Streptococcal toxic shock syndrome (STSS) can be defined as a septic shock syndrome resulting from infection with toxin-producing group A streptococci (GAS). STSS can sporadically present as primary peritonitis in previously healthy persons. Signs of STSS are non-specific and patients generally present with flu-like symptoms and can develop a life-threatening toxic shock syndrome in just a few hours. Diagnosis is mainly by a combination of physical examination, laboratory/culture results, and exclusion of surgical causes by means of imaging modalities and/or surgical exploration. GAS remain penicillin-sensitive and most are clindamycin-sensitive. Prompt supportive treatment, possibly together with high-dose intravenous immunoglobulins, is crucial.

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Keywords Group A Streptococcus, Primary peritonitis, Streptococcal toxic shock syndrome, Streptococcus group A, adnexitis, adult, adult respiratory distress syndrome, amoxicillin plus clavulanic acid, article, bacterium culture, case report, cefuroxime, ciprofloxacin, clindamycin, computer assisted tomography, differential diagnosis, female, gentamicin, group A streptococcal infection, human, hydrocortisone, metronidazole, penicillin G, peritonitis, physical examination, toxic shock syndrome, transvaginal echography
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Journal International Journal of Infectious Diseases
Tilanus, A.M.R, de Geus, H.R.H, Rijnders, B.J.A, Dwarkasing, R.S, van der Hoven, B, & Bakker, J. (2010). Severe group A streptococcal toxic shock syndrome presenting as primary peritonitis: A case report and brief review of the literature. International Journal of Infectious Diseases, 14(SUPPL. 3). doi:10.1016/j.ijid.2009.07.014