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Fascitis necrosante palpebral y shock tóxico por Streptococcus pyogenes Necrotizing fasciitis of the eyelids and toxic shock syndrome due to Streptococcus pyogenes  [cached]
Raúl Bustos B,Gonzalo Soto G,Lilian Hickmann O,Carlos Torres B
Revista chilena de infectología , 2009,
Abstract: La fascitis necrosante (FN) es una infección grave de los tejidos subcutáneos, localizada más frecuentemente en extremidades, tronco y pelvis. El compromiso de la cara y la región palpebral es inusual. Reportamos el curso clínico de un ni o de tres a os, previamente sano, que presentó una FN palpebral bilateral asociado a shock tóxico por Streptococcus pyogenes, secundaria a un trauma localizado. El paciente requirió tratamiento en cuidado intensivo con resucitación enérgica, antimicrobianos, inmunoglobulina intravenosa y desbridamiento quirúrgico precoz, lo que permitió su evolución favorable. Necrotizing fasciitis (NF) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. Extremities, trunk and pelvis are the most common body sites affected. Periorbital celullitis with necrotizing fasciitis of the eyelid is rare. We report the case of a three years oíd child with bilateral NF of the eyelids and toxic shock syndrome secondary to Streptococcus pyogenes infection ocurring after a minor skin trauma. Early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.
Emergence of Streptococcus pyogenes emm102 Causing Toxic Shock Syndrome in Southern Taiwan during 2005–2012  [PDF]
Jiun-Nong Lin, Lin-Li Chang, Chung-Hsu Lai, Hsi-Hsun Lin, Yen-Hsu Chen
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081700
Abstract: Background Streptococcal toxic shock syndrome (STSS) is an uncommon but life-threatening disease caused by Streptococcus pyogenes. Methods To understand the clinical and molecular characteristics of STSS, we analyzed clinical data and explored the emm types, superantigen genes, and pulsed-field gel electrophoresis of causative S. pyogenes isolates obtained between 2005 and 2012. Results In total, 53 patients with STSS were included in this study. The median age of the patients was 57 years (range: 9–83 years), and 81.1% were male. The most prevalent underlying disease was diabetes mellitus (45.3%). Skin and soft-tissue infection accounted for 86.8% of STSS. The overall mortality rate was 32.1%. Underlying diseases had no statistical impact on mortality. A total of 19 different emm types were identified. The most prevalent emm type was emm102 (18.9%), followed by emm11 (17%), emm1 (11.3%), emm87 (9.4%), and emm89 (7.5%). There was no statistically significant association between emm type and a fatal outcome. Among the superantigen genes, speB was the most frequently detected one (92.5%), followed by smeZ (90.6%), speG (81.1%), speC (39.6%), and speF (39.6%). The majority of emm102 strains were found to have speB, speC, speG, and smeZ. The presence of speG was negatively associated with a fatal outcome (P = 0.045). Conclusions Our surveillance revealed the emergence of uncommon emm types, particularly emm102, causing STSS in southern Taiwan. Characterization of clinical, epidemiological, and molecular characteristics of STSS will improve our understanding of this life-threatening disease.
Síndrome del shock tóxico estreptocócico tras fascitis necrotizante por estreptococo pyogenes Streptococcal toxic shock syndrome after necrotizing fascitis due to streptococcus pyogenes  [cached]
A. Rodríguez Lorenzo,J. Midón Míguez,F. Martelo Villar
Cirugía Plástica Ibero-Latinoamericana , 2007,
Abstract: La fascitis necrotizante por Estreptococo Pyogenes es una emergencia quirúrgica con una tasa de mortalidad elevada por la rápida progresión a shock y fallo multiorgánico. El reto supone realizar un diagnóstico precoz, ya que suele ser confundido con una infección leve de tejidos blandos. Presentamos dos casos clínicos de fascitis necrotizante que presentaron en 24 horas un Síndrome de Shock Tóxico Estreptocócico. Revisamos el mecanismo patogénico, diagnóstico y tratamiento descritos para este cuadro y discutimos las recomendaciones para su manejo establecidas en la literatura. Necrotizing fascitis by Streptococcus Pyogenes is a surgical emergency with a high mortality task due to a rapid progression of the illness to shock and organ failure. The challenge is to perform a prompt diagnosis because it is often confused with a minor soft-tissue infection. We present two cases of necrotizing fascitis by Streptococcus Pyogenes who in 24 hours developed a Streptococcal Toxic Shock Syndrome. In addition, we review the pathogenic mechanism, diagnosis and treatment of this syndrome and we discuss its management following literature recommendations.
