Group A Streptococcal Infections in Obstetrics and Gynecology

Abstract

Group A streptococcal (GAS) infections continue to be an infrequent, but potentially lethal infections in women despite the victory over childbed fever in the 1800s. Invasive group A streptococcal infection still causes 40% of septic deaths among patients with postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome. Many times symptoms and signs of this infection are nonspecific, but laboratory evaluation can suggest serious infection. The prudent combination of antibiotic and surgical therapy can be lifesaving.

Post partum infections: A review for the non-OBGYN

“…A patient who presents with signs of severe systemic illness, diarrhea, and/or abdominal pain out of proportion to physical findings should raise suspicion for group A Streptococcus (GAS) infection which requires urgent antibiotic and surgical management given the risk of toxic-shock syndrome, necrotizing fasciitis and death. 20,21 Outbreaks of GAS infection in postpartum women have often been linked back to colonized or infected health care providers prompting the CDC to recommend health care worker screening when two or more episodes of postpartum GAS infection cases are identified over a six-month period. 18,20 Late postpartum endometritis (47 days) should raise suspicion for Chlamydia trachomatis, beyond the common pathogens, and testing for Chlamydia should be done when endometritis presents 47 days after delivery and in patients at high risk such as adolescents.…”

Toxic Shock Syndrome detected at 21 weeks’ gestation complicating acute chorioamnionitis with intact sac

“…Over the past twenty-five years, there has been a rise in invasive group A streptococcal infections [1, 7,8] during pregnancy, with an incidence 20 times higher in pregnant women compared to nonpregnant women [1,9]. The greater susceptibility of parturient women to contract such an infection has been demonstrated [8] and is due to skin and mucosal lesions on delivery, vaginal pH variation after the rupture of the amniotic sac, which promotes microorganism growth, and temporary immunosuppression linked to pregnancy [1,3].…”

“…Group A streptococcal toxicity is linked to its virulence factors [9]: the antiphagocytic surface protein M, and pyrogenic exotoxin (Spe-A) essentially produced by the M1 and M3 serotypes [2]. Although there are almost 150 different M serotypes, only some are responsible for invasive infections.…”

Postpartum Sinus Tachycardia

“…First, S. pyogenescan be potentially extremely morbid having an estimated case fatality ratio of fifteen to twenty percent skyrocketing to forty to sixty percent in the presence of septic shock [8]. Further, this makes GAS one of the most lethal bacterial pathogens known to mankind with postpartum women incurring a 20-fold increased incidence of GAS [8]. Despite this tremendous risk to pregnant and postpartum women it is estimated that fifteen to twenty percent of school aged children may carry this bacterial strain [9].…”