Severe group a streptococcal soft-tissue infections in Ontario: 1992-1996

Abdu Sharkawy, Donald E. Low, Raphael Saginur, Daniel Gregson, Benjamin Schwartz, Peter Jessamine, Karen Green, Allison McGeer, H. D. Davies, W. Gold, M. Loeb, J. Talbot, M. Lovgren, B. Mederski, L. Trpeski, A. Sarabia, A. Simor, B. Willey

Research output: Contribution to journalArticlepeer-review

126 Scopus citations


A prospective, population-based, surveillance study of invasive soft-tissue infections due to group A streptococci was conducted in Ontario, Canada, from 1992 through 1996. Demographic and clinical information was obtained by patient interview and chart review. Isolates were characterized by M protein and T agglutination typing. The incidence of necrotizing fasciitis (NF) increased from 0.08 cases per 100, 000 population in 1992 to 0.49 cases per 100, 000 population in 1995. The case-fatality rate was 13% (68 of 520 patients died). Hypotension and multiorgan dysfunction complicated 64 cases (12%), and NF complicated 119 cases (23%). Underlying diabetes, alcohol abuse, cancer, and cardiac and pulmonary disease increased the risk of disease. Prior use of nonsteroidal anti-inflammatory agents did not influence disease severity. All 197 patients without NF, underlying illness, and hypotension at presentation survived, as did 95 (99%) of 96 normotensive patients who were <65 years old but who had underlying chronic illness. Previously healthy patients without hypotension or NF may be considered for outpatient treatment.

Original languageEnglish (US)
Pages (from-to)454-460
Number of pages7
JournalClinical Infectious Diseases
Issue number4
StatePublished - Feb 15 2002
Externally publishedYes

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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