Asian Pacific Journal of Tropical Biomedicine

Issue 3,2012 Table of Contents

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  • 1  Pharmacognostic evaluation of leaf and root bark of Holoptelea integrifolia Roxb.
    Dinesh Kumar Karunesh Kumar Sunil Kumar Tarun Kumar Ajay Kumar Om Prakash
    2012(3):169-175. DOI: 10.1016/S2221-1691(12)60036-7
    [Abstract](20) [HTML](0) [PDF 1.27 M](74)
    Objective: To evaluate the pharmacognostic characters of an important medicinal plant, Holoptelea integrifolia (H. integrifolia) Roxb. Methods: The pharmacognostic studies were carried out in terms of organoleptic, microscopic, macroscopic and fluorescence analysis. Results: The characteristic microscopic features of leaves were observed as trichomes, multicellular trichomes, xylem cells, phloem cells, collenchyma, vascular bundles, spongy parenchyma and palisade cells. The characteristic microscopic features of root bark included cork cambium, primary cortex, phloem fibers, medullary rays, endodermis, pericycle and lignified fibers in the transverse section and longitudinal section. The characteristic microscopy of root bark powder showed the presence of cortex cells, sieve tubes, calcium oxalate crystals and lignified fibers. Macroscopic study showed that leaf shape-oval, apex-acute, base-cordate and leaf margin was entire with glabrous surface, bitter taste and characteristic odour. The morphological features of root bark showed deep fissured, rough and firm surface with rhitydome and the periderm parallel to cambium. Conclusions: Various pharmacognostic characters observed in this study help in the identification and standardization of H. integrifolia.
    2  Antioxidant and antibacterial activity of different parts of Leucas aspera
    Ai Lan Chew Jeyanthi James Antony Jessica Sreenivasan Sasidharan
    2012(3):176-180. DOI: 10.1016/S2221-1691(12)60037-9
    [Abstract](21) [HTML](0) [PDF 695.73 K](72)
    Objective: To evaluate antioxidant, antimicrobial and cytotoxic activity of different parts (root, flower, leaf and stem) of Leucas aspera (L. aspera) (Labiatae). Methods: Different parts of L. aspera were extracted with 80% (v/v) methanol. The methanol extracts were subjected to antioxidant, antimicrobial and brine shrimp lethality assay. Results: All the extracts showed moderate to potent antioxidant activity, among which the root extract demonstrated the strongest antioxidant activity with the IC50 value of 6.552 μg/mL. Methanol extract of root possessed antioxidant activity near the range of vitamin E and thus could be a potential rich source of natural antioxidant. In case of antimicrobial screening, crude extracts of root, flower, leaf and stem showed notable antibacterial activity against tested microorganisms. The root extract showed the highest mean zone of inhibition ranging from 9.0-11.0 mm against tested microorganisms, at a concentration of 100 mg/mL. In the brine shrimp lethality bioassay, it was evident that the methanol root extract did not show significant toxicity. The LC50 value for 12 h and 24 h observation was 2.890 mg/mL and 1.417 mg/mL, respectively. Conclusions: The present finding suggests that the methanol root extract of L. aspera could be developed as pharmaceutical products.
    3  Immunological effect of aqueous extract of Vernonia amygdalina and a known immune booster called immunace® and their admixtures on HIV/AIDS clients: a comparative study
    Momoh MA Muhamed U Agboke AA Akpabio EI Uduma Eke Osonwa
    2012(3):181-184. DOI: 10.1016/S2221-1691(12)60038-0
    [Abstract](18) [HTML](0) [PDF 648.72 K](71)
    Objective: To investigate the immunological effect of Vernonia amygdalina (V. amygdalina) leaf extract and immunace® on HIV infected patients taking highly active antiretroviral therapy. Methods: Fresh V. amygdalina leaves were collected within Nsukka area in Enugu State. The leaves were rinsed with distilled water. Two handful of cleaned fresh leaves were soaked in 200 mL water and squeezed gently by hand to a mixture. Clients were divided into four groups and each group was given different combination. They took the medication for four weeks. The immune effect was tested against marketed immune booster in some retroviral clients. Results: The mean absolute CD4 count was increased in the client who took the extract or supplement. And the clients who took both the extract and supplement had a greater increase in the CD4 count. The increased CD4 was significant as compared with the control group (P<0.05). The skin rashes were also improved in the entire groups. Conclusions: It can be concluded that the aqueous extract of V. amygdalina and immunace or both have immunological effect on HIV infected patients. Therefore, we suggest that the V. amygdalina extract or immunace or both could be used as adjuvant in the management of HIV/AIDS clients.
