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Group B Streptococcal Necrotizing Fasciitis and Streptococcal Toxic Shock–Like Syndrome in Adults
Michael A. Gardam, MSc, MD;
Donald E. Low, MD;
Raphael Saginur, MD;
Mark A. Miller, MSc, MD
Arch Intern Med. 1998;158:1704-1708.
Necrotizing fasciitis, which is a severe and uncommon infection involving the subcutaneous tissues, is usually caused by group A streptococci. To our knowledge, however, group B streptococci (Streptococcus agalactiae) have been reported to cause necrotizing fasciitis in only 4 instances (2 involving neonates) over the past 4 decades. We report 3 cases of group B streptococcal necrotizing fasciitis in adults that occurred in southern Ontario and Quebec within a 10-month period. All 3 patients had significant underlying illness, and all required surgical debridement in addition to antibiotic therapy. One of the cases fulfilled the criteria for streptococcal toxic shock–like syndrome. Group B streptococcus has been recognized as a frequent cause of serious disease in adults. It has become evident over the past decade that invasive streptococcal infections are on the increase. We speculate that group B streptococcus has recently acquired an increased ability to cause necrotizing fasciitis and suggest that this may represent the emergence of a new clinical syndrome in adults.
From the Department of Microbiology and Division of Infectious Disease, Sir Mortimer B. Davis–Jewish General Hospital, McGill University, Montreal, Quebec (Drs Gardam and Miller); the Department of Microbiology and the Division of Infectious Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Dr Low); and the Division of Infectious Disease, Ottawa Civic Hospital, University of Ottawa, Ottawa, Ontario (Dr Saginur).
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