Preventive effects of a major component of green tea, epigallocathechin-3-gallate, on hepatitis-B virus DNA replication.

BACKGROUND: Hepatitis B virus infection is one of the major world health problems. Epigallocatechin-3 gallate is the major component of the polyphenolic fraction of green tea and it has an anti-viral, anti-mutagenic, anti- tumorigenic, anti-angiogenic, anti-proliferative, and/or pro-apoptotic effects on mammalian cells. In this study, our aim was to investigate the inhibition of HBV replication by epigallocatechin-3 gallate in the Hep3B2.1-7 hepatocellular carcinoma cell line. MATERIALS AND METHODS: HBV-replicating Hep3B2.1-7 cells were used to investigate the preventive effects of epigallocatechin-3 gallate on HBV DNA replication. The expression levels of HBsAg and HBeAg were determined using ELISA. Quantitative real-time-PCR was applied for the determination of the expression level of HBV DNA. RESULTS: Cytotoxicity of epigallocathechin-3-gallate was not observed in the hepatic carcinoma cell line when the dose was lower than 100 µM. The ELISA method demonstrated that epigallocatechin-3 gallate have strong effects on HBsAg and HBeAg levels. Also it was detected by real-time PCR that epigallocatechin-3 gallate could prevent HBV DNA replication. CONCLUSIONS: The obtained data pointed out that although the exact mechanism of HBV DNA replication and related diseases remains unclear, epigallocatechin-3 gallate has a potential as an effective anti-HBV agent with low toxicity.

Comparison of surface swab and quantitative biopsy cultures dependent on isolated microorganisms from burn wounds.

OBJECTIVE: Infections are one of the most important and potentially serious complications of burn wounds. Quantitative biopsy cultures are useful for showing that a burn wound infection is not present, but these cultures are not useful for showing that an infection is present. Swab cultures are used to diagnosis surface colonization and may not accurately reflect the organism(s) causing the wound infection. MATERIALS AND METHODS: To perform a comparison of surface swab and biopsy cultures for isolated microorganisms from burn wounds, 160 biopsy/surface swab pairs were collected from 160 patients. RESULTS: Seventy-seven patients (48.1%) showed positive micro-organism cultures from the burn wounds; 19.3 percent had both positive surface cultures and significant bacterial counts from the biopsy cultures, whereas 28.8 percent of the patients had only positive surface cultures. There was moderate agreement (41%) between the results of surface swab and quantitative biopsy cultures used to diagnose burn wound infections. Pseudomonas aeruginosa (45.5%) was the most predominantly isolated bacteria from the wounds, and there was good concordance between the results of the surface swab and quantitative biopsy culture samples (78%). Coagulase-negative Staphylococci (CNS) and Escherichia coli strains were only isolated from the surface swab samples because they are colonizing bacteria. The univariate analysis revealed that there were significant associations between the results of the positive biopsy cultures and the total surface body area, open flame burns, prolonged hospitalization and female gender (p<0.05). CONCLUSION: Surface swab and quantitative biopsy cultures have a high rate of concordance in predicting P. aeruginosa invasion and the colonization of E. coli and CNS strains in burn wounds.

Persistence of nosocomial pathogens on various fabrics.

OBJECTIVE: Fabrics can become contaminated with high numbers of microorganisms that may be pathogenic to patients in a hospital setting and can play an important role in the chain of infection. The aim of this study was to investigate the survival of several clinical bacterial and fungal isolates on several fabrics commonly used in hospitals. MATERIALS AND METHODS: Bacterial and fungal survival was tested on the following materials, each of which are commonly used in our hospital: 100% smooth cotton, 60% cotton-40% polyester, 100% wool and 100% silk. One isolate each of Candida albicans, Candida tropicalis, Candida krusei, Candida glabrata, Candida parapsilosis, Geotrichum candidum, Aspergillus fumigatus, Cryptococcus neoformans, vancomycin resistant Enterococcus faecium (VRE, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) positive Escherichia coli, inducible beta-lactamase (IBL) positive Pseudomonas aeruginosa, IBL-positive Acinetobacter baumannii and Stenotrophomonas maltophilia were used to contaminate fabrics. The survival of these microorganisms was studied by testing the fabric swatches for microbial growth. RESULTS: The median survival times for all the tested bacteria and fungi were as follows: 26 days on cotton, 26.5 days on cotton-polyester, 28 days on silk, and 30 days on wool. Among the bacterial species tested, E. faecium had the longest survival time on cotton-polyester fabrics. For the fungal isolates, it was observed that C. tropicalis and C. krusei survived for the shortest amount of time on cotton fabrics in the present study. CONCLUSION: This survival data indicate that pathogenic microorganisms can survive from days to months on commonly used hospital fabrics. These findings indicate that current recommendations for the proper disinfection or sterilization of fabrics used in hospitals should be followed to minimize cross-contamination and prevent nosocomial infections.