    4  Antiarthritic effects of Ajuga bracteosa Wall ex Benth. in acute and chronic models of arthritis in albino rats
    Gaurav Kaithwas Raju Gautam Sanjay M Jachak Arvind Saklani
    2012(3):185-188. DOI: 10.1016/S2221-1691(12)60039-2
    [Abstract](6) [HTML](0) [PDF 685.04 K](71)
    Objective: To evaluate the antiarthritic activity of Ajuga bracteosa using albino rats. Methods: The antiarthritic activity of 70% ethanolic extract of Ajuga bracteosa (EEAB) was evaluated against turpentine oil- and formaldehyde- induced acute non immunological and complete freund’s adjuvant (CFA)-induced chronic immunological arthritis in albino rats. Results: EEAB showed a significant (P<0.05) and dose dependent inhibitory effect against acute and chronic models of arthritis. EEAB exhibited better antiarthritic activity than the standard aspirin. Conclusions: EEAB exhibits a significant and promising antiarthritic activity against acute and chronic arthritis and supports the traditional use of Ajuga bracteosa for rheumatism and other inflammatory diseases.
    5  Antibacterial activity of leaves extracts of Trifolium alexandrinum Linn. against pathogenic bacteria causing tropical diseases
    Abdul Viqar Khan Qamar Uddin Ahmed Indu Shukla Athar Ali Khan
    2012(3):189-194. DOI: 10.1016/S2221-1691(12)60040-9
    [Abstract](18) [HTML](0) [PDF 685.27 K](74)
    Objective: To investigate antibacterial potential of Trifolium alexandrinum (T. alexandrinum) Linn. against seven gram positive and eleven gram negative hospital isolated human pathogenic bacterial strains responsible for many tropical diseases. Methods: Non-polar and polar extracts of the leaves of T. alexandrinum i.e., hexane, dichloromethane (DCM), ethyl acetate (EtOAc), methanol (MeOH) and aqueous (AQ) extracts at five different concentrations (1, 2, 5, 10 and 15 mg/ mL) were prepared to evaluate their antibacterial value. NCCL standards were strictly followed to perform antimicrobial disc susceptibility test using disc diffusion method. Results: Polar extracts demonstrated significant antibacterial activity against tested pathogens. EtOAc and MeOH extracts showed maximum antibacterial activity with higher inhibition zone and were found effective against seventeen of the tested pathogens. While AQ plant extract inhibited the growth of sixteen of the test strains. EtOAc and MeOH plant extracts inhibited the growth of all seven gram positive and ten of the gram negative bacterial strains. Conclusions: The present study strongly confirms the effectiveness of crude leaves extracts against tested human pathogenic bacterial strains causing several tropical diseases. Since Egyptian clover is used as a fodder plant, it could be helpful in controlling various infectious diseases associated with cattle as well.
    6  Assessment of effect of hydroalcoholic and decoction methods on extraction of antioxidants from selected Indian medicinal plants
    Mital Kaneria Bhavana Kanani Sumitra Chanda
    2012(3):195-202. DOI: 10.1016/S2221-1691(12)60041-0
    [Abstract](22) [HTML](0) [PDF 1020.97 K](72)
    Objective: To assess the effects of extraction methods on antioxidant activities of selected Indian medicinal flora. Methods: Different parts of plants were extracted by hydroalcoholic and decoction methods using water and various concentrations of methanol (ME) viz. 75%, 50% and 25% ME. The antioxidant activity of all the different extracts was evaluated using two different antioxidant assays viz. 2,2-diphenyl-1-picryl hydrazyl (DPPH) free radical scavenging assay and superoxide anion radical scavenging assay. Total phenol and flavonoid content was also estimated. Results: The results showed that the extracting solvent significantly altered the antioxidant property estimations of screened plants. High correlations between phenolic compositions and antioxidant activities of extracts were observed. High levels of antioxidant activities were detected in Manilkara zapota (M. zapota) as compared with other screened plants. Conclusions: The results obtained appear to confirm the effect of different methods on extraction of antioxidants and antioxidant property of M. zapota.
