I read with interest the case of streptococcal myositis that was recently reported by Dalal et al.
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The authors are correct in stating that, ‘Emerging antibiotic treatment for severe group A streptococcal infections includes adding clindamycin to high doses of penicillin.’My colleagues and I recently completed a population-based retrospective study of invasive group A streptococcal (GAS) infections in the southern state of Florida, USA (population of Florida in 2000: 15 658 227).
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A total of 257 cases of invasive GAS infection were identified. These cases were patients who were hospitalised throughout Florida between August 1996 and August 2000 and were reported to the Florida Department of Health. The overall hospital mortality rate was 18% (41/228). We found that treatment with clindamycin strongly protected against hospital mortality in patients who had necrotising fasciitis (adjusted odds ratio=0.11, p=0.038) but not in patients who did not have necrotising fasciitis (adjusted odds ratio=1.01, p=0.989).2.
Both of these odds ratios were adjusted for the use of beta-lactam antibiotics and other relevant variables.Mr Dalal and colleagues wisely point out the need for the rapid diagnosis of an invasive GAS infection. I re-examined our case series and found that invasive GAS infection was suspected in only 2% (5/228) of these patients at the time of admission to hospital. Two of the 257 cases had streptococcal myositis (both of these patients also had GAS bacteraemia). The outpatient clinician needs to be aware of this rare but potentially fatal manifestation of invasive GAS disease.
References
- Streptococcal myositis: a lesson.Br J Plast Surg. 2002; 55: 682-684
- Invasive group A streptococcal infections in Florida.South Med J. 2003; (in press)
- Invasive group A streptococcal disease and intensive care unit admissions.Intensive Care Med. 2002; 28: 1822-1824
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© 2003 The British Association of Plastic Surgeons. Published by Elsevier Inc. All rights reserved.
