Invasive Streptococcal Group A Infection and Toxic Shock Syndrome in Songklanagarind Hospitalt
SURAT TONGYOO,M.D.*, PASIRI SITHINAMSUWAN,M.D.*, NUALTA APAKUPAKUL,M.A.,M.Sc.**, PANTIP CHAYAKUL,M.D.*
Affiliation : * Department of Medicine, ** Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand. t This article was previously presented as an oral presentation at the 17'h Annual Conference of the Royal College of Physicians of Thailand on April24-27, 2001 by S.T.
Objectives : Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is strepto coccal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital).
Method :The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prog nostic factors were analyzed by logistic regression model. Result : 176 cases of STSS and streptococcal group A infection, 89.9 per cent were com munity acquired infections. About 70 per cent of the infected patients had previous underlying con ditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1% ). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p<0.025), history of steroid use (odds ratio 11.17, p
Keywords : Invasive Streptococcal Group A Infection, STSS, Streptococcal Toxic Shock Syndrome