    7  Biochemical changes in phenols, flavonoids, tannins, vitamin E, β-carotene and antioxidant activity during soaking of three white sorghum varieties
    Abd El-Moneim MR Afify Hossam S El-Beltagi Samiha M Abd El-Salam Azza A Omran
    2012(3):203-209. DOI: 10.1016/S2221-1691(12)60042-2
    [Abstract](20) [HTML](0) [PDF 718.30 K](70)
    Objective: To investigate the changes in total phenols, flavonoids, tannins, vitamin E, β-carotene and antioxidant activity during soaking of three white sorghum varieties. Methods: The changes in total phenols, total flavonoids, tannins, phenolic acids compounds, flavonoid components, vitamin E, β-carotene and antioxidant activity during soaking of sorghum grains were determined. Results: Total phenols, total flavonoids, tannins, vitamin E, β-carotene and antioxidant activity in raw sorghum were ranged from 109.21 to 116.70, 45.91 to 54.69, 1.39 to 21.79 mg/100 g, 1.74 to 5.25, 0.54 to 1.19 mg/kg and 21.72% to 27.69% and 25.29% to 31.97%, respectively. The above measured compounds were significantly decreased after soaking. p-Hydroxybenzoic acid, vanillic acid, syringic acid and cinnamic acid represent the major phenolic acids in Dorado variety. While ferulic acid, p-coumaric acid, gallic acid and caffeic acid represent the major phenolic acids in Shandaweel-6. On the other hand, protocatechuic acid represents the major phenolic acids in Giza-15. Regarding flavonoids components, Dorado was the highest variety in kampferol and naringenin while Shandaweel-6 was the highest variety in luteolin, apigenin, hypersoid, quercetin and christen. Finally, Giza-15 was the highest variety in catechin. Phenolic acids, flavonoid compounds and antioxidant activities were decreased after soaking. Conclusions: Sorghum varieties have moderate quantities from total phenols, total flavonoids, tannins, phenolic acids compounds, flavonoid components, vitamin E, β-carotene and antioxidant activity which decreased after soaking.
    8  Evaluation of safety profile of black shilajit after 91 days repeated administration in rats
    Velmurugan C Vivek B Wilson E Bharathi T Sundaram T
    2012(3):210-214. DOI: 10.1016/S2221-1691(12)60043-4
    [Abstract](16) [HTML](0) [PDF 1.07 M](76)
    Objective: To evaluate the safety of shilajit by 91 days repeated administration in different dose levels in rats. Methods: In this study the albino rats were divided into four groups. Group Ⅰ received vehicle and group Ⅱ, Ⅲ and Ⅳ received 500, 2 500 and 5 000 mg/kg of shilajit, respectively. Finally animals were sacrificed and subjected to histopathology and iron was estimated by flame atomic absorption spectroscopy and graphite furnace. Results: The result showed that there were no significant changes in iron level of treated groups when compared with control except liver (5 000 mg/kg) and histological slides of all organs revealed normal except negligible changes in liver and intestine with the highest dose of shilajit. The weight of all organs was normal when compared with control. Conclusions: The result suggests that black shilajit, an Ayurvedic formulation, is safe for long term use as a dietary supplement for a number of disorders like iron deficiency anaemia.
    9  Biocompatibility of folate-modified chitosan nanoparticles
    Subhankari Prasad Chakraborty Sumanta Kumar Sahu Panchanan Pramanik Somenath Roy
    2012(3):215-219. DOI: 10.1016/S2221-1691(12)60044-6
    [Abstract](14) [HTML](0) [PDF 859.18 K](68)
    Objective: To evaluate the acute toxicity of carboxymethyl chitosan-2, 2’ ethylenedioxy bis- ethylamine-folate (CMC-EDBE-FA) and as well as possible effect on microbial growth and in vitro cell cyto-toxicity. Methods: CMC-EDBE-FA was prepared on basis of carboxymethyl chitosan tagged with folic acid by covalently linkage through 2, 2’ ethylenedioxy bis-ethylamine. In vivo acute toxicity, in vitro cyto-toxicity and antimicrobial activity of CMC-EDBE-FA nanoparticle were determined. Results: Vancomycin exhibited the antibacterial activity against vancomycin sensitive Staphylococcus aureus, but CMC-EDBE-FA nanoparticle did not give any antibacterial activity as evidenced by minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), disc agar diffusion (DAD) and killing kinetic assay. Further, the CMC-EDBE-FA nanoparticle showed no signs of in vivo acute toxicity up to a dose level of 1 000 mg/kg p.o., and as well as in vitro cyto-toxicity up to 250 μg/mL. Conclusions: These findings suggest that CMC-EDBE-FA nanoparticle is expected to be safe for biomedical applications.
