Stevens D L
University of Washington School of Medicine, Seattle, Washington, USA.
Emerg Infect Dis. 1995 Jul-Sep;1(3):69-78. doi: 10.3201/eid0103.950301.
Since the 1980s there has been a marked increase in the recognition and reporting of highly invasive group A streptococcal infections with or without necrotizing fasciitis associated with shock and organ failure. Such dramatic cases have been defined as streptococcal toxic-shock syndrome. Strains of group A streptococci isolated from patients with invasive disease have been predominantly M types 1 and 3 that produce pyrogenic exotoxin A or B or both. In this paper, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared to those of streptococcal toxic-shock syndrome. Current concepts in the pathogenesis of invasive streptococcal infection are also presented, with emphasis on the interaction between group A Streptococcus virulence factors and host defense mechanisms. Finally, new concepts in the treatment of streptococcal toxic-shock syndrome are discussed.
自20世纪80年代以来，对伴有或不伴有坏死性筋膜炎且与休克及器官衰竭相关的高侵袭性A组链球菌感染的认识和报告显著增加。此类严重病例已被定义为链球菌中毒性休克综合征。从侵袭性疾病患者中分离出的A组链球菌菌株主要为产生致热外毒素A或B或两者的M1型和M3型。本文介绍了链球菌菌血症、肌炎和坏死性筋膜炎的临床及人口统计学特征，并与链球菌中毒性休克综合征的特征进行了比较。还介绍了侵袭性链球菌感染发病机制的当前概念，重点是A组链球菌毒力因子与宿主防御机制之间的相互作用。最后，讨论了链球菌中毒性休克综合征治疗的新概念。