Incidence and risk factors of vancomycin-resistant enterococcus colonization in burn unit patients.

This study was aimed to identify the incidence of vancomycin-resistant enterococcus (VRE) colonization in burn patients, to collate risk factors for colonization and to determine the VRE resistance profile to different antimicrobial agents. This prospective study was carried out on the burn unit, during the period from September 2008 to January 2010, in 128 patients who were hospitalized at least 3 weeks or more. Periodic swabs were taken from burn wound, rectal, axillary, umblicaly and throat regions of the patients on admission and 7th, 14th, 21st days of hospitalization. Demographics and known risk factors were retrieved and assessed by statistical methods. Only 20 patients (15.6%) were colonized with enterococci on admission and these strains isolated from rectal, umblical and throat samples were sensitive to vancomycin. Initial VRE isolation was made in the first samples from the rectum of two patients on the 7th day. The rates of rectal, umblical, throat and axillary colonization increased to 21.9%, 3.1%, 3.1% and 3.1% at 28th day, respectively. VRE strains were the first isolated from burn wounds of only one patient (0.8%) on the 14th day and the colonization rate increased to 7.0% at the 28th day. Our study indicated that rectal colonization was seen more than other sites of colonization and was strictly correlate to colonizing enterococci between burn wound and other body regions. Multivariate analyses showed that glycopeptide use, burn depth and total burn surface area were independent risk factors for acquisition of VRE. All VSE strains were susceptible to teicoplanin, tigecycline and linezolid. VSE strains were more resistant to gentamicin and streptomycin, and VRE strains were more resistant to penicillin and ampicillin. The present study showed tigecycline and linezolid to be most active agents against VRE strains. The determined VRE colonization and risk factors of VRE acquisition are expected to be useful in establishing guidelines for preventing VRE infection in burn unit.

Incidence and risk factors of the secondary skin infections in patients with radiodermatitis.

OBJECTIVE: The aim of this prospective study was to investigate the incidence and risk factors of secondary infected radiodermatitis in patients receiving radiotherapy and to determine isolated microorganisms' resistance profiles to different antimicrobial agents. MATERIALS AND METHODS: The study comprised 62 patients admitted to the Regional Training and Research Hospital from January 2009 to January 2010. Radiodermatitis was graded according to the National Cancer Institute's Common Toxicity Criteria version 3.0. Potential risk factors for secondary infection were recorded and evaluated by univariate and multivariate analyses. RESULTS: In 62 patients, grade 1, 2, 3 and 4 radiodermatitis were observed in 33 (53.2%), 11 (17.7%), 8 (12.9%) and 10 (16.2%) patients, respectively. Skin infection secondary to radiodermatitis occurred in 14 patients (infected patients), 21.4%, 21.4% and 57.2% of whom had grade 2, 3 and 4 radiodermatitis, respectively. Forty-eight patients were found to be colonized with micoorganisms (colonized patients). In the univariate analysis, concurrent endocrine therapy and radiodermatitis grade differed significantly between infected and colonized patients (p<0.05). Multivariate analyses showed that the radiodermatitis grade was an independent risk factor for the acquisition of infection (p<0.05). The microbial pathogens isolated from patients with skin infection were seven methicillin-resistant coagulase-negative Staphylococcus (MRCNS) strains, three methicillin-resistant Staphylococcus aureus (MRSA) strains, two Candida sp., one methicillin-sensitive coagulase-negative Staphylococcus (MSCNS) strain and one methicillin-sensitive S. aureus (MSSA) strain. Staphylococci strains were more resistant to beta-lactam antibiotics. No glycopeptide resistance was found. CONCLUSION: The results of this study indicate that high-grade radiodermatitis leads to an increased risk for secondary infection of the skin with pathogens.