    10  Alteration of chemical behavior of L-ascorbic acid in combination with nickel sulfate at different pH solutions in vitro
    Shaheen A Maniyar Jameel G Jargar Swastika N Das Salim A Dhundasi Kusal K Das
    2012(3):220-222. DOI: 10.1016/S2221-1691(12)60045-8
    [Abstract](19) [HTML](0) [PDF 776.08 K](70)
    Objective: To evaluate the alteration of chemical behavior of L-ascorbic acid (vitamin C) with metal ion (nickel) at different pH solutions in vitro. Methods: Spectra of pure aqueous solution of L-ascorbic acid (E mark) compound and NiSO4 (H2O) (sigma USA) were evaluated by UV visible spectrophotometer. Spectral analysis of L-ascorbic acid and nickel at various pH (2.0, 7.0, 7.4 and 8.6) at room temperature of 29 ℃ was recorded. In this special analysis, combined solution of L-ascorbic acid and nickel sulfate at different pH was also recorded. Results: The result revealed that λmax (peak wavelength of spectra) of L-ascorbic acid at pH 2.0 was 289.0 nm whereas at neutral pH 7.0, λmax was 295.4 nm. In alkaline pH 8.6, λmax was 295.4 nm and at pH 7.4 the λmax of L-ascorbic acid remained the same as 295.4 nm. Nickel solution at acidic pH 2.0 was 394.5 nm, whereas at neutral pH 7.0 and pH 7.4 were the same as 394.5 nm. But at alkaline pH 8.6, λmax value of nickel sulfate became 392.0 nm. The combined solution of L-ascorbic acid and nickel sulfate (6 mg/mL each) at pH 2.0 showed 292.5 nm and 392.5 nm, respectively whereas at pH 7.0, L-ascorbic acid showed 296.5 nm and nickel sulfate showed 391.5 nm. At pH 7.4, L-ascorbic acid showed 297.0 nm and nickel sulfate showed 394.0 nm in the combined solution whereas at pH 8.6 (alkaline) L-ascorbic acid and nickel sulfate were showing 297.0 and 393.5 nm, respectively. Conclusions: Results clearly indicate an altered chemical behavior of L-ascorbic acid either alone or in combination with nickel sulfate in vitro at different pH. Perhaps oxidation of L-ascorbic acid to L-dehydro ascorbic acid via the free radical (HSc*) generation from the reaction of H2ASc + Ni (Ⅱ) is the cause of such alteration of λmax value of L-ascorbic acid in the presence of metal nickel.
    11  Establishment of a molecular tool for blood meal identification in Malaysia
    Ernieenor Faraliana Che Lah Mariana Ahamad Mohd Subail Haron Ho Tze Ming
    2012(3):223-227. DOI: 10.1016/S2221-1691(12)60046-X
    [Abstract](26) [HTML](0) [PDF 725.38 K](78)
    Objective: To establish a polymerase chain reaction (PCR) technique based on cytochrome b (cytb) gene of mitochondria DNA (mtDNA) for blood meal identification. Methods: The PCR technique was established based on published information and validated using blood sample of laboratory animals of which their whole gene sequences are available in GenBank. PCR was next performed to compile gene sequences of different species of wild rodents. The primers used were complementary to the conserved region of the cytb gene of vertebrate’s mtDNA. A total of 100 blood samples, both from laboratory animals and wild rodents were collected and analyzed. The obtained unknown sequences were compared with those in the GenBank database using BLAST program to identify the vertebrate animal species. Results: Gene sequences of 11 species of wild animals caught in 9 localities of Peninsular Malaysia were compiled using the established PCR. The animals involved were Rattus (rattus) tanezumi, Rattus tiomanicus, Leopoldamys sabanus, Tupaia glis, Tupaia minor, Niviventor cremoriventor, Rhinosciurus laticaudatus, Callosciurus caniseps, Sundamys muelleri, Rattus rajah and Maxomys whiteheadi. The BLAST results confirmed the host with exact or nearly exact matches (>89% identity). Ten new gene sequences have been deposited in GenBank database since September 2010. Conclusions: This study indicates that the PCR direct sequencing system using universal primer sets for vertebrate cytb gene is a promising technique for blood meal identification.
