Population-Based Surveillance for Group A Streptococcal Necrotizing Fasciitis: Clinical Features, Prognostic Indicators, and Microbiologic Analysis of Seventy-Seven Cases
Section snippets
Patients
Active, population-based surveillance of group A streptococcal infections in Ontario, Canada (population 10.9 million in 1994)[16]has been conducted by our group since November 1991 for necrotizing fasciitis, and since January 1992 for all invasive disease.[17]All microbiology laboratories serving Ontario hospitals notified the study office whenever group A streptococcus was isolated from specimens other than throat or eye swabs. Attending physicians were then contacted to determine whether the
Patient Characteristics
Seventy-seven cases of group A streptococcal necrotizing fasciitis were identified between November 1991 and May 1995. The incidence of disease increased during this time period from a rate of 0.085 per 100,000 population in the first 12 months of surveillance to 0.40 per 100,000 population in the last 12 months (P <0.001). Cases occurred more often in the winter months; 61% of cases occurred between December and March (P <0.001). The rate of disease increased with increasing age, with annual
Discussion
The most severe form of soft tissue infection caused by group A Streptococcus is necrotizing fasciitis, characterized by necrosis and inflammation of fascia and subcutaneous tissues. Previous reports of this disease have included case reports and retrospective reviews involving relatively small numbers of cases.13, 14, 15, 24, 25, 26Using stringent diagnostic criteria, the cases herein described represent the largest series of group A streptococcal necrotizing fasciitis reported to date, and
Acknowledgements
Supported in part by grants from the Centers for Disease Control and Prevention, Atlanta, Georgia, USA, (CDC Contract No. 200-91-0929); Canadian Bacterial Diseases Network; and M.D.S. Health Group Limited, Toronto, Ontario, Canada.
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