OBJECTIVES: Following the recent report of necrosing fasciitis cases in Great Britain, we conducted a study of group A streptococci infections in France to evaluate the frequency and severity of the different clinical presentations, particularly necrosing fasciitis. METHODS: Thirteen hospital laboratories were selected because of the large number of group A streptococci blood cultures they observed in 1993. The microbiologists in these hospitals, in relation with clinicians, identified 83 patients with a group A streptococci bacteraemia between January 1, 1993 and June 30, 1994. RESULTS: Sixty-three percent of the patients had an underlying condition: 39% had a chronic general or local disease and 24% had severe immunodepression. The skin portal of entry was found for 70% of the cases. Patients were divided into 4 groups according to the clinical picture: there were 16 cases of streptococci shock syndrome, 13 with deep infections, 25 infections of soft tissue (including 3 cases of fasciitis) and 29 cases of isolated bacteraemia. CONCLUSION: Overall, one-fourth of the patients died due to the streptococci infection, one-half of whom had a toxic shock syndrome. Mortality was correlated with age and health status, but also with the clinical presentation of the disease. Compared with former years, there was no increase in the number of group A streptococci infections, nor in the number of necrotizing fasciitis in France in 1993. However, streptococci shock syndrome is of particular importance because of its frequency and poor outcome.
OBJECTIVES: Following the recent report of necrosing fasciitis cases in Great Britain, we conducted a study of group A streptococci infections in France to evaluate the frequency and severity of the different clinical presentations, particularly necrosing fasciitis. METHODS: Thirteen hospital laboratories were selected because of the large number of group A streptococci blood cultures they observed in 1993. The microbiologists in these hospitals, in relation with clinicians, identified 83 patients with a group A streptococcibacteraemia between January 1, 1993 and June 30, 1994. RESULTS: Sixty-three percent of the patients had an underlying condition: 39% had a chronic general or local disease and 24% had severe immunodepression. The skin portal of entry was found for 70% of the cases. Patients were divided into 4 groups according to the clinical picture: there were 16 cases of streptococci shock syndrome, 13 with deep infections, 25 infections of soft tissue (including 3 cases of fasciitis) and 29 cases of isolated bacteraemia. CONCLUSION: Overall, one-fourth of the patients died due to the streptococci infection, one-half of whom had a toxic shock syndrome. Mortality was correlated with age and health status, but also with the clinical presentation of the disease. Compared with former years, there was no increase in the number of group A streptococci infections, nor in the number of necrotizing fasciitis in France in 1993. However, streptococci shock syndrome is of particular importance because of its frequency and poor outcome.