Abstract
Purpose: To review the literature on group A streptococcal toxic shock syndrome, (STSS).
Data source: Medline and EMBASE searches were conducted using the key words group A streptococcal toxic shock syndrome, alone and in combination with anesthesia; and septic shock, combined with anesthesia. Medline was also searched using key words intravenous immunoglobulin, (IVIG) and group A streptococcus, (GAS); and group A streptococcus and antibiotic therapy. Other references were included in this review if they addressed the history, microbiology, pathophysiology, incidence, mortality, presentation and management of invasive GAS infections. Relevant references from the papers reviewed were also considered. Articles on the foregoing topics were included regardless of study design. Non-English language studies were excluded. Literature on the efficacy of IVIG and optimal antibiotic therapy was specifically searched.
Principal findings: Reports of invasive GAS infections have recently increased. Invasive GAS infection is associated with a toxic shock syndrome, (STSS), in 8 – 14% of cases. The STSS characteristically results in shock and multi-organ failure soon after the onset of symptoms, and is associated with a mortality of 33 – 81%. Many of these patients will require extensive soft tissue debridement or amputation in the operating room, on an emergency basis. The extent of tissue debridement required is often underestimated before skin incision.
Conclusions: Management of STSS requires volume resuscitation, vasopressor/inotrope infusion, antibiotic therapy and supportive care in an intensive care unit, usually including mechanical ventilation. Intravenous immunoglobulin infusion has been recommended. Further studies are needed to define the role of IVIG in STSS management and to determine optimal anesthetic management of patients with septic shock.
Résumé
Objectif: Passer en revue la documentation sur le syndrome de choc toxique streptococcique de groupe A (SCTS).
Sources: Des recherches ont été menées dans Medline et EMBASE en utilisant les mots-clés:group A streptococcal toxic shock syndrome, seul et en combinaison avecanesthesia; septic shock, combiné avecanesthesia. Dans Medline, nous avons aussi utilisé les entréesintravenous immunoglobulin (immunoblobuline intraveineuse, IGIV) etgroup A streptococcus (streptocoque du groupe A, SGA) etantibiotic therapy. Nous avons retenu d’autres références qui concernaient l’histoire, la microbiologie, la physiopathologie, l’incidence, la mortalité, la présentation et le traitement des infections invasives de SGA. Les références pertinentes provenant des articles révisés ont aussi été conservées. Les articles concernant les sujets déjà cités ont été retenus sans tenir compte du type d’étude. On a exclu les études d’autres langues que l’anglais. La documentation sur l’efficacité de l’IGIV et sur l’antibiothérapie optimale a été spécialement recherchée.
Constatations principales: Les articles sur les infections envahissantes de SGA ont récemment augmenté. L’infection invasive de SGA est associée au syndrome de choc toxique (SCTS) dans 13–14 % des cas. Le SCTS cause, de façon caractéristique, un choc et une défaillance multiorganique peu après l’apparition des symptômes. Il s’accompagne d’un taux de mortalité de 33–81 %. Nombre des patients atteints auront besoin, de manière urgente, d’un débridement considérable du tissu mou ou d’une amputation. L’étendue du débridement tissulaire requis est souvent sous-estimée avant l’incision cutanée.
Conclusion: Le traitement du SCTS exige la restauration de la masse sanguine, des perfusions de vasopresseurs/inotropes, une antibiothérapie et des soins de soutien, incluant habituellement une ventilation mécanique, à l’unité des soins intensifs. La perfusion intraveineuse d’immunoglobuline est recommandée. D’autres études sont nécessaires pour définir le rôle de l’IGIV dans le traitement du SCTS et déterminer la ligne de conduite anesthésique la plus avantageuse pour les patients en choc septique.
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Baxter, F., McChesney, J. Severe group a streptococcal infection and streptococcal toxic shock syndrome. Can J Anaesth 47, 1129–1140 (2000). https://doi.org/10.1007/BF03027968
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DOI: https://doi.org/10.1007/BF03027968