[Review of Changes in Group A Streptococcal Infections. Case reports: Streptococcal toxic shock syndrome and necrotizing fasciitis.].

In the last years there has been an increase in serious invasive group A streptococcal infections. Necrotizing fasciitis is one of them. These infections have mostly affected young and middle aged people without known risk factors. The first symptoms are usually pain and influenza like symptoms and then following rapid deterioration with shock and multiorgan failure. This has been called streptococcal toxic shock syndrome (STSS). The literature on STSS and necrotizing fasciitis is reviewed. Symptoms and signs and treatment of STSS are discussed, as are theories about increased pathogenicity of group A streptococcus and pathogenesis of STSS. Increased pathogenicity seems largely due to a combination of M types 1 or 3 and streptococcal pyrogen exotoxin (SPE) production. M proteins increase the pathogenicity and SPE can cause shock and multiorgan failure. Neutralising anti-M and anti-SPE antibodies most likely protect against STSS. Two cases are reviewed, both young men with invasive group A streptococcal infections, serotype M-l. One developed STSS and died in three days the other developed an typical abscess and responded to therapy with drainage and antibiotics.