Transmission of 'Toxic Strep' syndrome from an infected child to a firefighter during CPR

Several cases of a toxic shocklike syndrome have been reported in the United States during the past five years in association with Streptococcus pyogenes infection. We report a case of a firefighter exposed during attempted CPR to the secretions of an S pyogenes-infected child. The firefighter developed an infection of the hand and subsequent febrile illness with hypotension, erythematous rash, renal failure, and hypocalcemia. Bacterial isolates of blood and cerebrospinal fluid from the deceased child were identical in type and exotoxin production with isolates grown from the hand wound of the firefighter. This is the first reported case of documented transmission of S pyogenes causing a toxic shocklike syndrome in an emergency medical technician.