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Arai T, Takai Y, Samejima K, Matsunaga S, Ono Y, Seki H. How could we suspect life-threatening perinatal group A streptococcal infection? J Obstet Gynaecol Res 2020; 46:2573-2581. [PMID: 32945073 PMCID: PMC7756575 DOI: 10.1111/jog.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/22/2020] [Accepted: 09/05/2020] [Indexed: 12/01/2022]
Abstract
AIM Perinatal group A streptococcal infection is a rare but life-threatening condition. Few reports have focused on its clinical characteristics and how to prevent deterioration. We report our experience with two antenatal fatal cases and reviewed 96 cases in the literature to assess the clinical characteristics of group A streptococcal infection. METHODS English-language clinical reports of antenatal and postnatal group A streptococcal infection in 1974-2019 were retrieved and examined. Relationships between clinical characteristics and maternal outcomes were assessed. RESULTS Univariate analysis revealed that antenatal group A streptococcal infection was significantly associated with an age of ≤19 or ≥ 35 years, cesarean section, sore throat as an initial symptom, positive throat culture, maternal death and fetal death. Multivariate analysis revealed that antenatal onset (odds ratio = 7.922, 95% confidence interval = 1.297-48.374; P = 0.025) and a quick sepsis-related organ-failure assessment score (qSOFA; low blood pressure, high respiratory rate or altered mental status) of ≥2 (odds ratio = 6.166, 95% confidence interval = 1.066-35.670; P = 0.042) were significantly related to maternal death. CONCLUSION Per our findings, antenatal group A streptococcal infection was significantly associated with maternal and fetal death. Further, the antenatal infection was revealed as a more critical risk factor. We suggest that the presence of any sign related to the qSOFA is a potential clue suspecting perinatal group A streptococcal infection in primary obstetric facilities.
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Affiliation(s)
- Tomohiro Arai
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yasushi Takai
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Kouki Samejima
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Shigetaka Matsunaga
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Yoshihisa Ono
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Hiroyuki Seki
- Center for Maternal, Fetal, and Neonatal Medicine, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
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Yokoyama M, Oyama F, Ito A, Yokota M, Matsukura D, Tsutsumi S, Kasai T, Nitobe Y, Morikawa A, Ozaki T, Yokoyama Y. Streptococcal Toxic Shock Syndrome: Life Saving Role of Peritoneal Lavage and Drainage. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2016; 9:75-7. [PMID: 27579001 PMCID: PMC4991574 DOI: 10.4137/ccrep.s40217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/11/2016] [Accepted: 07/18/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE We encountered a case where an infection with group A streptococcus (GAS; ie, Streptococcus pyogenes) initially caused primary peritonitis and then subsequently caused streptococcal toxic shock syndrome. The patient’s life was likely saved by an emergency laparotomy followed by extensive peritoneal lavage and drainage. CASE PRESENTATION A 40-year-old woman was admitted to the Emergency Department for lower abdominal pain and numbness in the extremities. She presented with systemic inflammatory response syndrome. An emergency laparotomy was performed, and ascites that resembled pus and general peritonitis were noted. Peritoneal lavage and drainage were performed, and GAS was isolated from peritoneal fluid. Gram staining of cervical polyp specimens revealed Gram-positive bacteria. CONCLUSIONS The patient was diagnosed with streptococcal toxic shock syndrome due to an ascending GAS infection originating from vagina.
