A Case Study of Surviving Puerperal Group A Sepsis

Abstract

Background Suspected group A sepsis should be regarded as an obstetric emergency given the high mortality associated with the condition. Case We describe the anonymous case of a woman who survived puerperal sepsis following a 16‐day hospital course, including obstetric history and birth summary, and review of atypical subjective symptoms of group A strep (GAS) sepsis. Clinical findings are presented, including vital signs, lab abnormalities (leukopenia), diagnostic testing, and the major goals of sepsis management. We discuss GAS as pathogen and associated virulence factors that enable it to evade phagocytosis and increase the ability to multiple in blood and cause disease. Group A strep is the leading pathogen linked to maternal mortality, and when associated with sepsis there is a 30% to 50% mortality rate; once shock develops the mortality rate approaches 60%. Conclusion The occurrence of GAS sepsis remains low. However, given the combination of relative rarity and atypical presentation, recognition is frequently a stumbling block to treatment. Therefore, special attention to the identification of the atypical symptoms associated with GAS sepsis is important due to the high risk of associated mortality. It is recommended that pregnant and postpartum women who present with atypical symptoms be evaluated with consideration of eliminating GAS infection from the differential before seeking other causes. Nurses are the front‐line staff caring for childbearing women and need to be aware of the threat of GAS sepsis. If we improve awareness, early recognition, and rapid treatment, lives can be saved. Suspected group A sepsis should be regarded as an obstetric emergency given the high mortality associated with the condition. We describe the anonymous case of a woman who survived puerperal sepsis following a 16‐day hospital course, including obstetric history and birth summary, and review of atypical subjective symptoms of group A strep (GAS) sepsis. Clinical findings are presented, including vital signs, lab abnormalities (leukopenia), diagnostic testing, and the major goals of sepsis management. We discuss GAS as pathogen and associated virulence factors that enable it to evade phagocytosis and increase the ability to multiple in blood and cause disease. Group A strep is the leading pathogen linked to maternal mortality, and when associated with sepsis there is a 30% to 50% mortality rate; once shock develops the mortality rate approaches 60%. The occurrence of GAS sepsis remains low. However, given the combination of relative rarity and atypical presentation, recognition is frequently a stumbling block to treatment. Therefore, special attention to the identification of the atypical symptoms associated with GAS sepsis is important due to the high risk of associated mortality. It is recommended that pregnant and postpartum women who present with atypical symptoms be evaluated with consideration of eliminating GAS infection from the differential before seeking other causes. Nurses are the front‐line staff caring for childbearing women and need to be aware of the threat of GAS sepsis. If we improve awareness, early recognition, and rapid treatment, lives can be saved.