Vaccine based on a ubiquitous cysteinyl protease and streptococcal pyrogenic exotoxin A protects against Streptococcus pyogenes sepsis and toxic shock  [cached]
Ulrich Robert G
Journal of Immune Based Therapies and Vaccines , 2008, DOI: 10.1186/1476-8518-6-8
Abstract: Background The gram-positive bacterium Streptococcus pyogenes is a common pathogen of humans that causes invasive infections, toxic-shock syndrome, rheumatic fever, necrotizing fasciitis and other diseases. Detection of antibiotic resistance in clinical isolates has renewed interest in development of new vaccine approaches for control S. pyogenes sepsis. In the study presented, a novel protein vaccine was examined. The vaccine was based on a recombinant protein fusion between streptococcal pyrogenic exotoxin B (SpeB), a cysteinyl protease expressed by all clinical isolates, and streptococcal pyrogenic exotoxin A (SpeA), a superantigen produced by a large subset of isolates. Results A novel protein was produced by mutating the catalytic site of SpeB and the receptor binding surface of SpeA in a fusion of the two polypeptides. Vaccination of HLA-DQ8 transgenic mice with the SpeA-SpeB fusion protein protected against a challenge with the wild-type SpeA that was lethal to na ve controls, and vaccinated mice were protected from an otherwise lethal S. pyogenes infection. Conclusion These results suggest that the genetically attenuated SpeA-SpeB fusion protein may be useful for controlling S. pyogenes infections. Vaccination with the SpeA-SpeB fusion protein described in this study may potentially result in protective immunity against multiple isolates of S. pyogenes due to the extensive antibody cross-reactivity previously observed among all sequence variants of SpeB and the high frequency of SpeA-producing strains.
Síndrome de shock tóxico neonatal por Streptococcus pyogenes: Reporte de caso y revisión de la literatura Neonatal toxic shock syndrome due to Streptococcus pyogenes: Case report and literature review  [cached]
Manuel Díaz A
Revista chilena de infectología , 2007,
Abstract: Se realizó un resumen de la historia clínica de un recién nacido (RN) fallecido por síndrome de shock tóxico (SST) a Streptococcus pyogenes y se revisó la literatura existente al respecto mediante la búsqueda en distintas bases de datos y otras fuentes. Previo a nuestro paciente se han publicado seis RNs con SST por S. pyogenes con la descripción clínica de los mismos y otros tres RNs sin información detallada de los casos. Se concluye que, en la actualidad, la infección por S. pyogenes no es ya un flagelo en el período neonatal, pero cuando se presenta, puede provocar SST con elevada letalidad The clinical history of a newborn child who died from toxic shock syndrome (TSS) due to group A Streptococcus (GAS) was summarized. Literature was reviewed by searching different databases and other sources. Previous to our patient, there were 6 neonatal patients with TSS due to GAS published with the clinical description of the cases and three others without detailed information. In conclusion, nowadays, infection due to GAS is not a frequent devastating disease during the neonatal period, but when it is present it can cause TSS with high lethality
Caracterización molecular de Streptococcus pyogenes causantes de enfermedad invasora y síndrome de shock tóxico estreptocócico Molecular characterization of Streptococcus pyogenes from invasive disease and streptococcal toxic shock syndrome episodes  [cached]
