A Fatal Case of Streptococcal Toxic Shock Syndrome Caused By Genotype Emm1 In The Third Trimester of Pregnancy, China

Abstract Background: Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare invasive disease, causing a high risk of maternal and fetal mortality during pregnancy. We report a fatal case of a female caused by GAS-TSS in the third trimester of pregnancy in Guangzhou, China. Case presentation: The patient is a 33-year-old female who presented at 37 weeks’ gestation with a history of three hours fever. The patient underwent an early onset and rapid progression with dramatic clinical picture and laboratory characters within 24 hours. The neonate survived after an aggressive anti-infection treatment.The GAS strains were isolated from two bottles of blood cultures and airway secretion culture, which confirmed as Streptococcus pyogenes associated with genotype emm1 by molecular analysis.Conclusion: Dramatic clinical picture and laboratory characters of the pregnant woman presented here might help improve clinicians' awareness and recognition of Streptococcus pyogenes, which could be of great importance for the early diagnosis of GAS- TSS in pregnancy.

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A Fatal Case of Streptococcal Toxic Shock Syndrome Developing in the Third Trimester of Pregnancy, China

10.21203/rs.3.rs-452042/v1 ◽

2021 ◽

Author(s):

Yasha Luo ◽

Minling Zheng ◽

Yanyuan Chen ◽

Chunming Gu ◽

Lijuan Lv ◽

...

Keyword(s):

Streptococcus Pyogenes ◽

Toxic Shock Syndrome ◽

Fatal Case ◽

Invasive Disease ◽

Fetal Mortality ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Third Trimester ◽

The Third ◽

Emergency Cesarean

Abstract Background Group A streptococcal (GAS) toxic shock syndrome (TSS) is a rare invasive disease, causing a high risk of maternal and fetal mortality during pregnancy. We report a fatal case of a female caused by GAS-TSS in the third trimester of pregnancy in Guangzhou, China. Case presentation: The patient is a 33-year-old female who presented at 37 weeks’ gestation with a history of three hours fever. She underwent an emergency cesarean section due to fetal bradycardia. The neonate survived after an aggressive anti-infection treatment. However, the patient’s condition deteriorated rapidly after the operation and the patient died of disseminated intravascular coagulation and septic shock within 24h after admission. She was finally diagnosed with GAS-TSS. The GAS strains were isolated from two bottles of blood cultures, which confirmed as Streptococcus pyogenes by 16S gene sequencing and identified as serotype M1 by molecular typing. Conclusions Dramatical clinical picture and laboratory characters of the pregnant woman presented here might help improve clinicians' awareness and recognition of Streptococcus pyogenes, which could be of great importance for the early diagnosis of GAS- TSS in pregnancy.

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Group A Streptococcal Toxic Shock Syndrome Developing in the Third Trimester of Pregnancy

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744902000248 ◽

2002 ◽

Vol 10 (4) ◽

pp. 209-216 ◽

Cited By ~ 23

Author(s):

Nancy F. Crum ◽

Helen M. Chun ◽

Thomas G. Gaylord ◽

Braden R. Hale

Keyword(s):

Toxic Shock Syndrome ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Third Trimester ◽

The Third ◽

Group A

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Group A streptococcal toxic shock syndrome with extremely aggressive course in the third trimester

Journal of Obstetrics and Gynaecology Research ◽

10.1111/j.1447-0756.2010.01259.x ◽

2010 ◽

Vol 36 (4) ◽

pp. 852-855 ◽

Cited By ~ 11

Author(s):

Takashi Sugiyama ◽

Takumi Kobayashi ◽

Kenji Nagao ◽

Tsuyoshi Hatada ◽

Hideo Wada ◽

...

Keyword(s):

Toxic Shock Syndrome ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Third Trimester ◽

The Third ◽

Group A

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Streptococcal toxic shock syndrome occurring in the third trimester of pregnancy: A case report

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.13418 ◽

2017 ◽

Vol 43 (10) ◽

pp. 1639-1643

Author(s):

Mohamad Irani ◽

Rodney McLaren ◽

Richard H. Savel ◽

Oksana Bogatyryova ◽

Fady Khoury-Collado

Keyword(s):

Case Report ◽

Toxic Shock Syndrome ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Third Trimester ◽

The Third

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A Patient of Using Presepsin to Diagnose Streptococcal Toxic Shock Syndrome during Anticancer Drug Treatment

Case Reports in Critical Care ◽

10.1155/2019/3240501 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Gaku Takahashi

Keyword(s):

Blood Culture ◽

Toxic Shock Syndrome ◽

Lower Leg ◽

Rapid Progression ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Anticancer Chemotherapy ◽

