2 cases of severe Streptococcus group a infection
Stegmayr, B.; Burman, L.A.; Bäcklund, U.; Holm, S.; Settergren, B.; Svanström, M.
Lakartidningen 86(43): 3672-3675
1989
ISSN/ISBN: 0023-7205 PMID: 2682089 Document Number: 331600
During recent years there have been several cases of death due to severe infection caused by GAS. Here we report two cases treated at our hospital, one of a patient presenting with preshock (case 1), the other of a patient with septic shock (case 2), in both of whom the concentrations of various coagulation factors and platelet counts were low. Other clinical findings common to both cases were scarlet coloured maculopapular exanthema, relative bradycardia, excessive tendency to develop oedema, and impaired function both in the lungs, kidneys and brain; and both patients were devoid of antibodies against the most predominant toxins (B and C) of the GAS strains isolated. Initial treatment comprised extensive administration of fluids, antibiotics, antithrombin, and low dose hydrocortisone. Plasma exchange by continuous centrifugation (CS 3000 Travenol Baxter) was given twice in case 1 and five times in case 2. In case 2, besides human immunoglobulin with a high anti-GAS (toxins A, B and C) antibody content given at admission, the patient received respiratory support, infusion of inotropic drugs and CAVH. Both patients recovered. The risk of death is high in cases of progressive multiple organ failure during the course of septic shock; and where conventional treatment combinations fail to remedy the condition, adjuvant treatment components may prove successful.
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