F. Traverso,M. Sparo,V. Rubio,J.A. Sáez Nieto
Revista argentina de microbiolog?-a , 2010,
Abstract: Streptococcus pyogenes es el agente causal de varias enfermedades comunes entre las que se incluyen la faringoamigdalitis, la escarlatina y el impétigo. Sin embargo, en las últimas décadas se ha registrado mundialmente un resurgimiento de casos de enfermedad invasora y síndrome de shock tóxico estreptocócico (SSTE). El propósito del presente trabajo fue estudiar la diversidad genética, los factores de virulencia (genes spe, sme, ssa) y la sensibilidad a los antibióticos de 10 cepas de S. pyogenes causantes de enfermedad invasora y SSTE. Los aislamientos fueron recuperados de hemocultivos de pacientes internados en el Hospital Santamarina y en la Nueva Clínica Chacabuco (Tandil, Argentina) entre diciembre de 2000 y abril de 2005. Predominaron 2 patrones de electroforesis en campo pulsante. El más frecuente comprendió 5 aislamientos del tipo emm1-T1, con perfil de toxinas speA, speB, speF, speG y smeZ. El segundo patrón más frecuente incluyó 2 aislamientos tipo emm3-TNT (speB, speF, speG). Estos dos tipos (emm1 y emm3) fueron los prevalentes en las infecciones invasoras. Las otras tres cepas correspondieron a los tipos emm49-TNT (speB, speC, speF, speG), emm75-T25 (speB, speF, speG) y emm83-TNT (speB, speF, speG, ssa, smeZ). Se encontró diversidad genética entre las cepas aisladas, pero todos los aislamientos fueron sensibles a penicilina, cefotaxima, eritromicina, clindamicina, cloranfenicol, tetraciclina y rifampicina. Por tal motivo, aún es válido el tratamiento empírico con penicilina asociada a clindamicina. Streptococcus pyogenes causes a variety of common human diseases, including pharyngitis, scarlet fever and impetigo. Nevertheless, the past decades have witnessed a worldwide resurgence in invasive disease and streptococcal toxic shock syndrome (STSS). The objective of the present study is to evaluate the genetic diversity, virulence gene distribution (spe, sme and ssa genes) and susceptibility pattern of 10 S. pyogenes isolates causing invasive disease and STSS. The isolates were recovered from blood cultures of hospitalized patients at Hospital Santamarina and Nueva Clínica Chacabuco, Tandil, Buenos Aires, Argentina between 12/2000-04/2005. Two pulse field gel electrophoretic patterns predominated. The most frequent one included 5 characteristic isolates of emm1-T1 type, toxin gene profile speA, speB, speF, speG and smeZ. The second pattern included 2 characteristic isolates of emm3-TNT type (speB, speF, speG). The other 3 isolates corresponded to types emm49-TNT (speB, speC, speF, speG), emm75-T25 (speB, speF, speG) and emm83-TNT (speB, speF,
Protective Effect of Hainosankyuto, a Traditional Japanese Medicine, on Streptococcus pyogenes Infection in Murine Model  [PDF]
Masaaki Minami,Mariko Ichikawa,Nanako Hata,Tadao Hasegawa
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0022188
Abstract: Streptococcus pyogenes (S. pyogenes) causes various serious diseases including necrotizing fasciitis and streptococcal toxic shock syndrome. One serious problem observed recently with S. pyogenes therapy is attenuation of the antibiotic effect, especially penicillin treatment failure and macrolide resistance. Hainosankyuto, a traditional Japanese medicine based on ancient Chinese medicine, has been used for treatment of infectious purulent diseases in Japan. In this study, we investigated the protective and therapeutic efficacy of Hainosankyuto against S. pyogenes-skin infection.
