Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature.

The clinical features of group A beta-hemolytic streptococcal sepsis were studied in 15 consecutive patients seen at an urban general hospital over a two-year period. Although 14 of the 15 patients had underlying disease, no patient had malignancy and none had undergone immunosuppressive therapy. Only one infection was nosocomially acquired. Mortality was 20%. Bacteremia arose from a cutaneous infection in 10 cases, from pneumonia in two, and from the urinary tract in one. Streptococcal bacteremia was unexpected in the remaining patients, two women who presented with severe abdominal pain. Unlike most other patients described in the literature, neither woman had an identifiable primary focus of infection. A review of the literature for potential sources of group A streptococcal bacteremia revealed that this pathogen is not part of the indigenous flora of the normal host at any body site.