Flesh-Eating Bacteria: Current Status of Group A Streptococcal Infectious Gangrene in Taiwan
1996 Vol.12 NO.7
Twenty-seven cases of group A streptococcal infectious gangrene were collected from Taiwan medical centers between January 1991 and June 1994. These included 4 cases of invasive cellulitis, 14 cases of necrotizing fasciitis and 9 cases of streptococcal toxic shock-like syndrome (STSS) as a complication of necrotizing fasciitis. The leading underlying disease for all 27 cases was diabetes (8/27, 29.6%); the most common predisposing factor was trauma (13/27, 48.1%). Clinical symptoms included reddening, swelling and pain of local soft tissue, fever and bullae. Invasion of the lower limbs was most common (17/27, 62.9%). The relevant clinical factors from the three groups showed no significant differences. Treatment was primarily by the use of antibiotics and surgical debridement/drainage. Prognosis in general was good. However, there were 6 deaths and all belong to the group with STSS. Therefore, risk factors of STSS such as older age, hypotension, renal impairment, diarrhea, group A streptococcal bacteremia should be identified as early as possible for active treatment. The specific mechanism of group A streptococcal toxic shock-like syndrome in Taiwan requires further investigation and research.