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Affiliation(s)
- Minako Yokoyama
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Fumie Oyama
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Asami Ito
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Megumi Yokota
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Daisuke Matsukura
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Shinji Tsutsumi
- Department of Surgery, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Tomonori Kasai
- Comprehensive Medical Care Unit, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yohshiro Nitobe
- Department of Orthopedics, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Akiko Morikawa
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Takashi Ozaki
- Department of Obstetrics and Gynecology, Aomori Prefectural Central Hospital, Aomori, Japan
| | - Yoshihito Yokoyama
- Department of Obstetrics and Gynecology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Lamb LEM, Sriskandan S, Tan LKK. Bromine, bear-claw scratch fasciotomies, and the Eagle effect: management of group A streptococcal necrotising fasciitis and its association with trauma. THE LANCET. INFECTIOUS DISEASES 2015; 15:109-21. [PMID: 25541175 DOI: 10.1016/s1473-3099(14)70922-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Necrotising fasciitis is a rare, but potentially fatal, soft-tissue infection. Historical depictions of the disease have been described since classical times and were mainly recorded in wartime reports of battle injuries. Although several different species of bacteria can cause necrotising fasciitis, perhaps the most widely known is group A streptococcus (GAS). Infection control, early surgical debridement, and antibiotic therapy are now the central tenets of the clinical management of necrotising fasciitis; these treatment approaches all originate from those used in wars in the past 150 years. We review reports from the 19th century, early 20th century, and mid-20th century onwards to show how the management of necrotising fasciitis has progressed in parallel with prevailing scientific thought and medical practice. Historically, necrotising fasciitis has often, but not exclusively, been associated with penetrating trauma. However, along with a worldwide increase in invasive GAS disease, recent reports have cited cases of necrotising fasciitis following non-combat-related injuries or in the absence of antecedent events. We also investigate the specific association between GAS necrotising fasciitis and trauma. In the 21st century, molecular biology has improved our understanding of GAS pathogenesis, but has not yet affected attributable mortality.
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Affiliation(s)
- Lucy E M Lamb
- Department of Medicine, Imperial College London, Hammersmith Campus, Hammersmith Hospital, London, UK
| | - Shiranee Sriskandan
- Department of Medicine, Imperial College London, Hammersmith Campus, Hammersmith Hospital, London, UK
| | - Lionel K K Tan
- Department of Medicine, Imperial College London, Hammersmith Campus, Hammersmith Hospital, London, UK.
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Gursoy-Mert H, Altan-Koran M, Noyan U, Kadir T, Cologlu S, Yilmaz S. Evaluation of the effectiveness of Er:YAG laser and conventional periodontal treatment in a patient with acute streptococcal gingivitis: a 2-year follow-up. Photomed Laser Surg 2011; 28:841-5. [PMID: 21142726 DOI: 10.1089/pho.2009.2705] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the effectiveness of Er:YAG laser and conventional periodontal therapy in the treatment of acute streptococcal gingivitis both clinically and microbiologically. BACKGROUND DATA This case report describes a 2-year follow-up of a 30-year-old, female, chronic periodontitis patient, presenting severe gingival inflammation, sensitivity, pain, and acute gingival lesions that were treated with Er:YAG laser and conventional hand and ultrasonic instruments. MATERIALS AND METHODS Before the initial periodontal treatment, microbiological samples were taken from the lesion sites with sterile paper points from the sulcuses bilaterally, and excisional biopsies were obtained from the lesions. Following diagnostic tests, the lesions were identified as acute streptococcal gingivitis. Following the measurement of clinical indices, initial periodontal therapy was performed with Er:YAG laser on the right side and conventional hand and ultrasonic instruments on the left side, which were performed as two sessions at weekly intervals. As an adjunct to mechanical periodontal therapy, 500 mg amoxicillin was prescribed t.i.d. for a week. RESULTS Microbiological samples grew mostly Streptococcus sp. and black pigmented obligate anaerobic bacteria. The histopathological examination revealed acanthosis, papillomatosis, and spongiotic lesions in the keratinized stratified squamous epithelium; infiltration of polymorphonuclear neutrophils, lymphocytes, and macrophages and plasma cells in the connective tissue; infiltration and accumulation of polymorphonuclear neutrophils in the epithelium, especially in the spongiotic lesions; and formation of microabscess-like clusters. After the initial periodontal treatment, clinical and microbiological measurements were repeated and reductions in clinical indices and the number of microorganisms were observed. both treatment modalities gave similar results, and no recurrences were observed during the 2-year follow-up. CONCLUSION Er:YAG laser seems to be promising and as effective as conventional periodontal therapy in the treatment of acute streptococcal gingivitis.
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Affiliation(s)
- H Gursoy-Mert
- Department of Periodontology, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey.