    12  Unusual developing sites of dengue vectors and potential epidemiological implications
    Hamady Dieng Rahman GM Saifur Abu Hassan Ahmad MR Che Salmah Al Thbiani Aziz Tomomitsu Satho Fumio Miake Zairi Jaal Sazaly Abubakar Ronald Enrique Morales
    2012(3):228-232. DOI: 10.1016/S2221-1691(12)60047-1
    [Abstract](17) [HTML](0) [PDF 765.96 K](67)
    Objective: To identify the unusual breeding sites of two dengue vectors, i.e. Aedes albopictus (Ae. albopictus) and Aedes aegypti (Ae. aegypti). Methods: During the second half of 2010, we performed an occasional survey in rural (Teluk Tempoyak) and urban (Gelugor) areas of Penang Island, Malaysia, to identify cryptic breeding sites. Results: In the rural area, we found heterogeneous immature stages of Ae. albopictus in the water bowl of an encaged bird. We also observed Ae. aegypti eggs deposited in the flush tank of a toilet in the urban area. Conclusions: It can be concluded that both breeding patterns can increase contact with hosts (humans and birds) and presumably population densities of Ae. albopictus and Ae. aegypti, thereby potentially boosting the risks for spread and transmission of arboviral diseases.
    13  The occurrence of Helicobacter pylori in hydatid liver disease
    Adil Edan Alsaimary Hayder M Abdulnbi Abdulhadi Laibi Ahmed Rasheed Jwad
    2012(3):233-234. DOI: doi:10.1016/S2221-1691(12)60048-3
    [Abstract](22) [HTML](0) [PDF 0.00 Byte](74)
    Objective: To detect the prevalence of Helicobacter pylori (H. pylori) in hydatid liver disease. Methods: A total of 58 patients with hydatid liver disease attending AL-Sadder Teaching Hospital in Al-Najaf and Al-Basrah governorate from February to August, 2008 were included in and A. One hundred and twenty 1st degree relative patients (group B) and 20 normal presons including 10 males and 10 females (group C) as control were detected for the to exclude lung hydrated cyst. Chest X-ray was done for the above groups hydrated cyst. The patients were screened by ultrasound to obtain intra abdominal hydrated cytst and and enzyme-link immuno sorbent assay (ELISA) test was utilized to detect the H. pylori infection. Results: Fifty eight patients from group A with hydatid liver disease, 30 male (t5e1s.t7. %) and 28 female (48.3%) were screened for the presence of H. pylori infection by using ELISA We found that 28 patients from group A had positive ELISA test including 19 male (32.8%) and 9a nfdem ale (15.5%) (P<0.01). However, there were no positive results of H. pylori infection in group B and C by chest X-ray, ultrasound and ELISA test. Conclusions: It can be concluded that there is a strong relationship between hydatid liver disease and presence of H. pylori.
    14  Efficacy and side effects of praziquantel in the treatment of Schistosomiasis mansoni in schoolchildren in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia
    Berhanu Erko Abraham Degarege Konjit Tadesse Asnake Mathiwos Mengistu Legesse
    2012(3):235-239. DOI: 10.1016/S2221-1691(12)60049-5
    [Abstract](19) [HTML](0) [PDF 705.99 K](75)
    Objective: To evaluate the efficacy and side effects of praziquantel (PZQ) in the treatment of schistosomiasis in Ethiopia. Methods: In a cross-sectional study, stool specimens were collected from randomly selected 299 school children in Shesha Kekele Elementary School, Wondo Genet, Southern Ethiopia, in April 2010. Stool specimens were examined using a single Kato-Katz thick smear for Schistosoma mansoni (S. mansoni) ova. Children who were found positive for S. mansoni were treated with a single oral dose of PZQ at 40 mg/kg bw and interviewed for treatment-related symptoms 24 hours after drug administration. Four weeks post-treatment, stool specimens were collected from the same children and examined following the same procedure as in the pre- treatment. Drug efficacy was determined based on cure and egg reduction rates. Results: Pre- treatment prevalence of S. mansoni infection was 74.9% with geometric mean egg count of 268. The evaluated generic PZQ produced an overall cure rate of 73.6% (P<0.000 1, OR: 8.33, CI: 5.3-13.1) and egg reduction rate of 68.2% (P=0.03, F=0.64). The cure rate showed significant association with age (χ2=11, P=0.004), the highest rate being observed in the 15-22 age group. 83% of S. mansoni infected children showed various treatment-related symptoms, the most frequent being headache, nausea, and abdominal pain. These symptoms were associated with age (P<0.001) and pre-treatment intensity of infection (P<0.05). Conclusions: The present observations revealed relatively lower cure and egg reduction rates of the PZQ evaluated as compared to previous reports for other PZQ brands in Ethiopia. Hence, in depth studies are recommended to clarify whether the present relatively lower cure rate is the actual cure rate of the praziquantel evaluated, treatment failure, or reduced susceptibility of the parasite. Treatment-related side effects observed were transient and tolerable.
