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Infectious Diseases in Obstetrics and Gynecology
Volume 10, Issue 4, Pages 217-222
http://dx.doi.org/10.1155/S106474490200025X

Two Cases of Delayed Diagnosis of Postpartal Streptococcal Toxic Shock Syndrome

Clinic for Anesthesiology and Intensive Care Medicine, Friedrich-Schiller University, Bachstr. 18, Jena 07743, Germany

Received 20 February 2002; Accepted 31 May 2002

Copyright © 2002 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Puerperal sepsis due to group A β-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.

Case: 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.

Conclusions: 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.