Cases of streptococcal toxic shock syndrome in Germany since 1989, toxin (mitogen) expression, content of toxin genes and relation to M-serotypes.

Abstract

A worldwide increase of severe invasive Streptococcus pyogenes infections beginning from the skin or soft tissue infections (cellulitis, fasciitis, myositis) has been reported during the last decade. This so-called Streptococcal Toxic Shock Syndrome (STSS) is considered as a resurgence of the historically known fulminant or toxic scarlet fever. It is characterized by fever, multiorgan failure, skin desquamation and occurs mainly in young/middle-aged, otherwise healthy adults within hours of the onset of symptoms. The onset of STSS seems to be related to the efficacy of bacterial products and host factors (particularly the immune state) of the patients. Bacterial products which are believed to be causally involved in these infections are the M-protein, different enzymes and the various erythrogenic toxins (ET or SPE), the streptococcal mitogenicity factor MF, the streptococcal superantigen (SSA), low molecular weight proteins (LMP) and the cell bound streptococcal membrane protein (CAP) (1). Our interest in this investigation has been focused on the examination of STSS strains isolated in Germany since 1989, when the first case was reported. More than 70 S. pyogenes strains isolated from cases of STSS in Germany and a group of control strains isolated from healthy people or from patients suffering from harmless streptococcal diseases were typed and investigated with regard to content of speA, speB, speC, and MF genes, toxin expression (ETA and ETC) and for mitogenic activity in culture supernatants. The results of this investigation are presented and discussed.KeywordsBacterial ProductSoft Tissue InfectionMitogenic ActivityToxin GeneGene DetectionThese keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.