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Yamada T, Yamada T, Yamamura MK, Katabami K, Hayakawa M, Tomaru U, Shimada S, Morikawa M, Seki T, Ariga S, Ishikawa K, Ikebe T, Gando S, Minakami H. Invasive group A streptococcal infection in pregnancy. J Infect 2010; 60:417-24. [DOI: 10.1016/j.jinf.2010.03.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 03/17/2010] [Accepted: 03/18/2010] [Indexed: 12/18/2022]
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Seki M, Saito M, Iida KI, Taniai H, Soejima T, Nakayama H, Yoshida SI. Onset of streptococcal toxic shock syndrome is accelerated by bruising in a mouse model. Microb Pathog 2008; 44:339-43. [DOI: 10.1016/j.micpath.2007.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2007] [Revised: 10/18/2007] [Accepted: 10/18/2007] [Indexed: 10/22/2022]
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Ozkaya G, Shorbagi A, Ulger Z, Saglam A, Aybar M, Sardan YC, Uzun O. Invasive group A streptococcal infection with pancarditis caused by a new emm-type 12 allele of Streptococcus pyogenes. J Infect 2005; 53:e1-4. [PMID: 16364444 DOI: 10.1016/j.jinf.2005.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 09/30/2005] [Accepted: 10/04/2005] [Indexed: 11/19/2022]
Abstract
Throughout the 1980s, a progressive increase in the incidence of Streptococcus pyogenes-related invasive infections has occurred. It has been suggested that a host-related immunogenetic background, as well as bacterial virulence factors may play an important role in the outcome of streptococcal infections. Here, we present the first case of pancarditis in the literature caused by direct bacterial invasion due to a new emm-type 12 allele of S. pyogenes in an immunocompetent patient. The pathogenesis of this invasive infection, as well as predictors of poor prognosis are discussed.
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Affiliation(s)
- Gülşen Ozkaya
- Section of Infectious Diseases Unit, Hacettepe University School of Medicine, Ankara, Turkey.
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Katz J, Guelmann M, Rudolph M, Ruskin J. Acute streptococcal infection of the gingiva, lower lip, and pharynx--a case report. J Periodontol 2002; 73:1392-5. [PMID: 12479644 DOI: 10.1902/jop.2002.73.11.1392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Streptococcal gingivostomatitis is a rare phenomenon in a non-compromised host and not commonly reported in the dental literature. Early diagnosis and distinction from viral infections, especially HSV infection, are of the utmost importance. The early use of penicillin is essential in preventing a cascade of events, resulting in severe fasciitis, destruction of tissues, and subsequent rheumatic fever and rheumatic heart disease. METHODS A unique case of group A beta-hemolytic streptococcal infection affecting the pharynx, lower lip, and gingiva of a healthy 19-year-old male is presented. RESULTS The streptococcal infection was responsive to penicillin treatment. CONCLUSIONS In view of the increased use of antibiotics and the development of aggressive strains, the dental clinician has to consider streptococcal infection in the differential diagnosis of gingival and soft tissue infections.
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Affiliation(s)
- Joseph Katz
- Division of Oral Medicine, Department of Oral Surgery and Diagnostic Sciences, University of Florida, College of Dentistry, Gainesville, FL 32610-0416, USA.
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Crum NF, Chun HM, Gaylord TG, Hale BR. Group A streptococcal toxic shock syndrome developing in the third trimester of pregnancy. Infect Dis Obstet Gynecol 2002; 10:209-16. [PMID: 12648315 PMCID: PMC1784620 DOI: 10.1155/s1064744902000248] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Group A streptococcal (GAS) toxic shock syndrome (TSS) is an uncommon, but life-threatening infection during pregnancy and should be considered in rapid onset of shock. Most cases described in the literature have occurred in the puerperium. We report a case of GAS TSS occurring during the third trimester of pregnancy in a previously healthy woman. CASE A 31-year-old female, who was 34 weeks pregnant, presented with fevers and a prodromal 'flu-like' illness. She rapidly developed shock and multiorgan failure. Blood cultures revealed GAS bacteremia and the patient met criteria for streptococcal TSS. Despite her eventual recovery, her infant died on postpartum day 15 as a consequence of the mother's TSS. CONCLUSIONS This case is unusual in that there were no identifiable initiating events or source of the streptococcal infection, and the TSS developed during pregnancy rather than after delivery. Early recognition of GAS infections is important given the rapid onset and high morbidity and mortality associated with these infections. This is the first reported case utilizing intravenous immunoglobulin for GAS TSS in the puerperium.
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Affiliation(s)
- Nancy F Crum
- Internal Medicine Department, Naval Medical Center San Diego, San Diego, CA 92134, USA.
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