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2025, Vol: 15, Issue: 1
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Review Article


Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles

Kannan Subbaram, Razana Faiz, Zeba Un Naher, Punya Laxmi Manandhar, Sheeza Ali, Sina Salajegheh Tazerji, Phelipe Magalhães Duarte.


Abstract
Streptococcus pyogenes is responsible for the severe clinical condition known as type 2 necrotizing fasciitis and toxic shock syndrome (TSS), which are linked to extremely high morbidity and death in both developed and developing countries. It can also be caused by Staphylococcus aureus and S. pyogenes B and G strains. The bacteria rapidly spread into deep tissues, tendons, fascia, and muscles leading to this devastating condition, called type 2 necrotizing fasciitis, from which the bacteria get its name "flesh-eating bacterium". TSS can develop as a result of S. pyogenes infection, typically after the bacteria enter the bloodstream. The bacteria in the bloodstream produce streptococcal pyrogenic exotoxins (A, B, and C). These pyrogenic exotoxins are the cause of streptococcal TSS. TSS and type-2-necrotizing fasciitis patients may have rash, fever, chills, hypotension, necrosis, desquamation, multi-organ failure, and sudden death. Following COVID-19, there was a significant increase in TSS and type-2 necrotizing fasciitis cases around the world. Over 800 instances of streptococcal TSS have been reported in Japan this year alone. The higher prevalence of post-COVID-19 TSS and type-2 necrotizing fasciitis could be related to changed immunological status, a lack of hygiene measures, overcrowding, and enhanced bacterial virulence. Natural COVID-19 infection and COVID-19 vaccination has probably altered the immune status thereby increasing streptococcal TSS cases.

Key words: Toxic shock syndrome, Type 2 necrotizing fasciitis, COVID-19, Flesh eating bacteria, Streptococcus pyogenes


 
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How to Cite this Article
Pubmed Style

Subbaram K, Faiz R, Naher ZU, Manandhar PL, Ali S, Tazerji SS, Duarte PM. Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. J Microbiol Infect Dis. 2025; 15(1): 1-4. doi:10.5455/JMID.2025.v15.i1.1

Web Style

Subbaram K, Faiz R, Naher ZU, Manandhar PL, Ali S, Tazerji SS, Duarte PM. Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. https://www.jmidonline.org/?mno=218308 [Access: April 21, 2025]. doi:10.5455/JMID.2025.v15.i1.1

AMA (American Medical Association) Style

Subbaram K, Faiz R, Naher ZU, Manandhar PL, Ali S, Tazerji SS, Duarte PM. Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. J Microbiol Infect Dis. 2025; 15(1): 1-4. doi:10.5455/JMID.2025.v15.i1.1


Vancouver/ICMJE Style

Subbaram K, Faiz R, Naher ZU, Manandhar PL, Ali S, Tazerji SS, Duarte PM. Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. J Microbiol Infect Dis. (2025), [cited April 21, 2025]; 15(1): 1-4. doi:10.5455/JMID.2025.v15.i1.1


Harvard Style

Subbaram, K., Faiz, . R., Naher, . Z. U., Manandhar, . P. L., Ali, . S., Tazerji, . S. S. & Duarte, . P. M. (2025) Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. J Microbiol Infect Dis, 15 (1), 1-4. doi:10.5455/JMID.2025.v15.i1.1


Turabian Style

Subbaram, Kannan, Razana Faiz, Zeba Un Naher, Punya Laxmi Manandhar, Sheeza Ali, Sina Salajegheh Tazerji, and Phelipe Magalhães Duarte. 2025. Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. Journal of Microbiology and Infectious Diseases, 15 (1), 1-4. doi:10.5455/JMID.2025.v15.i1.1


Chicago Style

Subbaram, Kannan, Razana Faiz, Zeba Un Naher, Punya Laxmi Manandhar, Sheeza Ali, Sina Salajegheh Tazerji, and Phelipe Magalhães Duarte. "Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles." Journal of Microbiology and Infectious Diseases 15 (2025), 1-4. doi:10.5455/JMID.2025.v15.i1.1


MLA (The Modern Language Association) Style

Subbaram, Kannan, Razana Faiz, Zeba Un Naher, Punya Laxmi Manandhar, Sheeza Ali, Sina Salajegheh Tazerji, and Phelipe Magalhães Duarte. "Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles." Journal of Microbiology and Infectious Diseases 15.1 (2025), 1-4. Print. doi:10.5455/JMID.2025.v15.i1.1


APA (American Psychological Association) Style

Subbaram, K., Faiz, . R., Naher, . Z. U., Manandhar, . P. L., Ali, . S., Tazerji, . S. S. & Duarte, . P. M. (2025) Post COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: Review of articles. Journal of Microbiology and Infectious Diseases, 15 (1), 1-4. doi:10.5455/JMID.2025.v15.i1.1


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