Late cutaneous syphilis and neurosyphilis.

We report two syphilitic cases of indeterminable duration. The dramatic cutaneous lesions of the female patient, compatible with secondary-tertiary syphilis associated with a positive VDRL reaction in CSF together with the criteria of neurosyphilis in her male companion (despite normal TPHA and IgG indices), led us to treat both of them in an optimal way. The clinical and serological evolution was favourable.

[Streptococcus beta hemolytic necrotizing fasciitis. 5 cases in the Brussels area]. / Fasciite nécrosante à streptocoque beta hémolytique du groupe A. Cinq cas dans la région bruxelloise.

In the Brussels area five cases of necrotizing fasciitis occurred during the past two years in patients devoid of any pathology likely to lower the immune defence mechanisms. Alcoholism and the use of non-steroidal anti-inflammatory drugs seem to act as contributory factors. Necrotizing fasciitis develops alone or as complication of a pre-existent dermo-hypodermic infection. A massive use of antibiotics and a wide surgical slitting up failed to prevent a fatal issue in all five patients. Extremely early massive surgery remains vital in this disease.

[Epidemiology and etiopathogeny of necrotizing fasciitis and streptococcal shock syndrome]. / Epidémiologie et étiopathogénie des fasciites nécrosantes et du syndrome de choc streptococcique.

A significant increase in the frequency of necrotizing fasciitis caused by streptococci of group A has recently been noted. The disease usually appears in individuals without obvious risk factors. The initial lesion is often quite ordinary, and the evolution towards a toxic shock very swift. This evolution can be summarized as follows: 1) localized infection; 2) bacteraemia with circulating toxins and soft tissue necrosis; 3) production of cytokines by the immune cells of the host, leading to a rapidly irreversible toxic shock Serotypes 1, 3, 12 and 28 of group A streptococcus are usually involved. The virulence of some serotypes might be explained by the acquisition of a toxic gene. The sensitivity of the host is linked to the genetic expression of the V. beta. elements on the surface of lymphocytes. Antibiotics cannot save the patient when necrotizing fasciitis is installed. Surgery must be massive and performed early.

[Fulminant erysipelas]. / Erysipèle fulminant.

An apparent resurgence of invasive and life-threatening group A streptococcal infections in young and previously healthy hosts is reported in several countries. We report a case of fatal necrotizing fasciitis and review the spectrum of these clinical syndromes, including the invasive soft tissue infections. This changing pattern of infection could be explained by an increased incidence of some serotypes of group A Streptococcus carrying specific virulence factors, such as pyrogenic exotoxins.