Effects of different blood groups on the reproduction of periodontal pocket bacteria.

BACKGROUND: Many studies have been conducted proving the relation between different blood groups and certain diseases. It was claimed in these studies that H pylori showed different distribution according to different blood groups. In dentistry, the relation between blood groups and dental diseases was investigated in a limited number of studies and it was concluded that there might be a relation between them. The aim of the present study was to determine whether the bacteria isolated from the periodontal pockets of individuals with periodontal diseases indicated differences in CFU amounts to form colonies in different ABO blood groups. METHODS: Bacterial samples obtained from the individuals with periodontal diseases from the worst affect sites were inoculated into culture media formed by blood taken from 32 individuals who were systemically and periodontally healthy and who had different blood groups. The colony numbers of these bacteria were observed. RESULTS: Although periodontal pocket bacteria formed colonies in different numbers in different ABO blood groups (p < 0.05), no statistically significant difference was determined in the reproduction of these bacteria in different Rh blood groups and different sexes (p > 0.05). CONCLUSION: Different ABO blood groups may show differences in significant rates in the colonisation numbers of the bacteria that are the main cause of periodontal diseases.

MRSA genotypes in Turkey: persistence over 10 years of a single clone of ST239.

OBJECTIVES: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of life-threatening human infections. The clinical impact of MRSA is mounting, not only due to the ever-increasing prevalence but also due to the occurrence of new, community-acquired MRSA strains. The aim of this prospective, multi-centre study was to determine the prevalence and genetic relatedness of clinically relevant MRSA isolates, in Turkey. METHODS: During a 1-year period, data from 20 successive patients with invasive S. aureus infections were collected from eight university hospitals, geographically distributed over the six main regions of Turkey. Among these S. aureus isolates, the genetic association of MRSA isolates was investigated by pulsed-field gel electrophoresis (PFGE) and spa typing. A selected number of isolates were also analyzed by multilocus sequence typing (MLST). Furthermore, Panton Valentine leucocidin (PVL) genes were examined. RESULTS: In this study, the rate of methicillin resistance in S. aureus in patients with apparent infections (sepsis, meningitis, lung abscess or septic arthritis) ranged from 12 to 75% within the seven participating centres. Typing by pulsed-field gel electrophoresis and spa typing revealed the presence of 22 closely related genotypes. According to the PFGE and spa typing results, 53 out of 54 MRSA isolates were closely related. These isolates were of spa type t030 or a related spa type, contain an SCC mec type III element and belong to sequence type ST239. None of the isolates contained the PVL genes. CONCLUSIONS: Despite the broad surface area of Turkey, a single predominant clone of ST239 circulates in hospitals in different regions and only few new types of MRSA were introduced over the past years. These results place Turkey in the epicenter of ST239 prevalence.

[Nosocomial urinary tract infections in the intensive care unit patients]. / Yogun bakim hastalarinda görülen nozokomiyal uriner sistem enfeksiyonlari.

The aim of this prospective study was to determine the frequency of nosocomial urinary tract infections (UTI) and risk factors in intensive care unit patients. A total of 110 patients were included in the study, and UTI developed in 39.1% of them. The mean age of patients with UTI (53.6+/-20.0 yrs) was found higher than the patients without UTI (39.7+/-22.2 yrs), (p<0.01), whereas there was no gender associated difference between these two groups (p>0.01). No patient had developed symptoms suggesting UTI. All of the UTI has developed in patients with urinary catheter. Infections occurred in 72.2% of the patients with catheter lasting for seven days or more, and 24.3% of those lasting less than seven days (p<0.001). The UTI development rate was found as 31.3% in the patients who had been using antibiotics, while this ratio was 50% in those who had not used antibiotics (p<0.05). Pyuria was detected in 86.1% and 17.9% of the patients with and without UTI, respectively (p<0.001). Detection of bacteria in urine by the examination of Gram stained preparations, and the tests of peripheral blood leucocyte counting and CRP levels were not found sensitive and specific for nosocomial UTI. The prevalence of UTI increased gradually by the duration of hospitalization. The most frequently isolated microorganisms were found as Candida (27.2%), Escherichia coil (27.2%) and staphylococci (12.9%). Since nosocomial UTI which are important causes of morbidity in intensive care unit patients, are difficult to diagnose and treat, more efforts should be used for preventive measures.

