Abstract
There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.
Highlights
Group A streptococci (GAS), or Streptococcus pyogenes, is a widely carried pathogen, sometimes asymptomatically, or causing mild localized self-limiting infections such as impetigo and pharyngitis
Invasive GAS causes rare but serious infectious conditions in women: Toxic Shock-Like Syndrome (TSLS) which is associated with early onset shock and multi-organ system failure, necrotizing fasciitis (NF) which involves local necrosis of subcutaneous soft tissues and skin, and bacteremia which can cause focal infections including meningitis, pneumonia, peritonitis, osteomyelitis, septic arthritis, myositis, postoperative wound infections and puerperal sepsis, the latter being a major cause of maternal mortality
In order to find clues to better understand the pathogenesis of invasive GAS (iGAS), Zhu et al used transposon-directed insertion-site sequencing (TraDIS) to study the virulence gene expression of 2 specific GAS serotypes known to be involved in necrotizing myositis in humans [12,13]
Summary
Group A streptococci (GAS), or Streptococcus pyogenes, is a widely carried pathogen, sometimes asymptomatically, or causing mild localized self-limiting infections such as impetigo and pharyngitis. Invasive GAS (iGAS) causes rare but serious infectious conditions in women: Toxic Shock-Like Syndrome (TSLS) which is associated with early onset shock and multi-organ system failure, necrotizing fasciitis (NF) which involves local necrosis of subcutaneous soft tissues and skin, and bacteremia which can cause focal infections including meningitis, pneumonia, peritonitis, osteomyelitis, septic arthritis, myositis, postoperative wound infections and puerperal sepsis, the latter being a major cause of maternal mortality. Incidence of these invasive infections is very low, around 1–8 per 100,000 population per year, but has a potential case fatality rate ranging from 5% to.
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