Interactions of Lactobacilli with Pathogenic Streptococcus pyogenes  [PDF]
Mark L. Westbroek,Crystal L. Davis,Lena S. Fawson,Travis M. Price
Infectious Diseases in Obstetrics and Gynecology , 2010, DOI: 10.1155/2010/289743
Abstract: Objective. To determine whether (1) a decreased concentration of Lactobacilli allows S. pyogenes to grow; (2) S. pyogenes is able to grow in the presence of healthy Lactobacillus concentrations; (3) S. pyogenes is capable of inhibiting Lactobacilli. Methods. One hundred fifty patient samples of S. pyogenes were mixed with four different concentrations of L. crispatus and L. jensenii. Colony counts and pH measurements were taken from these concentrations and compared using t-tests and ANOVA statistical analyses. Results. Statistical tests showed no significant difference between the colony counts of S. pyogenes by itself and growth when mixed with Lactobacilli, and no significant difference between the colony counts of S. pyogenes in the four different concentrations of Lactobacilli. Conclusion. The statistical data representing the growth of these two organisms suggests that Lactobacilli did not inhibit the growth of S. pyogenes. Also, S. pyogenes did not inhibit the growth of Lactobacilli. 1. Introduction Lactobacillus bacteria (Lactobacilli) are large Gram positive rods that exist as nonpathogenic microbiota. Lactobacilli have been extensively studied due to their remarkable ability to inhibit the growth of other organisms through bactericidal activity and by producing lactic acid as a byproduct of metabolism [1, 2]. Lactic acid production, production of bacteriocins, and the production of hydrogen peroxide have led to an abundance of research involving the ability of Lactobacilli to inhibit pathogens. Lactobacillus species have proven effective at inhibiting the growth of bacterial and fungal pathogens which commonly cause vaginosis. Lactobacillus species, specifically L. crispatus and L. jensenii, are the predominant flora in the vagina, and thus minimize opportunities for infection [3–8]. Several common pathogens that Lactobacilli inhibit are: Candida albicans, Escherichia coli (including E. coli O157:H7); and Neisseria gonorrhoeae [1, 2, 5–9]. Due to their ability to inhibit other organisms, Lactobacilli are commonly used for probiotic therapy to enhance intestinal microbiota, as well as to treat vaginosis. The principle of this treatment is to increase the concentration of Lactobacilli, which will inhibit pathogens and allow the body’s immune system to overcome the infection without the use of antimicrobials [8, 9]. Streptococcus pyogenes, often referred to as Group A strep, is a Gram positive coccus which tends to group together in chains. S. pyogenes causes the infection commonly known as “strep throat” and is the cause of 90% of bacterial
Fascitis necrosante palpebral y shock tóxico por Streptococcus pyogenes
Bustos B,Raúl; Soto G,Gonzalo; Hickmann O,Lilian; Torres B,Carlos;
Revista chilena de infectología , 2009, DOI: 10.4067/S0716-10182009000200007
Abstract: necrotizing fasciitis (nf) is a serious infection that compromises subcutaneous tissue, fascia, and adipose tissue, with high mortality rate and sequelae. extremities, trunk and pelvis are the most common body sites affected. periorbital celullitis with necrotizing fasciitis of the eyelid is rare. we report the case of a three years oíd child with bilateral nf of the eyelids and toxic shock syndrome secondary to streptococcus pyogenes infection ocurring after a minor skin trauma. early recognition leading to intensive care treatment and prompt surgical debridement were critical in the favourable outcome of the child.
Streptococcus pyogenes genome exposed  [cached]
Tudor Toma
Genome Biology , 2001, DOI: 10.1186/gb-spotlight-20010419-01
Abstract: Ferretti et al. determined the S. pyogenes genome sequence using the whole-genome shotgun approach. The genome contains 1,752 predicted protein-encoding genes of which more than 40 putative virulence-associated genes have been identified. Other genes so far identified encode proteins likely to be associated with microbial 'molecular mimicry' of host characteristics and implicated in diseases such as rheumatic fever and acute glomerulonephritis. Four different bacteriophage genomes were also detected, implying that bacteriophages are important in horizontal gene transfer and suggesting a possible mechanism for generating new bacterial strains with increased pathogenic potential (Proc Natl Acad Sci USA 2001, 98:4658-4663).It is expected that understanding of the complete S. pyogenes genome will facilitate the development of more efficient drugs and the design of more specific vaccines.
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