Two cases of delayed diagnosis of postpartal streptococcal toxic shock syndrome.

Wolfram Schummer,Claudia Schummer

doi:10.1155/s106474490200025x

Abstract

Puerperal sepsis due to group A beta-hemolytic streptococcal (GAS) toxic shock syndrome is associated with very high morbidity and mortality. Luckily it is now rare, but diagnosis is not always easy. This report demonstrates the problem of recognizing this disease, and summarizes the current knowledge on the pathomechanism and management of streptococcal toxic shock syndrome. Two cases of postpartum streptococcal toxic shock syndrome due to GAS are described. In both cases the correct diagnosis was delayed for several days. The first patient was sent home with the diagnosis of German measles; the second patient was transferred to our neurological intensive care unit with the diagnosis of meningitis. Both patients were admitted to the intensive care unit in profound shock, both developed multiple organ failure, and one patient died. GAS may produce virulence factors that cause host tissue pathology. Besides aggressive modern intensive care treatment, early diagnosis and correct choice of anti-streptococcal antibiotics are crucial. A possible adverse effect of non-steroidal anti-inflammatory agents requires confirmation in a multicenter study.

Highlights

Puerperal sepsis is a preventable postpartal complication, if early signs are recognized and treated adequately
When the diagnosis of a Group A b-hemolytic streptococcal infection was confirmed from blood cultures and abdominal swabs – both taken on the day of admission to the intensive care unit (ICU) – penicillin G was added to the antimicrobial regimen 24 hours later
Puerperal infection due to group A b-hemolytic streptococcal (GAS) became a rare disease in the 20th century

Summary

Background

Puerperal sepsis due to group A b-hemolytic streptococcal (GAS) toxic shock syndrome is associated with very high morbidity and mortality. It is rare, but diagnosis is not always easy. The first patient was sent home with the diagnosis of German measles; the second patient was transferred to our neurological intensive care unit with the diagnosis of meningitis. Both patients were admitted to the intensive care unit in profound shock, both developed multiple organ failure, and one patient died.

INTRODUCTION

Findings

DISCUSSION