From the Guidelines
Invasive Group A Streptococcal (GAS) infections can lead to serious complications, including toxic shock syndrome and necrotizing fasciitis, which require prompt recognition and aggressive management with supportive and non-supportive care to reduce morbidity and mortality. The complications of invasive GAS infections can be categorized into supportive and non-supportive management. Supportive complications include:
- Toxic shock syndrome, requiring fluid resuscitation, vasopressors, mechanical ventilation, and intensive care monitoring 1
- Necrotizing fasciitis, often necessitating surgical debridement, wound care, and pain management 1
- Sepsis, requiring aggressive fluid therapy and hemodynamic support
Non-supportive complications include specific antimicrobial therapy, typically high-dose penicillin G (4 million units IV every 4 hours) or clindamycin (600-900 mg IV every 8 hours) for 10-14 days 1. Clindamycin is particularly valuable as it inhibits toxin production and works during the stationary growth phase of bacteria. For patients with necrotizing fasciitis, early surgical intervention is essential alongside antibiotics. Intravenous immunoglobulin (IVIG) at 1-2 g/kg may be considered for severe toxic shock syndrome to neutralize bacterial toxins, although its efficacy is still being debated 1. The most recent study on IVIG therapy for necrotizing infections caused by GAS suggests that it may be beneficial in improving outcomes, but more research is needed to confirm its effectiveness 1.
The management of invasive GAS infections requires a multidisciplinary approach, including infectious disease specialists, surgeons, and critical care specialists. Prompt recognition and aggressive management of these complications are crucial to reduce morbidity and mortality, as mortality rates can be high, particularly with toxic shock syndrome and necrotizing fasciitis, which can progress rapidly within hours 1.
From the Research
Complications of Invasive Group A Streptococcus (GAS) Infections
The complications of invasive GAS infections can be severe and life-threatening. Some of the complications include:
- Streptococcal toxic shock syndrome (STSS) 2, 3, 4
- Necrotizing fasciitis 2, 3, 4, 5
- Organ failure 2, 3
- High morbidity and mortality 3, 6
Supportive Care
Supportive care for invasive GAS infections often involves:
- Intensive care 3
- Early recognition of the disease and prompt initiation of supportive care 3
- Antibacterial therapy, including penicillin and clindamycin 3, 6, 5
- Intravenous immunoglobulin therapy in cases of toxic shock syndrome and severe invasive infection 2, 3, 5
Non-Supportive Care
Non-supportive care for invasive GAS infections may include: