock, or frank soft tissue necrosis or gangrene should raise suspicion of streptococcal toxic shock syndrome. In differentiating early necrotizing fasciitis from cellulitis and uncomplicated soft tissue injury, severe pain in the setting of a normal appearance or modest local changes may be the most distinguishing feature. Although supportive care is similar to that used for other severe infections, optimal treatment may require antibiotics such as clindamycin rather than those used in standard broad-spectrum regimens. The definitive test for GAS necrotizing fasciitis is tissue biopsy, and the mainstays of therapy are debridement and, if necessary, amputation.
KW - Case definition: TSS
KW - Clinical Conclusions
KW - Photographic evidence of gangrene
KW - Treatment options
UR - http://www.scopus.com/inward/record.url?scp=0036073724&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0036073724&partnerID=8YFLogxK
M3 - Article
VL - 17
SP - 257
EP - 264
JO - Journal of Critical Illness
JF - Journal of Critical Illness
SN - 1040-0257
IS - 7
ER -