Streptococcus pyogenes and Bone Resorption

Excerpt

To the Editor: We would like to add several comments to those of Hríbalová (1). Since our case report in 1983, several other investigators have suggested a role for Streptococcus pyogenes as a causative agent for the toxic shock syndrome (2, 3). The possibility that streptococcal pyrogenic exotoxins may have a pathophysiologic role is intriguing, as such a role is often described for staphylococcal toxins in the staphylococcal toxic shock syndrome. We recently isolated a fourth (not previously described) streptococcal pyrogenic exotoxin (SPE-D) from the Streptococcus pyogenes isolated from the patient whose case we previously reported. This strain also produced