Clinical Observation
August 10/24, 1998

Group B Streptococcal Necrotizing Fasciitis and Streptococcal Toxic Shock–Like Syndrome in Adults

Author Affiliations

From the Department of Microbiology and Division of Infectious Disease, Sir Mortimer B. Davis–Jewish General Hospital, McGill University, Montreal, Quebec (Drs Gardam and Miller); the Department of Microbiology and the Division of Infectious Disease, Mount Sinai Hospital, University of Toronto, Toronto, Ontario (Dr Low); and the Division of Infectious Disease, Ottawa Civic Hospital, University of Ottawa, Ottawa, Ontario (Dr Saginur).


Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1998

Arch Intern Med. 1998;158(15):1704-1708. doi:10.1001/archinte.158.15.1704

Necrotizing fasciitis, which is a severe and uncommon infection involving the subcutaneous tissues, is usually caused by group A streptococci. To our knowledge, however, group B streptococci (Streptococcus agalactiae) have been reported to cause necrotizing fasciitis in only 4 instances (2 involving neonates) over the past 4 decades. We report 3 cases of group B streptococcal necrotizing fasciitis in adults that occurred in southern Ontario and Quebec within a 10-month period. All 3 patients had significant underlying illness, and all required surgical debridement in addition to antibiotic therapy. One of the cases fulfilled the criteria for streptococcal toxic shock–like syndrome. Group B streptococcus has been recognized as a frequent cause of serious disease in adults. It has become evident over the past decade that invasive streptococcal infections are on the increase. We speculate that group B streptococcus has recently acquired an increased ability to cause necrotizing fasciitis and suggest that this may represent the emergence of a new clinical syndrome in adults.