Puerperal Group A Streptococcal sepsis: a case report

Authors

  • Nithya J. Department of Obstetrics and Gynaecology, GKNM Hospital, Coimbatore, Tamil Nadu, India
  • Sathyamurthy G. Division of Critical Care Medicine, GKNM Hospital, Coimbatore, Tamil Nadu, India
  • Balavinoth R. Division of Infectious diseases, GKNM Hospital, Coimbatore, Tamil Nadu, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20214665

Keywords:

Group A Streptococci infection, Toxic shock syndrome, Puerperal sepsis

Abstract

Group A Streptococcal (GAS) sepsis in puerperium is one of the recognised causes of maternal mortality. Though the onset is often insidious, it can progress rapidly to a life-threatening invasive infection, toxin-mediated shock, and end-organ failure, even before clinical signs become apparent. We report a case of puerperal GAS sepsis that was successfully managed. 24-years-old para 1 was readmitted to the intensive care unit requiring non-invasive ventilation on postnatal day 6 with clinical and biochemical features of sepsis. Blood culture, episiotomy wound swab, and high vaginal swab grew GAS. Broad-spectrum antibiotics initiated. She developed ascites that progressively increased and needed therapeutic paracentesis. She was discharged after four weeks of hospitalization. Early identification and prompt treatment are the keys to prevent severe morbidity and maternal mortality.

Author Biographies

Nithya J., Department of Obstetrics and Gynaecology, GKNM Hospital, Coimbatore, Tamil Nadu, India

Chairperson, Department of Obstetrics and Gynaecology

Sathyamurthy G., Division of Critical Care Medicine, GKNM Hospital, Coimbatore, Tamil Nadu, India

Director, Division of critical care medicine

Balavinoth R., Division of Infectious diseases, GKNM Hospital, Coimbatore, Tamil Nadu, India

Consultant, Division of infectious diseases

References

Rimawi BH, Soper DE, Eschenbach DA. Group A streptococcal infections in obstetrics and gynecology. Clin Obstet Gynecol. 2012;55(4):864-74.

Bonet M, Oladapo OT, Khan DN, Mathai M, Gülmezoglu AM. New WHO guidance on prevention and treatment of maternal peripartum infections. Lancet Glob Health. 2015;3(11):667-8.

Bonet M, Oladapo OT, Khan DN, Mathai M, Gülmezoglu AM. New WHO guidance on prevention and treatment of maternal peripartum infections. Lancet Glob Health. 2015;3(11):667-8.

Hamilton SM, Stevens DL, Bryant AE. Pregnancy-related group A streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome. Clin Infect Dis. 2013;57:870-6.

Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs. 2012;72(9):1213-27.

Palaniappan N, Menezes M, Willson P. Group A streptococcal puerperal sepsis: management and prevention. Obstet Gynaecol. 2012;14:9-16.

Chuang I, Van BC, Beall B, Schuchat A. Population-based surveillance for postpartum invasive group a streptococcus infections, 1995-2000. Clin Infect Dis. 2002;35(6):665-70.

Olp RJ, Chamales IA, Schmiedecke SS. A Case Study of Puerperal Group A Streptococcal Infection Complicated by Toxic Shock Syndrome. AJP Rep. 2020;10(1):1-4.

Deutscher M, Lewis M, Zell ER, Taylor TH, Van BC, Schrag S, et al. Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women. Clin Infect Dis. 2011;53:114-23.

Soper DE. Early recognition of serious infections in obstetrics and gynecology. Clin Obstet Gynecol. 2012;55(04):858-63.

Phupong V, Lersbuasin P, Kengsakul M, Lertkhachonsuk R. Invasive group A streptococcal infection in postpartum period mimics hypovolaemic shock. J Obstet Gynaecol. 2016;36(3):283-4.

Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. Active Bacterial Core Surveillance Team.The epidemiology of invasive group A streptococcal infection and potential vaccine implications: the United States, 2000-2004. Clin Infect Dis. 2007;45(7):853-62.

Cantwell R, Brock T, Cooper G, Dawson A, Drife J, Garrod D, et al. Saving Mothers' Lives: Reviewing maternal deaths to make motherhood safer: 2006-2008. The Eighth Report of the Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG. 2011;118(1):1-203.

Greer O, Shah NM, Johnson MR. Maternal sepsis update: current management and controversies. Obstet Gynaecol. 2020;22:45-55.

Elton RJ, Chaudhari S, Sepsis in obstetrics. BJA Edu. 2015;15(5):259-64.

Babiker A, Li X, Lai YL, Strich JR, Warner S, Sarzynski S, et al. Effectiveness of adjunctive clindamycin in β-lactam antibiotic-treated patients with invasive β-haemolytic streptococcal infections in US hospitals: a retrospective multicentre cohort study. Lancet Infect Dis. 2021;21(5):697-710.

Downloads

Published

2021-11-25

Issue

Section

Case Reports