Prevalence of metallo-beta-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates.

The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.

The risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa in the burn unit.

OBJECTIVE: This study was conducted to determine the risk factors for acquisition of imipenem-resistant Pseudomonas aeruginosa (IRPA) in the burn unit. METHODS: Patients hospitalized in the burn unit from July 2003 to November 2004 were included in this study. The features of patients with isolated IRPA were compared with those of patients with isolated imipenem-susceptible P. aeruginosa (ISPA). Demographic features, total burn surface area (TBSA), burn depth, antimicrobials used in 15-day period before isolation, and presence of IRPA in the unit at the same period were included in the risk factors analysis. RESULTS: P. aeruginosa was recovered from 133 patients in this period, 93 were IRPA and 40 were ISPA. There was no significant difference between patients with ISPA and patients with IRPA in terms of age, TBSA, and burn depth. In multivariate logistic regression analysis, hospital stay before isolation (odds ratio (OR): 3.6), carbapenem usage (OR: 7.4), broad-spectra antibiotic usage (OR: 6.5), previous presence of ISPA in the patient (OR: 1.7) and presence of IRPA in the unit at the same period (OR: 2.6) were independent risk factors for acquisition of IRPA. CONCLUSION: Long hospitalization time, previous imipenem/meropenem use, previous broad-spectra antibiotic use, previous presence of ISPA in a patient and presence of IRPA in a unit at the same period were associated with acquisition of IRPA in the burn unit. In order to decrease the incidence of IRPA isolation, the usage of broad-spectra antibiotics, especially carbapenem, should be restricted, hospitalization time should be shortened if possible, and universal isolation precautions should be strictly applied to prevention cross-contamination.

[Etiological agents in bacterial meningitis and cerebrospinal fluid shunt infections and their antibiotic susceptibilities]. / Akut bakteriyel menenjit ve santral sinir sistemi sant enfeksiyonlarinda etkenler ve antibiyotik duyarliliklari.

Akut bakteriyel menenjit ve santral sinir sistemi sant enfeksiyonlarinda etkenler ve antibiyotik duyarliliklari

[A transfusion-transmitted malaria case]. / Transfüzyonla bulasan bir sitma olgusu.

Malaria is a rare but potentially serious complication of blood transfusion. In this report a transfusion-transmitted malaria case has been presented. A 47-years-old woman admitted to our clinic with the complaints of striking fever with chills, diarrhea and vomiting. She had history of an operation and transfusion before 10 days of admission. On physical examination jaundice, splenomegaly and abdominal tenderness were detected. Laboratory results revealed anemia, and elevated LDH and bilirubin levels. Examination of thin blood films yielded Plasmodium vivax trophozoites. Chloroquine was initiated for therapy and the patient was successfully treated. On the other hand, informations about her blood donor indicated that he had been in the military service in Southeast Anatolia of Turkey where malaria is endemic. All the efforts to reach the donor, for his diagnosis and treatment, were failed. Since our region (Northeast Anatolia) is not an endemic area for malaria and the patient had no travel history to an endemic area, it has been considered that the transmission route of malaria in this case was blood transfusion. In conclusion, as there are no available approved tests for malaria screening of donations, the transfusion-transmitted malaria can only be prevented by careful questioning of the donors.

[The pathogens and their antibiotic sensitivities in hospital-acquired pneumonia cases]. / Hastane kökenli pnömoni olgularinda etkenler ve antibiyotik duyarliliklari.

