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      Surviving Postpartum Group A Streptococcus Sepsis Complicated by Multiorgan System Failure: A Complex Case Presentation

      case-report
      1 , , 2 , 3 , 3
      ,
      Cureus
      Cureus
      clinical management, multidisciplinary care, cardiomyopathy, toxic shock syndrome, peripartum sepsis, group a streptococcus

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          Abstract

          Postpartum group A streptococcal (GAS) sepsis is a rare obstetric complication with severe clinical implications and high morbidity and mortality, presenting diagnostic and management challenges. This report analyzes a complex case of postpartum GAS sepsis, highlighting the importance of understanding the pathophysiology and clinical trajectories of this often fatal pathogen. A comprehensive analysis was conducted on a patient with postpartum GAS sepsis. Literature review and case comparisons informed the study's context. Medical history, clinical presentation, diagnostic procedures, interventions, and outcomes were reviewed and documented. The patient presented on postpartum day 5 with abdominal pain and vaginal bleeding. Her condition rapidly deteriorated, requiring aggressive interventions and systemic support. Blood cultures confirmed GAS bacteremia. She developed toxic shock syndrome, cardiomyopathy with acute cardiac failure, and seizures secondary to subdural empyema. Multidisciplinary care facilitated eventual clinical recovery. Obstacles in achieving treatment balance were evident, underscoring the systemic nature of GAS infection and the significance of interdisciplinary collaboration. This case underscores the complex pathophysiology of postpartum GAS sepsis and the importance of prompt treatment initiation, aggressive intervention, and a multidisciplinary approach to management. The study contributes to the understanding of disease progression and clinical management in severe peripartum infections, reaffirming the need for further research to improve outcomes.

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          Most cited references14

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          Population-based surveillance for postpartum invasive group a streptococcus infections, 1995-2000.

          Estimates of disease burden and data on the sources of invasive postpartum group A streptococcus (GAS) infections will help guide public health action. Active, population-based surveillance was conducted in 9 regions from 1995 through 2000. A case of GAS infection was defined as isolation of GAS from a sterile site in a resident of a surveillance area who was pregnant or in the postpartum period. Census and live birth data were used to calculate rates. Eighty-seven cases of postpartum GAS infection (2.2% of 3957 invasive GAS infections) occurred at 3%-8% of hospitals annually. We estimate that 220 cases occurred annually in the United States. Two or more cases were noted during 6 months at 8 hospitals, during 1 year at 13 hospitals, and during 2 years at 16 hospitals. Cases due to identical emm types clustered more frequently than expected by chance. Although postpartum GAS infections are rare, the clustering of infections due to identical strains suggests that some invasive cases may have a common source and, therefore, may be preventable.
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            Vaginal-rectal colonization with group A streptococci in late pregnancy.

            OBJECTIVE: To determine the vaginal-rectal colonization rate with group A streptococci in late pregnancy. METHODS: All patients delivering at a northern New England hospital over a 38 month period had 35-37 week vaginal-rectal swabs cultured for group A and group B streptococci, using selective media and slide agglutination. RESULTS: Six thousand nine hundred forty-four screening cultures were obtained. Among these 1,393 were positive for group B streptococci and 2 for group A streptococci, yielding colonization rates of 20.1% and 0.03%, respectively. CONCLUSIONS: Vaginal-rectal colonization with group A streptococci is rare, arguing against the need for establishing group A streptococcal screening programs in pregnancy. An approach for managing this uncommon finding is presented.
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              Incidence and severity of invasive Streptococcus pneumoniae, group A Streptococcus, and group B Streptococcus infections among pregnant and postpartum women.

              The epidemiology of streptococcal infection in pregnant and postpartum women is poorly described in recent literature. We used data from multistate surveillance for invasive Streptococcus pneumoniae, group A Streptococcus (GAS), and group B Streptococcus (GBS) infections to estimate disease incidence and severity in these populations. Cases were reported through the Centers for Disease Control and Prevention Active Bacterial Core surveillance, an active population- and laboratory-based system. A case was defined as illness in a woman aged 15-44 years with streptococcus isolated from a normally sterile body site during 2007-2009. Pregnant or postpartum status was recorded at the time of culture. Incidence was calculated as cases per 1000 woman-years with use of national Census data; 95% confidence intervals were calculated on the basis of λ distribution. We used multivariable logistic regression to explore associations between pregnant or postpartum status and hospital length of stay, a marker of disease severity. We identified 1848 cases in women; 6.0% of women were pregnant, and 7.5% were postpartum. Pregnant women had a higher mean incidence of GBS disease, compared with nonpregnant women (0.04 cases per 1000 woman-years [range, 0.03-0.05 cases per 1000 woman-years] vs 0.02 cases per 1000 woman-years [range, 0.02-0.02 cases per 1000 woman-years]). Postpartum women had elevated mean incidence of all 3 pathogens, compared with nonpregnant women (S. pneumoniae: 0.15 cases per 1000 woman-years [range, 0.09-0.25 cases per 1000 woman-years] vs 0.052 cases per 1000 woman-years [range, 0.049-0.056 cases per 1000 woman-years]; GAS: 0.56 cases per 1000 woman-years [range, 0.42-0.70 cases per 1000 woman-years] vs 0.019 cases per 1000 woman-years [range, 0.017-0.021 cases per 1000 woman-years]; GBS: 0.49 cases per 1000 woman-years [range, 0.36-0.64 cases per 1000 woman-years] vs 0.018 [range, 0.016-0.020 cases per 1000 woman-years]). Neither pregnancy nor postpartum status was associated with longer length of stay among women infected with any of the 3 pathogens. Although invasive streptococcal infections do not appear to be more severe in pregnant or postpartum women, postpartum women have a 20-fold increased incidence of GAS and GBS, compared with nonpregnant women.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                14 March 2024
                March 2024
                : 16
                : 3
                : e56167
                Affiliations
                [1 ] Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, USA
                [2 ] General Surgery, Allegheny Health Network, Pittsburgh, USA
                [3 ] Obstetrics and Gynecology, Allegheny Health Network, Pittsburgh, USA
                Author notes
                Article
                10.7759/cureus.56167
                11015903
                38618427
                253fecdd-e4e2-48cc-90b2-62a13af38c92
                Copyright © 2024, Saab et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 March 2024
                Categories
                Neurosurgery
                Obstetrics/Gynecology
                General Surgery

                clinical management,multidisciplinary care,cardiomyopathy,toxic shock syndrome,peripartum sepsis,group a streptococcus

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