The characteristics of overwhelming infection with group A beta hemolytic streptococcus are:

1. The infection usually follows surgery or trauma to an extremity; the trauma may be trivial or even inapparent.

2. In the first stage of infection the tissue becomes edematous, enythematous, warm, often painful, and the entire process usually spreads contiguously and rapidly from the original focus. There are two clinical dissociations: the patient seems too ill for the amount of skin abnormality and the wound appears too benign for the source of a bacteremia.

3. In the second stage, the wound edges often become blue-black, frequently with vesicles and patches of gangrene. A necrotizing fasciitis is commonly noted at this time.

4. Finally the patient may go into shock with or without signs of consumptive coagulopathy.

Seven cases in orthopaedic patients are described, four of whom died of the infection. Two other patients required amputation and one had a permanent neurological deficit. Immediate intensive antibiotic therapy and surgical treatment are indicated as soon as a presumptive bacteriological diagnosis by smear can be made. Treatment should not be delayed until the results of culture are known.