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Group A streptococci (GAS) are an important cause of severe soft-tissue infections such as necrotizing fasciitis. Using immunostaining techniques, researchers investigated bacterial location, viability, and load in 70 snap-frozen biopsy specimens from 17 patients in Ontario with GAS soft-tissue infections.
GAS were present in all 70 specimens. High bacterial counts were seen in 12 of the 24 specimens obtained >3 days after initiation of intravenous clindamycin in combination with a β-lactam. In 43% of the biopsies, bacteria occurred only intracellularly (predominantly in macrophages and occasionally in neutrophils). Purely intracellular accumulation of bacteria was found mainly in specimens characterized by little inflammation and low bacter…