Dynamic precautions in the early diagnosis and treatment of hospital acquired pneumonias are necessary because of their high mortality. In these patients, invasive diagnostic approaches may be needed since clinical and radiological findings and other non-invasive approaches frequently fail to establish the diagnosis. Thirty eight patients were prospectively included in the study. Average age of patients was 45.5 +/- 16.4 years; 31 were males (81.6%) and 7 (18.4%) were females. Pneumonia was detected in 9 (23.7%) cases during the first five days and in 29 (76.3%) cases after the fifth day of admission to the hospital. Bronchoscopic interventions diagnostic purpose were carried out in 25 (65.8%) patients. The culture results were negative in 7 (18.4%) cases. While more than one pathogen was determined on the cultures of 16 (42.1%) patients only one pathogen was isolated in the cultures of 15 (39.4%) cases. The frequently isolated pathogen on cultures was Staphylococci (45.4%). Other pathogens were Enterobacter spp., Pseudomonas spp., Escherichia coli, Serratia and Streptococcus pneumoniae according to their frequency on cultures. High resistance rates to the third generation cephalosporins were determined. Eleven of 17 deaths in 38 pneumonia cases were attributable to pneumonia. As a conclusion, isolation of pathogen and antibiotic resistance should be determined in the cases with hospital acquired pneumonia. Invasive diagnostic interventions were not avoided when necessary. Although pro-BAL and PSB methods were expensive, their use in selected cases may prevent unnecessary antibiotic use and contribute to a decrease in mortality rate.

The time-related changes of antimicrobial resistance patterns and predominant bacterial profiles of burn wounds and body flora of burned patients.

To examine the bacterial isolates from the burn patients and to compare the antibiograms of the predominant bacteria isolated from 51 patients who were hospitalized at least 3 weeks or more over a period of 7 months, a prospective study was undertaken. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical region of the patients on admission and on 7th, 14th, and 21st days of hospitalization. Mean hospital stay was 36.5 days. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. During the next weeks, these bacteria were superceded by mainly Pseudomonas aeruginosa. Between admission and 21st day, the rates of methicillin resistance of staphylococci strains increased steadily. There was no vancomycin resistance in any staphylococci strains, although nine of the S. aureus isolates (2.7%) were resistant to teicoplanin. There were no strains producing inducible beta lactamase (IBL) among P. aeruginosa strains. One extended-spectrum beta-lactamase (ESBL)-producing strain was recovered on admission, although strains producing IBL and ESBL were detected at rates of 79.6 and 57.1%, respectively, on the 21st day. The nature of microbial wound colonization, flora changes, and antimicrobial sensitivity profiles should be taken into consideration in using empirical antimicrobial therapy of burned patients.

Changes of microbial flora and wound colonization in burned patients.

To determine time related changes of microbial colonization of burn wounds and body flora of burned patients, a prospective study was carried out. Fifty-one patients who were hospitalized at least 3 weeks were enrolled in the study. Periodic swabs were taken from burn wound, nasal, axillary, inguinal, and umbilical regions of the patients on admission and 7th, 14th, and 21st days of hospitalization. The mean body surface area burned was 22.9%. A total of 1098 microbial isolates were detected during the study period. Coagulase-negative staphylococci (CNS, 63.0%) and Staphylococcus aureus (19.7%) were the most prevalent isolates in admission cultures. There was a gradual decrease in the number of isolates of CNS and a marked increase in the numbers of S. aureus and Pseudomonas aeruginosa from admission to 21st day. At the 21st day, the most frequent organisms were S. aureus (37.6%), CNS (34.7%), and P. aeruginosa (16.2%). Methicillin resistance of staphylococci strains were increased constantly in study period. While 35.3% of burn wounds were sterile on admission, microbial colonization reached 86.3% within the first week. Nasal carriage of methicillin resistant S. aureus increased from 3.9% to 62.7% at 21st day. The nature of microbial wound colonization and flora changes should be taken into consideration in empirical antimicrobial therapy of burned patients.

