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Background  Streptococcal toxic shock syndrome (STSS) is an uncommon but life-threatening disease caused by  Streptococcus pyogenes .    Methods  To understand the clinical and molecular characteristics of STSS, we analyzed clinical data and explored the  emm  types, superantigen genes, and pulsed-field gel electrophoresis of causative  S. pyogenes  isolates obtained between 2005 and 2012.    Results  In total, 53 patients with STSS were included in this study. The median age of the patients was 57 years (range: 9–83 years), and 81.1% were male. The most prevalent underlying disease was diabetes mellitus (45.3%). Skin and soft-tissue infection accounted for 86.8% of STSS. The overall mortality rate was 32.1%. Underlying diseases had no statistical impact on mortality. A total of 19 different  emm  types were identified. The most prevalent  emm  type was  emm 102 (18.9%), followed by  emm 11 (17%),  emm 1 (11.3%),  emm 87 (9.4%), and  emm 89 (7.5%). There was no statistically significant association between  emm  type and a fatal outcome. Among the superantigen genes,  speB  was the most frequently detected one (92.5%), followed by  smeZ  (90.6%),  speG  (81.1%),  speC  (39.6%), and  speF  (39.6%). The majority of  emm 102 strains were found to have  speB ,  speC ,  speG , and  smeZ . The presence of  speG  was negatively associated with a fatal outcome ( P  = 0.045).    Conclusions  Our surveillance revealed the emergence of uncommon  emm  types, particularly  emm 102, causing STSS in southern Taiwan. Characterization of clinical, epidemiological, and molecular characteristics of STSS will improve our understanding of this life-threatening disease.

Emergence of Streptococcus pyogenes emm102 Causing Toxic Shock Syndrome in Southern Taiwan during 2005–2012