Toronto, April 1, 1999 - The deadly killer, Streptococcal Toxic Shock Syndrome, commonly associated with flesh eating disease, has a new foe.

Researchers from the Department of Microbiology at Mount Sinai and Princess Margaret Hospitals found that there was a 30 per cent reduction in mortality rates for patients treated with a medication called intravenous immunoglobulin. Their findings were released today in the journal Clinical Infectious Diseases. Streptococcal toxic shock syndrome (STSS) has an 81 per cent mortality rate. In December of 1994, noting a rise in STSS in Ontario the researchers treated 21 cases from across the country over the next five months with intravenous immunoglobulin (IVIG). Those outcomes were compared with 32 patients from Ontario who contracted STSS between 1992-95 and did not receive IVIG. The 30-day survival rate was 67 percent in the patients who received IVIG, compared to 34 in those who didn't.

"The creation of a province wide network to study this disease over the last nine years, has not only allowed us to discover the mechanism by which this organism strikes, but more importantly to evaluate new ways to treat this infection," says Dr. Donald Low, Microbiologist-in-Chief, for Mount Sinai and Princess Margaret Hospitals and Professor, Microbiology and Medicine for the University of Toronto.

"Anecdotal experience with the use of IVIG both at the turn of the century and in the late 1980's suggested that providing patients with antibodies could neutralize the toxins produced by the bacteria," says Low. "That led us to pursue a study of IVIG as a course of treatment during the late fall of 1994 in the face of escalating STSS cases."

STSS develops when a bacteria (group A streptococcus) produces a toxin that tricks the immune system into overreacting. The body releases small molecules called cytokines, which cause fever, low blood pressure and leakage of fluid from blood vessels into surrounding tissue. This inhibits adequate flow of blood and oxygen to many organs, including the kidney and brain, leading the person into shock and organ failure.

Group A Strep is a bacteria commonly found in the throats and on the skin of patients in the community. It is most often the cause of bacterial throat infections (strep throat). At the turn of the century this bacteria caused infections (such as Scarlet Fever) that were associated with a high mortality rate. For unexplained reasons, the severe complications associated with infections belonging to group A streptococcus almost disappeared from the mid 1930's until the mid 1980's, only to reappear in the form of STSS and Necrotizing Fasciitis, the latter commonly referred to as flesh eating disease.

In 1992 there were 24 cases of STSS reported in Ontario. Nine cases developed Necrotizing Fasciitis, which is the flesh eating disease that is often associated with STSS. In 1994 the numbers had risen to 42 with STSS and 33 with NF. Between January and March of this year there were 21 reported cases of STSS and nine with NF.

The researchers who conducted the study were: Drs. Donald Low, Allison McGeer and Rupert Kaul, from the Department of Microbiology for Mount Sinai and Princess Margaret Hospitals and the Department of Pathobiology and Laboratory Medicine, University of Toronto; Keith O'Rourke, Statistician, Loeb Health Research Institute and Adjunct Professor, Department of Surgery, Ottawa Hospital/ University of Ottawa; Dr. Benjamin Schwartz, Center for Disease Control and Prevention, Atlanta Ga.; Malak Kotb, Ph.D., University of Memphis; Anna Norrby-Teglund, Ph.D., Karolinska Institut, Stockholm, Sweden; and Dr. James Talbot, The National Centre for Streptococcas, Edmonton. Financial support for the project was provided by The Canadian Bacterial Diseases Network.

The ability to identify additional patients across Canada was facilitated by the participation of physicians from the Canadian Infectious Disease Society.

Since the study, one of the patients that survived has started a foundation, Strategies for Life, to raise funds to support research in this field.

Mount Sinai Hospital is a University of Toronto affiliated patient care, teaching and research centre, committed to excellence. Mount Sinai's mission is to provide leading edge patient care programs that are research based, to conduct internationally recognized research and to educate future health care practitioners. Mount Sinai's key priorities are work in the fields of Perinatology, Surgical Oncology, Musculoskeletal Disease, GI Disease, Molecular and Sub-specialty Medicine and, the work of its Samuel Lunenfeld Research Institute.

For further information please contact:

Rob Andrusevich
Media Relations Officer
Mount Sinai Hospital
(416) 586-3161