Successful Recovery ◽

Short Period ◽

Infection Focus

Background. Streptococcal toxic shock syndrome (STSS) is a rapidly progressive infection, with potentially rapid patient deterioration in a very short period. We experienced a rare case of STSS during anticancer chemotherapy, and we continuously measured presepsin (P-SEP) and evaluated its usefulness. Case Presentation. A 60-year-old woman with pulmonary metastasis from cervical cancer began anticancer chemotherapy. A fever of >40°C and right lower leg swelling developed on day 3. Symptoms worsened despite cefmetazole treatment (1.0 g/day). Blood culture was performed without suspecting STSS. On day 5, symptoms worsened and acute disseminated intravascular coagulation (DIC) and sequential organ failure assessment (SOFA) scores increased. C-reactive protein (CRP) increased from 28.8 mg/dl to 35.5 mg/dl and P-SEP also increased from 1,635 to 2,350 pg/mL. STSS was suspected due to the rapid progression of brown discoloration of the entire right lower leg. Ceftriaxone 2 g/day and clindamycin 1,200 mg/day were begun. On the evening of day 5, blood culture revealed rapidly progressive group A streptococci. After that, symptoms improved rapidly with treatment, and SOFA and DIC scores also decreased. While CRP remained at about 0.5 mg/dl, P-SEP remained slightly elevated at about 400 pg/mL. A residual infection focus was suspected. Contrast-enhanced computed tomography (CT) revealed a capsule-enclosed abscess in the right lower leg soleus muscle on day 32. Debridement was performed and antibiotics were continued until P-SEP was 88 pg/mL. CT confirmed the disappearance of the abscess. Conclusion. Prompt diagnosis by blood culture and a sufficiently early, appropriate change in antibiotic therapy led to successful recovery from STSS during anticancer chemotherapy without lower limb amputation. P-SEP was useful in assessment of the residual infection focus and suspending treatments.

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„Tempus fugit, venit mors” – a streptococcalis toxikus sokk szindrómáról egy eset kapcsán

Orvosi Hetilap ◽

10.1556/650.2019.31597 ◽

2019 ◽

Vol 160 (48) ◽

pp. 1887-1893

Author(s):

Bálint Gergely Szabó ◽

Rebeka Kiss ◽

Katalin Szidónia Lénárt ◽

Nikolova Radka ◽

Béla Kádár

Keyword(s):

Toxic Shock Syndrome ◽

Signs And Symptoms ◽

Rapid Progression ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock ◽

Life Threatening Illness ◽

Life Threatening ◽

Group A ◽

High Level ◽

Portal Of Entry

Abstract: Streptococcal toxic shock syndrome (STSS) is a hyperacute, life-threatening illness, a complication of invasive streptococcal (mostly group A, rarely groups B, G or C) infection. There is no portal of entry (skin, vagina, pharynx) in nearly half of the STSS cases. The initial signs and symptoms (fever, flu-like complaints, hypotension) are scarce and aspecific, but because of its rapid progression and poor prognosis, early high level of suspicion is necessary. Management has 3 crucial points: initiation of anti-streptococcal regimen (and intravenous immunoglobulin in some cases), aggressive intensive care support of multi-organ failure, and surgical control of the infective source. In this article, we present a case of a patient succumbing to streptococcal toxic shock syndrome which was preceded by primary S. pyogenes bacteremia, and review the key points of this potentially fatal disease for practising clinicians. Orv Hetil. 2019; 160(48): 1887–1893.

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Streptococcal Toxic Shock Syndrome in the Emergency Department

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0039-3401983 ◽

2020 ◽

Vol 15 (02) ◽

pp. 091-094

Author(s):

Carmina Guitart-Pardellans ◽

Vanessa Arias Constanti ◽

Victoria Trenchs Sainz de la Maza ◽

Nuria Elvira Sanz Marcos ◽

Iolanda Jordan García ◽

...

Keyword(s):

Emergency Department ◽

Toxic Shock Syndrome ◽

Early Stage ◽

Clinical Manifestations ◽

Pediatric Intensive Care ◽

Complete Recovery ◽

Final Diagnosis ◽

Rapid Progression ◽

Streptococcal Toxic Shock Syndrome ◽

Toxic Shock

Abstract Objective Streptococcal toxic shock syndrome (STSS) is a very rare and severe entity from among the invasive diseases caused by Streptococcus pyogenes, whose characteristics, treatment, morbidity, and mortality are little known in pediatrics. The aim of this study was to determine its prevalence and the characteristics of its presentation in the emergency department (ED) in Spain. Methods This is a descriptive and observational study. Patients from 1 month to 18 years of age, admitted to the ED with a final diagnosis of STSS between 2009 and 2014, were included. Patients whose parents or guardians did not allow informed consent were excluded. Results Nine cases were diagnosed (1/100,000 consultations); the median average age was 2 years, and five were girls. No patient had a significant medical history. The most frequent reason for consultation was fever (9/9), followed by respiratory symptoms (6/9). Six presented in the ED with shock. Seven were diagnosed with pleuropneumonia, one with meningitis, and one with necrotizing fasciitis. All patients required admission at the pediatric intensive care unit, mechanical ventilation, and inotropic support. All had a complete recovery. Conclusion STSS is a rare entity in the ED affecting healthy patients who presented respiratory or otorhinolaryngology disease. In our patients, nonspecific clinical manifestations and its rapid progression to shock are shown, meaning the importance of bearing this entity in mind in the emergency room. Understanding the epidemiology and clinical manifestations of this syndrome in our work area helps pediatricians to recognize it and to initiate the appropriate treatment at an early stage, which helps engender a quick and effective approach, essential for a favorable prognosis.

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