Clinical characteristics of the toxic shock-like syndrome caused by group A streptococci

Characteristic	Comment
Age group affected	All ages; predominantly adults
Sex most often affected	No predilection
Portal of entry	Variable, generally skin or soft tissue (also vagina and respiratory tract)
Clinical features	Fever; hypotension; altered mental status, coma; signs of soft tissue infection that usually progresses to necrotizing fasciitis or myositis; active varicella with secondary infection; multiorgan dysfunction, often with acute respiratory distress syndrome
Bacteremia	Often present (about 60 percent)
Causative organism	Group A Streptococcus
M serotype	Variable; 1, 3, 12, and 28 most common
Type of pyrogenic exotoxin	A, B, C, SSA, MF
Case-fatality rate	30 to 60 percent

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