Intravenous Immunoglobulin Adjunctive Therapy in Patients with Streptococcal Toxic Shock Syndrome and Necrotizing Fasciitis

Abstract

Streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis caused by group A streptococcus (GAS) are rapidly-progressive invasive diseases that are associated with high mortality rates, ranging from 30% to 80% despite prompt antibiotic therapy and surgical debridement (1). Intense research in the field of GAS pathogenesis has unraveled complex host-pathogen interplay and provided an impetus for the design of novel therapeutic strategies to attenuate or prevent these diseases. One of the more promising therapeutic strategies is the intravenous administration of polyspecific immunoglobulin (IVIG) to patients with severe invasive GAS infections. In this chapter, we will review the mechanistic actions and use of IVIG as adjunctive therapy for severe invasive GAS infections. In doing so, we will also highlight epidemiological and pathogenic aspects of invasive GAS infections and show how IVIG acts, in part, by attenuating the inflammatory cytokine cascade in these patients.