{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,4,2]],"date-time":"2025-04-02T13:43:56Z","timestamp":1743601436028},"reference-count":20,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T00:00:00Z","timestamp":1525305600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pathology International"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec><jats:label \/><jats:p>Five autopsy cases of fulminant group A streptococcal infection without gangrene in the extremities are presented. Clinical course of the fulminant illness was short (2\u20134 days). One pathological autopsy case was aged (86\u2010years\u2010old), and hemorrhagic cystitis was observed. The other four forensic autopsy cases were young (24\u201338 years\u2010old) with the mean age of 32, and the primary infective lesions were located in the postpartum endometrium, tonsil and bronchus (2 cases). Systemic coccal dissemination with poor neutrophilic reaction was seen in two of five cases. Bilateral renal cortical necrosis was noted in three cases (including two with bacterial embolism). Hemophagocytosis, probably resulting from hypercytokinemia, was characteristic in three cases without bacterial embolism. Gram\u2010positive cocci colonizing the hemorrhagic and necrotizing lesions were consistently immunoreactive for streptococcal antigens and Strep A (a carbohydrate antigen on group A streptococci). Neutrophilic reaction was mild in the primary infected foci. Clinicians should note that fulminant streptococcal infection (streptococcal toxic shock syndrome) in young and immunocompetent patients may not be associated with gangrene in the extremities. Autopsy prosecutors (diagnostic and forensic pathologists) must recognize the difficulty in making an appropriate autopsy diagnosis, particularly when bacterial embolism is not associated.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pin.12678","type":"journal-article","created":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T10:11:03Z","timestamp":1525342263000},"page":"419-424","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Fulminant group A streptococcal infection without gangrene in the extremities: Analysis of five autopsy cases"],"prefix":"10.1111","volume":"68","author":[{"given":"Shu","family":"Kato","sequence":"first","affiliation":[{"name":"Medical Student Fujita Health University School of Medicine Toyoake Aichi Japan"},{"name":"Department of Pathology Fujita Health University School of Medicine Toyoake Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Motoi","family":"Yanazaki","sequence":"additional","affiliation":[{"name":"Medical Student Fujita Health University School of Medicine Toyoake Aichi Japan"},{"name":"Department of Pathology Fujita Health University School of Medicine Toyoake Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kino","family":"Hayashi","sequence":"additional","affiliation":[{"name":"Tokyo Medical Examiner's Office Otsuka Tokyo Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fumiko","family":"Satoh","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine Kitasato University School of Medicine Sagamihara Kanagawa Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ichiro","family":"Isobe","sequence":"additional","affiliation":[{"name":"Department of Legal Medicine Fujita Health University School of Medicine Toyoake Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yutaka","family":"Tsutsumi","sequence":"additional","affiliation":[{"name":"Department of Pathology Fujita Health University School of Medicine Toyoake Aichi Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2018,5,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00422-08"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid0103.950301"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/1348-0421.12213"},{"key":"e_1_2_7_5_1","first-page":"4","article-title":"Immunostaining of pathogens with high sensitivity and inconsistent specificity","volume":"34","author":"Tsutsumi Y.","year":"2018","journal-title":"Antibiot Chemother"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.2169\/internalmedicine.47.1160"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199302000-00012"},{"key":"e_1_2_7_8_1","first-page":"1461","article-title":"Clinicopathological studies of renal cortical necrosis, with special reference to its pathogenesis","volume":"26","author":"Fukusato T.","year":"1984","journal-title":"Jpn J Nephrol"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.12099"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.micinf.2004.05.022"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1039\/C4AN00541D"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(97)90043-5"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0897.2010.00836.x"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/432729"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1086\/427286"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M513408200"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1086\/432485"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1086\/603541"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1074\/jbc.M704821200"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.01116-07"},{"key":"e_1_2_7_21_1","doi-asserted-by":"crossref","first-page":"219","DOI":"10.33073\/pjm-2010-034","article-title":"Pyogenic streptococci. 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