Toxic shock syndrome due to Lancefield group A and G streptococci:: current concepts, clinical aspects and therapeutic challenges

The authors describe the main features of toxic shock syndrome due to beta-haemolytic streptococci. Clinical pictures and consensus definition of this syndrome are both presented. Pathophysiological mechanisms responsible for the early onset of multiple organ dysfunction syndrome are discussed. The M-protein and exotoxin A are really key issues in the development of this syndrome. Molecular biology methods such as polymerase chain reaction (PCR) and reverse line blotting are extremely important for genotyping of streptococci strains, as the genotype is closely related to the mortality rate. Despite better understanding of the pathophysiological pathways involved and numerous experimental data, treatment of the most severe forms remains limited. The efficacy of more recent therapeutic approaches has yet to be evaluated. (C) 1999 Elsevier, Paris.