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The Journal of Bone and Joint Surgery 80:96-8 (1998)
© 1998 The Journal of Bone and Joint Surgery, Inc.

Case Report

Toxic Shock Syndrome in Association with Group-A Streptococcal Infection of a Knee Joint after a Total Knee Arthroplasty. A Case Report*

EDWARD D. RALPH, M.D., F.R.C.P.(C){dagger} and ROBERT B. BOURNE, M.D., F.R.C.S.(C){dagger}, LONDON, ONTARIO, CANADA

Investigation performed at London Health Sciences Centre, University Campus, London


   Introduction
 
There has been a marked increase in the incidence of severe group-A streptococcal infections in children and adults in the past decade3,4,7,13. Necrotizing fasciitis, bacteremia, and streptococcal toxic shock syndrome are the most common complications reported11. The estimated overall mortality rate associated with these severe infections has ranged from 30 to 80 per cent in series ranging in size from seven to fifty patients14. Early recognition of the potential severity of these infections is crucial to the successful management of these patients.

We report the first case, to our knowledge, of a patient who had streptococcal toxic shock syndrome in association with a severe group-A streptococcal infection of the knee after a total knee arthroplasty and review the diagnosis, pathophysiology, and treatment of this syndrome.


   Case Report
 
A thirty-seven-year-old man sought medical attention at another institution three hours after the sudden onset of severe pain and swelling in the . . . [Full Text of this Article]


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