Clinical Characteristics of and Preventative Strategies for Peripartum Group A Streptococcal Infections

Shinar, Shiri; Fouks, Yuval; Amit, Sharon; Pauzner, David; Tarabeia, Jalal; Schechner, Vered; Many, Ariel

doi:10.1097/aog.0000000000001238

Cited by 20 publications

(27 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We found that 26% of maternal iGAS cases were diagnosed using samples obtained from nonsterile sites; these cases were treated as iGAS due to systemic or severe clinical presentation. This highlights the fact that severe puerperal sepsis, requiring prophylaxis of the neonate and follow up in line with public health guidance, relies on the judgement of a clinician, and that a high level of suspicion is always warranted, as no single risk factor, clinical sign or laboratory index can indicate this serious complication …”

Section: Discussionmentioning

confidence: 99%

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Leonard

Wright

Saavedra-Campos

et al. 2018

BJOG

View full text Add to dashboard Cite

Objective We describe cases of invasive group A Streptococcus (iGAS) in mothers or neonates and assess management according to national guidelines, which recommend administering antibiotics to both mother and neonate if either develops iGAS infection within 28 days of birth and investigation of clusters in maternity units.Design Cross-sectional retrospective study. Setting and population Notified confirmed iGAS cases in either mothers or neonates with onset within 28 days of birth in London and the South East of England between 2010 and 2016Method Review of public health records of notified cases.Main outcome measures Incidence and onset time of iGAS in postpartum mothers and babies, proportion given prophylaxis, maternity unit clusters within 6 months.Results We identified 134 maternal and 21 neonatal confirmed iGAS infections. The incidence (in 100 000 person years) of iGAS in women within 28 days postpartum was 109 (95% CI 90-127) compared with 1.3 in other females aged 15-44. For neonates the incidence was 1.5 (95% CI 9-23). The median onset time was 2 days postpartum [interquartile range (IQR) 0-5 days] for mothers and 12 days (IQR 7-15 days) for neonates. All eligible mothers and most (109, 89%) eligible neonates received chemoprophylaxis. Of 20 clusters (59 cases of GAS and iGAS) in maternity units, two clusters involved possible transmission. However, in 6 of 15 clusters, GAS isolates were not saved for comparison even after relevant guidance was issued.Conclusions iGAS infection remains a potential postpartum risk. Prophylaxis among neonates and storage of isolates from maternity cases can be improved.

show abstract

Section: Discussionmentioning

confidence: 99%

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Leonard

Wright

Saavedra-Campos

et al. 2018

BJOG

View full text Add to dashboard Cite

show abstract

“…The population groups at most risk of being infected with GAS diseases included people with underlying medical conditions [10,17,27,[59][60][61][62], children (0 to 15 years) [8,11,36,[51][52][53][54][55][56] and the elderly [10,43,57,58]. Additionally, pregnant and postpartum women were also identified as groups at risk for GAS diseases [39,41,[63][64][65][66][67][68][69]. However, in the wider community, when gender was considered, boys and men were reported to be more at risk of being infected with GAS compared to girls and women [22,23,36,52,57,70].…”

Section: At-risk Groupsmentioning

confidence: 99%

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

2021

View full text Add to dashboard Cite

Streptococcus pyogenes, (colloquially named “group A streptococcus” (GAS)), is a pathogen of public health significance, infecting 18.1 million people worldwide and resulting in 500,000 deaths each year. This review identified published articles on the risk factors and public health prevention and control strategies for mitigating GAS diseases. The pathogen causing GAS diseases is commonly transmitted via respiratory droplets, touching skin sores caused by GAS or through contact with contaminated material or equipment. Foodborne transmission is also possible, although there is need for further research to quantify this route of infection. It was found that GAS diseases are highly prevalent in developing countries, and among indigenous populations and low socioeconomic areas in developed countries. Children, the immunocompromised and the elderly are at the greatest risk of S. pyogenes infections and the associated sequelae, with transmission rates being higher in schools, kindergartens, hospitals and residential care homes. This was attributed to overcrowding and the higher level of social contact in these settings. Prevention and control measures should target the improvement of living conditions, and personal and hand hygiene. Adherence to infection prevention and control practices should be emphasized in high-risk settings. Resource distribution by governments, especially in developed countries, should also be considered.

show abstract

“…Patients with nonspecific symptoms of STSS received early treatment only when they reported a positive family history of streptococcal infection or tested positive for GAS antigen. As close contact with patients having streptococcal infection is associated with the transmission of STSS,18,21,22 it is important to ask pregnant women regarding their medical history and consider GAS infection as part of the differential diagnosis of women presenting with symptoms of common cold (e.g. sore throat).…”

Section: Discussionmentioning

confidence: 99%

Nationwide study of mortality and survival in pregnancy‐related streptococcal toxic shock syndrome

Hayata

Nakata

Hasegawa

et al. 2020

J of Obstet and Gynaecol

View full text Add to dashboard Cite

Aim Streptococcal toxic shock syndrome is associated with the highest infection‐related maternal mortality rates. We conducted a comparative analysis of the background factors and treatment course between survivors and nonsurvivors to improve our understanding concerning the optimal initial treatment approach for this fulminant disease. Methods This retrospective observational study was conducted based on clinical data collected from two national organizations. Clinical data of patients who died or survived (i.e. background information, clinical course and treatment administered) were collected. Results Records of 13 dead and 15 surviving patients were collected and analyzed. No statistically significant differences were found between the groups regarding age, parity, season, gestational age or the patients' location at the onset of symptoms. After the initial symptom onset, the survivors received antibiotics more systematically during their first visit to a clinic (P = 0.006). More survivors had received treatment within 1 h of onset of fulminant disease (P = 0.069). The number of fetal deaths was significantly higher in the mortality group (P = 0.003), while the fetal survival number was higher in the group of maternal survivors (P = 0.055). Maternal survivors with nonspecific initial symptoms received early intervention when there was a family history of group A streptococcal infection or a positive rapid antigen test result. Conclusion Intensive care, including systemic antibiotic administration, may contribute to maternal survival when administered immediately (within 1 h) after the fulminant streptococcal toxic shock syndrome onset. Eliciting a family history of streptococcal infection and conducting a rapid antigen test can identify the patients needing early intervention.

show abstract

Clinical Characteristics of and Preventative Strategies for Peripartum Group A Streptococcal Infections

Cited by 20 publications

References 19 publications

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

Severe group A streptococcal infections in mothers and their newborns in London and the South East, 2010–2016: assessment of risk and audit of public health management

A Review of Streptococcus pyogenes: Public Health Risk Factors, Prevention and Control

Nationwide study of mortality and survival in pregnancy‐related streptococcal toxic shock syndrome

Contact Info

Product

Resources

About