Scarlet Fever and Necrotizing Fasciitis Caused by Coagulase-Positive Hemolytic Staphylococcus aureus, Phage Type 85

The syndromes of scarlet fever and necrotizing fasciitis are typically caused by group A hemolytic streptococci. A 23-year-old woman developed both syndromes. The causative organism was a coagulase-positive hemolytic Staphylococcus aureus, phage type 85. This staphylococcus produced exfoliative toxin in vitro but no delta toxin and only small amounts of alpha toxin. The organism was resistant to penicillin, tetracycline, and neomycin. Filtered broth cultures contained a factor that produced fever and a scarlatiniform rash in a Dick test-positive human volunteer. The staphylococcal erythrogenic toxin may cause the vasculitis of both staphylococcal scarlet fever and necrotizing fasciitis. Initial treatment of adults with suspected bacteremia and either scarlet fever or necrotizing fasciitis should include intravenous administration of a penicillinase-resistant penicillin until the antibiotic sensitivities of the causative organism are known.