A Critical Role of Tumor Necrosis Factor (TNF) α in Experimental Group A Streptococcal (GAS) Bacteremia

Abstract

In the last decade, there has been an increase in the incidence of Group A streptococcal (GAS) infections associated with bacteremia, shock, acute respiratory distress syndrome (ARDS), renal failure, aggressive soft tissue destruction and high mortality. These severe infections have now been described throughout the world. The most characteristic clinical finding in Streptococcal toxic shock syndrome (StrepTSS) is hypotension with associated multi-organ failure occurring early in the course of infection, sometimes even before an identifiable focus of infection can be ascertained (reviewed in⁵). Renal failure is common in StrepTSS (80%) and may precede hypotension in 50% of patients. ARDS occurs in 60% of these patients, a frequency which is among the highest of any infectious etiology. Finally, in spite of antibiotics, ventilator support, dialysis, pressors and aggressive fluid replacement, death rates range from 30% to as high as 80% (reviewed in⁵).