    15  Syzygium cumini (L.) Skeels: A review of its phytochemical constituents and traditional uses
    Muniappan Ayyanar Pandurangan Subash-Babu
    2012(3):240-246. DOI: 10.1016/S2221-1691(12)60050-1
    [Abstract](17) [HTML](0) [PDF 756.98 K](72)
    Syzygium cumini (S. cumini) (L.) Skeels (jambolan) is one of the widely used medicinal plants in the treatment of various diseases in particular diabetes. The present review has been primed to describe the existing data on the information on botany, phytochemical constituents, traditional uses and pharmacological actions of S. cumini (L.) Skeels (jambolan). Electronic database search was conducted with the search terms of Eugenia jambolana, S. cumini, jambolan, common plum and java plum. The plant has been viewed as an antidiabetic plant since it became commercially available several decades ago. During last four decades, numerous folk medicine and scientific reports on the antidiabetic effects of this plant have been cited in the literature. The plant is rich in compounds containing anthocyanins, glucoside, ellagic acid, isoquercetin, kaemferol and myrecetin. The seeds are claimed to contain alkaloid, jambosine, and glycoside jambolin or antimellin, which halts the diastatic conversion of starch into sugar. The vast number of literatures found in the database revealed that the extracts of different parts of jambolan showed significant pharmacological actions. We suggest that there is a need for further investigation to isolate active principles which confer the pharmacological action. Hence identification of such active compounds is useful for producing safer drugs in the treatment of various ailments including diabetes.
    16  Dermoid cyst in a domestic shorthair cat
    Akhtardanesh B Kheirandish R Azari O
    2012(3):247-249. DOI: 10.1016/S2221-1691(12)60051-3
    [Abstract](31) [HTML](0) [PDF 752.06 K](70)
    A 5-year-old neutered male domestic shorthair cat was presented for examination of a subcutaneous mass in his tail. The mass was firm, non-painful, oval, and approximately 2.5 × 3.5 cm. Surgical exploration revealed a well-circumscribed, encapsulated mass. The mass was removed and sectioned for histopathological examination. In gross section, it was filled with numerous dark hairs. Histologically the mass was consisted of haired skin with dermal cystic structures lined by stratified squamous epithelium. The cyst lumen contained squamous debris and filled with keratinous material. Numerous hair shafts were extended from the wall of the cyst. The sebaceous and apocrine gland adnexal structures were also observed which confirmed the diagnosis of dermoid cyst. No tumor recurrence was observed after surgery in fallowing checkups. Cutaneous or subcutaneous cysts of all types are considered rare in cats and to our knowledge this is the third reported case of cutaneous dermoid cyst of cats in veterinary literature which is different from the other cases because it occurred in dorsal midline in tail area whereas others occurred in flank area.
    17  Severe monobacterial necrotizing soft tissue infection by group A Streptococcus: A surgical emergency
    Lanitis S Khan MAA Sgourakis G Kontovounisios C Papaconstandinou T Karaliotas C
    2012(3):250-252. DOI: 10.1016/S2221-1691(12)60052-5
    [Abstract](6) [HTML](0) [PDF 722.43 K](66)
    Eight percent of necrotizing soft tissue infections (NSTI) are attributable to group A Streptococci (GAS), and among these, 50% develop streptococcal toxic shock syndrome. The reported mortality associated with NSTI reaches 32%. We present cases of two healthy individuals with minor GAS skin infection which developed to a rapidly progressed NSTI and sepsis despite of the antibiotic treatment, aiming to discuss the lessons learned from the course and management of these patients.

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