[Correlation of urinary tract infections with the vaginal colonization in postmenopausal women]. / Menopoz sonrasi dönemdeki kadinlarda üriner sistem enfeksiyonlari ile vajinal kolonizasyonun iliskisi.

Estrogen deficiency is a major contributor to the pathogenesis of urinary tract infections (UTI) in postmenopausal women. After menopause, the vaginal pH increases, lactobacilli disappear from the vaginal flora, and the vagina is predominantly colonized by Enterobacteriaceae, especially Escherichia coli. To better understand the associations between post-menopausal vaginal flora and the development of UTI, we conducted a prospective study among 87 postmenopausal women ages between 50-65 years. Vaginal samples were collected from lateral vaginal wall of women to perform a smear on a glass slide and placed on appropriate media. The smear was then stained with Gram stain. Urine samples were collected and cultured by standard bacteriologic techniques. Vaginal lactobacilli were present in 55.2%, and vaginal Enterobacteriaceae were present in 40.2% of the subjects. Heavy growth of lactobacilli was associated with a lower frequency of vaginal colonization with Enterobacteriaceae members (p<0.001), Streptococcus sp. (p<0.05) and Pseudomonas sp. (p<0.05). The most commonly isolated microorganism was E. coli. The frequency of asymptomatic bacteriuria and symptomatic UTI among postmenopausal women were found 17.5% (15/87) and 11.5% (10/87), respectively. As a result, Enterobacteriaceae colonization of the vagina in postmenopausal women increases the prevalence of asymptomatic bacteriuria and symptomatic UTI (p<0.01 and p<0.05, respectively).

[Activity of frequently used disinfectants and antiseptics against nosocomial bacterial types]. / Sik kullanilan dezenfektan ve antiseptiklerin nozokomiyal bakteriyel suslara karsi etkinligi.

In this study, bactericidal activity of widely used disinfectants and antiseptics (glutaraldehyde, laurylbispropylidentriamin 5 g and benzalkoniumchlorid 20 g, polyvinylpyrolidon iodine, benzalkonium chloride and sodium hypochloride) against some nosocomial bacterial isolates were investigated by qualitative and quantitative suspension test methods. One methicillin-resistant Staphylococcus aureus (MRSA), 6 multi drug-resistant Gram-negative hospital isolates (Escherichia coli, Pseudomonas aeruginosa, Enterobacter cloaca, Klebsiella pneumoniae, Citrobacter diversus, Serratia marcescens) and 3 standard strains of American Type Culture Collection (ATCC) bacteria (S. aureus, P. aeruginosa, E. coli) were tested against three different concentrations of disinfectants of which, manufacturer's recommended use-dilution, 1/2 and 1/4 of those recommended dilutions. All tested disinfectants were found effective in all three concentrations against nosocomial isolates in five minutes, by using both qualitative and quantitative suspension methods. When the test was repeated with albumine, bactericidal activities of disinfectants were found the same. Our findings showed that these disinfectants can be still used in safe for the sterilization in hospital, and routine disinfection protocols do not need to be alerted.

[Streptococcal toxic shock syndrome: a case report]. / Streptokokal toksik sok sendromu: bir olgu raporu.

Streptococcal toxic shock syndrome (STSS) is the most severe form of invasive infections caused by group A streptococci. In this report, a 36-years-old man who was admitted to our clinic with the complaints of fever, rash, skin lesions, abdominal pain, weakness and anuria for 2 days, has been presented. His body temperature was 39.5 degrees C and blood pressure was 50/20 mmHg. In physical examination, diffuse erythematous rash on the body, cellulitis on left leg and foot, fungal lesions on the toes, and abdominal tenderness were noted. Laboratory results revealed a dramatic increase in leukocyte count, increased sedimentation rate, elevated blood urea nitrogen, cretinine, liver enzymes and bilirubin levels. Group A streptococci were isolated from the blood culture of the patient. Despite supportive (intravenous saline, dopamine) and antibiotic (clindamycin-ceftriaxone combination) therapies, adult respiratory distress syndrome has developed in two days, and he died on the third day. This case was presented to draw attention to STSS, which was a rare clinical entity with rapid progression to mortality despite aggressive medical therapy.