Serious group A streptococcal infection around delivery

Area of Science:

• Obstetrics and Gynecology
• Infectious Diseases
• Critical Care Medicine

Background:

• Streptococcal toxic shock syndrome (STSS) is a severe condition with high mortality.
• Differentiating perinatal STSS is crucial for timely and appropriate management.
• Group A Streptococcus (GAS) is a significant pathogen in obstetric complications.

Purpose of the Study:

• To distinguish the clinical characteristics of perinatal group A streptococcal infection causing STSS from other forms of STSS.
• To identify specific features that aid in the early diagnosis of severe perinatal streptococcal disease.

Main Methods:

• Review of 38 fatal or CDC-criteria-meeting STSS obstetric cases.
• Inclusion of cases from hospital records, MEDLINE, and Japanese medical literature.
• Exclusion of early pregnancy or unclear deterioration interval cases, resulting in 30 analyzed cases.

Main Results:

• Perinatal group (deterioration within 12 hours of delivery) showed higher infant (10/17) and maternal (15/17) mortality than the puerperal group (0/13 and 7/13).
• Perinatal cases exhibited unusually strong labor (8/17) and evidence of serious sepsis (8/17), unlike puerperal cases with inflammation (10/13).
• Purulent myometritis was observed in three perinatal cases, with preceding sore throat reported in ten cases.

Conclusions:

• Perinatal STSS cases possess unique clinical features.
• Invasion of the myometrium followed by systemic dissemination via uterine contractions is a suspected mechanism.
• Recognition of unusual clinical signs is vital for diagnosing perinatal streptococcal toxic shock syndrome.