{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T17:40:43Z","timestamp":1789926043334,"version":"4.0.1"},"reference-count":22,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T00:00:00Z","timestamp":1743120000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Streptococcal toxic shock syndrome (STSS) is a serious and potentially fatal complication of invasive Streptococcus pyogenes (Group A Streptococcus, GAS) infection, often stemming from severe soft tissue infections. While uncommon, tonsillitis can also lead to STSS, with lethality rates reported as high as 70%. Methods: We present three cases of patients diagnosed with tonsillitis who developed STSS. Point-of-care testing for GAS antigens was utilized to facilitate rapid diagnosis. Results: In all three cases, the characteristic clinical presentations, including scarlatiniform rash, strawberry tongue, and signs of shock with multi-organ dysfunction, were observed. Microbiological evidence confirmed ongoing GAS infections, and point-of-care testing for GAS antigens assisted in the diagnosis of tonsillitis in conjunction with STSS, enabling timely treatment interventions. Conclusions: Rapid diagnosis is crucial for the optimal management of STSS. The point-of-care testing for GAS may be useful for diagnosing STSS associated with tonsillitis.<\/jats:p>","DOI":"10.3390\/clinpract15040070","type":"journal-article","created":{"date-parts":[[2025,3,28]],"date-time":"2025-03-28T06:45:51Z","timestamp":1743144351000},"page":"70","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Streptococcal Toxic Shock Syndrome: Diagnostic and Therapeutic Approaches Incorporating Point-of-Care Antigen Testing\u2014Case Series"],"prefix":"10.3390","volume":"15","author":[{"given":"Peter","family":"Mihalov","sequence":"first","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 83101 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Koval\u00edkov\u00e1","sequence":"additional","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 83101 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karol","family":"Lakti\u0161","sequence":"additional","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 83101 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matej","family":"Bend\u017eala","sequence":"additional","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 83101 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9337-8843","authenticated-orcid":false,"given":"Peter","family":"Sabaka","sequence":"additional","affiliation":[{"name":"Department of Infectology and Geographical Medicine, Faculty of Medicine, Comenius University in Bratislava, 83101 Bratislava, Slovakia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1186\/s13613-018-0438-y","article-title":"Streptococcal toxic shock syndrome in the intensive care unit","volume":"8","author":"Schmitz","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Sekizuka, T., Nai, E., Yoshida, T., Endo, S., Hamajima, E., Akiyama, S., Ikuta, Y., Obana, N., Kawaguchi, T., and Hayashi, K. (2017). Streptococcal toxic shock syndrome caused by the dissemination of an invasive emm3\/ST15 strain of Streptococcus pyogenes. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2870-2"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jiph.2012.07.006","article-title":"Group A Streptococcus Toxic Shock Syndrome: An outbreak report and review of the literature","volume":"5","author":"Hill","year":"2012","journal-title":"J. Infect. Public Health"},{"key":"ref_4","unstructured":"Ferretti, J.J., Stevens, D.L., and Fischetti, V.A. (2016). Streptococcal superantigens: Biological properties and potential role in disease. Streptococcus pyogenes: Basic Biology to Clinical Manifestations, The University Of Oklahoma Health Sciences Center."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.molmed.2013.10.004","article-title":"Streptococcal superantigens: Categorization and clinical associations","volume":"20","author":"Commons","year":"2014","journal-title":"Trends Mol. Med."},{"key":"ref_6","first-page":"1","article-title":"Streptococcal\u00a0superantigens","volume":"93","author":"Proft","year":"2007","journal-title":"Chem. Immunol. Allergy"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1128\/CMR.00101-13","article-title":"Disease manifestations and pathogenic mechanisms of group A Streptococcus","volume":"27","author":"Walker","year":"2014","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/cid\/ciw248","article-title":"Epidemiology of invasive group A streptococcal infections in the United States, 2005\u20132012","volume":"63","author":"Nelson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Atchade, E., De Tymowski, C., Grall, N., Tanaka, S., and Montravers, P. (2024). Toxic Shock Syndrome: A Literature Review. Antibiotics, 13.","DOI":"10.3390\/antibiotics13010096"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1046\/j.1469-0691.2002.00387.x","article-title":"Streptococcal toxic shock syndrome","volume":"8","author":"Stevens","year":"2002","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_11","first-page":"2285","article-title":"Streptococcus\u00a0pyogenes","volume":"Volume 2","author":"Bennett","year":"2015","journal-title":"Mandell, Douglas, and Bennett\u2019s Principles and Practice of Infectious Diseases"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2359","DOI":"10.1128\/JCM.00422-08","article-title":"Epidemiology of severe Streptococcus pyogenes disease in Europe","volume":"46","author":"Lamagni","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_13","first-page":"276","article-title":"Toxic shock syndrome due to group A streptococcal pharyngitis and bacteremia in adults","volume":"42","author":"Vucicevic","year":"2009","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1007\/s10096-020-04034-z","article-title":"Performance and user-friendliness of the rapid antigen detection tests QuickVue Dipstick Strep A test and DIAQUICK Strep A Blue Dipstick for pharyngotonsillitis caused by Streptococcus pyogenes in primary health care","volume":"40","author":"Boija","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.diagmicrobio.2018.03.018","article-title":"Clinical Impact of a Rapid Streptococcal Antigen Test on Antibiotic Use in Adult Patients","volume":"91","author":"Dodd","year":"2018","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1752","DOI":"10.1128\/AAC.47.5.1752-1755.2003","article-title":"Influences of linezolid, penicillin, and clindamycin, alone and in combination, on streptococcal pyrogenic exotoxin a release","volume":"47","author":"Coyle","year":"2003","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1093\/cid\/ciu449","article-title":"Clinical efficacy of polyspecific intravenous immunoglobulin therapy in patients with streptococcal toxic shock syndrome: A comparative observational study","volume":"59","author":"Darenberg","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Liu, Z., Jiang, X., Li, J., Ji, W., Zhou, H., Gong, X., Miao, B., Meng, S., Duan, L., and Shi, Q. (2023). Molecular characteristics and antibiotic resistance mechanisms of clindamycin-resistant Streptococcus agalactiae isolates in China. Front. Microbiol., 14.","DOI":"10.3389\/fmicb.2023.1138039"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1016\/S1473-3099(21)00456-4","article-title":"Increasing clindamycin resistance in group A streptococcus","volume":"21","author":"White","year":"2021","journal-title":"Lancet Infect. Dis."},{"key":"ref_20","first-page":"37","article-title":"Antimicrobial resistance rates of Streptococcus pyogenes in a Greek tertiary care hospital: 6-year data and literature review","volume":"46","author":"Meletis","year":"2023","journal-title":"New Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"ofad588","DOI":"10.1093\/ofid\/ofad588","article-title":"Comparison of Adjuvant Clindamycin vs. Linezolid for Severe Invasive Group A Streptococcus Skin and Soft Tissue Infections","volume":"10","author":"Heil","year":"2023","journal-title":"Open Forum Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/j.jemermed.2011.05.035","article-title":"The use of cephalosporins in penicillin-allergic patients: A literature review","volume":"42","author":"Campagna","year":"2012","journal-title":"J. Emerg. Med."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/4\/70\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:04:13Z","timestamp":1760029453000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/15\/4\/70"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,28]]},"references-count":22,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,4]]}},"alternative-id":["clinpract15040070"],"URL":"https:\/\/doi.org\/10.3390\/clinpract15040070","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,28]]}}}