A NEW-TYPE OF FULMINANT GROUP-A STREPTOCOCCAL INFECTION IN OBSTETRIC PATIENTS - REPORT OF 2 CASES

A new type of fulminant group A streptococcal infection in obstetric p atients is described. The illness occurs in late stage of pregnancy, a nd is preceded by an episode of upper respiratory tract infection. Thi s is followed by sudden onset of septicemia, subsequent hematogenous i nfection of the myometrium by the bacteria, and development of acute p urulent myometritis. Shock and multiorgan failure ensue rapidly. Progn osis of both the mother and fetus is very poor, as recognition of this serious condition is difficult until the late stage of the disease. T his type of infection is entirely different from classical puerperal s epsis in that the illness starts before delivery, and that there was n o evidence of ascending bacterial infections of the birth canal, such as acute endometritis or chorioamnionitis, in affected mothers. The un derlying mechanism for this serious infection remains unknown. Copyrig ht (C) 1997 by W.B. Saunders Company.