Document Detail

Successful management of severe group A streptococcal soft tissue infections using an aggressive medical regimen including intravenous polyspecific immunoglobulin together with a conservative surgical approach.
MedLine Citation:
PMID:  15849047     Owner:  NLM     Status:  MEDLINE    
Intravenous polyspecific immunoglobulin G (IVIG) has been reported to be efficacious as adjunctive therapy in patients with toxic shock syndrome caused by a group A streptococci (GAS). GAS is also an important cause of necrotizing fasciitis, for which an early and extensive surgical intervention is currently advocated. Here we report on the use of an aggressive medical regimen including high-dose IVIG together with a conservative surgical approach in severe GAS soft tissue infection. We describe 7 patients with severe soft tissue infection caused by GAS, who all were treated with effective antimicrobials and high-dose IVIG. Surgery was either not performed or only limited exploration was carried out. Six of the patients had toxic shock syndrome. All patients survived. Immunostaining of tissue biopsies from 2 of the patients revealed high levels of GAS, superantigen and pro-inflammatory cytokines initially, which were dramatically reduced in a repeat biopsy of the initial operative site collected from 1 of the patients 66 h post-IVIG administration. The study suggests that the use of a medical regimen including IVIG in patients with severe GAS soft tissue infections may allow an initial non-operative or minimally invasive approach, which can limit the need to perform immediate wide debridements and amputations in unstable patients.
Anna Norrby-Teglund; Matthew P Muller; Allison Mcgeer; Bing Siang Gan; Veena Guru; John Bohnen; Pontus Thulin; Donald E Low
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Scandinavian journal of infectious diseases     Volume:  37     ISSN:  0036-5548     ISO Abbreviation:  Scand. J. Infect. Dis.     Publication Date:  2005  
Date Detail:
Created Date:  2005-04-25     Completed Date:  2005-05-27     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0215333     Medline TA:  Scand J Infect Dis     Country:  Sweden    
Other Details:
Languages:  eng     Pagination:  166-72     Citation Subset:  IM    
Centre for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
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MeSH Terms
Anti-Bacterial Agents / administration & dosage,  therapeutic use*
Combined Modality Therapy
Fasciitis, Necrotizing / drug therapy,  microbiology
Immunoglobulins, Intravenous / administration & dosage,  therapeutic use*
Middle Aged
Shock, Septic / drug therapy,  microbiology
Soft Tissue Infections / microbiology,  physiopathology,  surgery,  therapy*
Streptococcal Infections / microbiology,  physiopathology,  surgery,  therapy*
Streptococcus pyogenes* / drug effects,  isolation & purification
Treatment Outcome
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Immunoglobulins, Intravenous
Comment In:
Scand J Infect Dis. 2006;38(8):742-3   [PMID:  16857634 ]

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