Norrby S R, Norrby-Teglund A
Department of Infectious Diseases, Lund University Hospital, Sweden.
Ann Acad Med Singap. 1997 Sep;26(5):691-3.
Important new information has been gained on the pathogenesis and treatment of life-threatening invasive infections caused by group A streptococci (GAS), i.e. the streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF). Both STSS and NF lead to superantigen reactions with activation of up to 10% of the CD4+ lymphocytes and release of large amounts of cytokines; mainly tumour necrosing factor beta, interferon gamma, interleukin 1 and interleukin 6. Streptococcal products known to trigger the superantigen reactions are the pyrogenic exotoxins, spe A, spe B and spe C and the M-proteins. Therapeutically clindamycin has been shown to reduce mortality in animal experiments in comparison to penicillin treatment. A possible mechanism is the effect of clindamycin on protein synthesis which might decrease the production of superantigens. In man, the use of intravenous immunoglobulin has been shown to significantly reduce mortality in STSS and NF. The most probable mechanism is neutralisation of superantigens by antibodies in the immunoglobulin preparations used.
关于A组链球菌（GAS）引起的危及生命的侵袭性感染，即链球菌中毒性休克综合征（STSS）和坏死性筋膜炎（NF）的发病机制和治疗，已获得重要的新信息。STSS和NF都会引发超抗原反应，激活高达10%的CD4+淋巴细胞，并释放大量细胞因子；主要是肿瘤坏死因子β、干扰素γ、白细胞介素1和白细胞介素6。已知能引发超抗原反应的链球菌产物是致热外毒素、spe A、spe B和spe C以及M蛋白。在动物实验中，与青霉素治疗相比，克林霉素已被证明可降低死亡率。一种可能的机制是克林霉素对蛋白质合成的作用，这可能会减少超抗原的产生。在人类中，静脉注射免疫球蛋白已被证明可显著降低STSS和NF的死亡率。最可能的机制是所用免疫球蛋白制剂中的抗体对超抗原的中和作用。
