Streptococcal Toxic Shock Syndrome due to Beta-hemolytic Streptococci : Clinical Features and Cytokines/ Chemokines Analysis of the Cases
Methods: Since January 2013 until March 2014, patients diagnosed as STSS due to β-hemolytic Streptococci were prospectively screened. Serum sample on admission was collected for measuring a variety of cytokines( IFN-γ, TNF-α, IL-1β, IL-6, IL-8, IL-12, IL-17, G-CSF, IL-10, IL-4) and chemokines( MCP-1, IP-10) levels. Bacterial strains from blood culture were categorized by Lancefield grouping and analyzed for emm type, speA, speB, speC, and speF.
Results: Nine patients were diagnosed as STSS. Mean age was 66-years old. Eight patients revealed cellulitis over lower extremities, of which five patients suffering from necrotizing fasciitis. Average period from onset of the symptoms to hospital visit was 2 days and mortality was 55.6%, despite intensive treatment including high amount of PCG/CLDM administration. Seven strains were categorized as group A and two were group B. There were two emm type 12, other strains revealed different type. All strains were negative for speA, and positive for speB and,speF. SpeC was positive among 50% of strains. Mean white blood cell count and creatine kinase level were 9522/μL and 2652 IU/L, respectively. Impressively, TNF-α and IL-1β were not elevated at all, but IFN-γ was slightly elevated (mean 288 pg/mL). Relatively large amount of IL-6, IL-8 and G-CSF were produced (mean 12967, 2433, 2328 pg/mL, respectively). Meanwhile, abundant amount of MCP-1 and IP-10 were observed (11026, 20682 pg/mL, respectively).
Conclusion: There are few reports that present immunological analysis along with clinical/bacterial features of STSS patients. Our results indicated reduced production of Th-1 type cytokines and increased production of MCP-1 and IP-10 might be prominently involved in STSS pathogenesis.
T. Ikebe, None
Y. Fukui, None
T. Tsubota, None
M. Honda, None
Y. Ishii, Toho Univesity Shool of Mediicne: Employee, Salary
K. Tateda, Toho Uneiversity School od Medicine: Employee, Salary