Two cases of severe infection with beta-haemolytic group A streptococci associated with a toxic-shock-like syndrome.

Two cases of severe infection due to Streptococcus pyogenes associated with a toxic-shock-like syndrome (TSLS) and also with serious soft-tissue infection are described. Serotyping and detection of A, B and C exotoxins were carried out on strains isolated from blood cultures and skin samples. The strain of serotype M1 T1, which produced 10 ng/ml of exotoxin A and also synthesised exotoxins B and C, caused severe TSLS associated with major skin lesions. The second strain of serotype M12 T12, which produced only 1 ng/ml of exotoxin A and synthesised exotoxin B, was associated with clinical manifestations of adult respiratory distress syndrome. The relationship between the magnitude of exotoxin production and the severity of clinical manifestations cannot be established from these two cases.