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Superantigens such as pyrogenic exotoxin A interact with monocytes and T lymphocytes in unique ways, resulting in T-cell proliferation and watershed production of monokines (e.g. tumor necrosis factor \u03b1, interleukin 1, interleukin 6), and lymphokines (e.g. tumor necrosis factor \u03b2, interleukin 2, and gamma-interferon). Penicillin, though efficacious in mild Streptococcus pyogenes infection, is less effective in severe infections because of its short postantibiotic effect, inoculum effect, and reduced activity against stationary-phase organisms. Emerging treatments for strep TSS include clindamycin and intravenous gamma-globulin.<\/jats:p>","DOI":"10.1146\/annurev.med.51.1.271","type":"journal-article","created":{"date-parts":[[2002,7,27]],"date-time":"2002-07-27T11:45:04Z","timestamp":1027770304000},"page":"271-288","source":"Crossref","is-referenced-by-count":153,"title":["Streptococcal Toxic Shock Syndrome Associated with Necrotizing Fasciitis"],"prefix":"10.1146","volume":"51","author":[{"given":"Dennis L.","family":"Stevens","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Washington School of Medicine, Seattle, Washington, and Veterans Affairs Medical Center, Infectious Diseases Section, Boise Idaho, 83702;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"22","reference":[{"key":"b1","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/174.3.500"},{"key":"b2","doi-asserted-by":"crossref","unstructured":"Kehoe MA, Kapur V, Whatmore AM, Musser JM. 1996. 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