Streptococcal Toxic Shock Syndrome in Two Patients Infected by a Colonized Surgeon |
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Authors: | J Rutishauser G Funke R Lütticken C Ruef |
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Institution: | Medizinische Klinik, Kantonsspital Luzern, Switzerland. |
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Abstract: | Summary
The incidence of severe invasive infections caused by Streptococcus pyogenes, a group A streptococcus (GAS), has increased in the past 10 years. Most cases occur outside of the hospital setting. We
report on two patients with nosocomial streptococcal toxic shock syndrome (StrepTSS). In patient 1 the syndrome was associated
with the development of necrotizing fasciitis following inguinal hernia repair. Patient 2 suffered from StrepTSS shortly after
receiving a tetanus vaccine in her left deltoid. Epidemiologic investigations of these cases, which were noted within 48 hours
of each other, showed that the same surgeon performed the vaccination on patient 2 after assisting a colleague during the
hernia repair procedure on patient 1. He was found to be a nasal carrier of GAS. All GAS isolates from the patients and the
surgeon were indistinguishable by pulsed field gel electrophoresis. PCR analysis demonstrated the presence of streptococcal
pyogenic exotoxins A and F. All strains were of the T-1 serotype and possessed the gene for M-protein 1. This report demonstrates
that a virulent strain of GAS may be spread by asymptomatically colonized medical personnel via the air route.
Received: February 26, 1999 · Revision accepted: May 26, 1999 |
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