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Case Reports
. 1994 Nov;5(6):276-81.
doi: 10.1155/1994/834746.

Group A streptococcal endometritis: Report of an outbreak and review of the literature

Z A Memish  1 , D Gravel-Tropper, C Oxley, B Toye, G E Garber
Affiliations
Case Reports

Group A streptococcal endometritis: Report of an outbreak and review of the literature

Z A Memish et al. Can J Infect Dis. 1994 Nov.

Abstract
in English, French

Two cases of group A streptococcus (gas) postpartum endometritis were diagnosed within 24 h following uncomplicated vaginal delivery. Investigation by the infection control service identified all 10 obstetric personnel who performed any invasive procedure on both cases. These personnel were questioned about a recent history of sore throat, skin lesions, vaginal or rectal symptoms. Throat and rectal cultures were obtained for gas from all 10 personnel. A carrier was identified among the personnel screened. This nurse was removed from direct patient care and treated with a two-week course of oral clindamycin and rifampin with documentation of carrier eradication of gas at the end of therapy, 30 days, 60 days and six months post-treatment. All three isolated strains were identical by restriction endonuclease analysis and by M and T typing. Rapid implementation of infection control measures were successful in arresting this outbreak, with no further cases of gas occurring in the subsequent year.

Deux cas d’endométrite post-partum à streptocoque du groupe A ont été diagnostiqués à l’intérieur d’une période de 24 heures après des accouchements par voies naturelles. Les recherches effectuées par le service de prévention des infections ont identifié 10 membrcs du personnel ayant procédé à des examens effractifs chez les deux parturientes. Ces personnes ont été interrogées sur de possibles antécédents récents de maux de gorge, de lésions cutanées ou de symptômes vaginaux ou rectaux. Des cultures de gorge et de selles ont été obtenues pour le dépistage du streptocoque du groupe A auprés des dix personnes examinées. Une porteuse a été identifiée parmi elles. Cette infirmière a été écartée des soins directs aux parturientes et traitées durant deux semaines par clindamycine et rifampin; 1’éradication du pathogène a été obtenue chez cette porteuse à la fin du traitement et 30 jours, 60 jours puis six mois après le traitement. Les trois souches isolées étaient identiques selon l’analyse de l’endonucléase de restriction et les typages M et T. L’application rapide de mesures de lutte contre l’infection a réussi à enrayer cette épidémie, aucun autre cas d’infection à streptocoque du groupe A ne s’étant déclaré au cours de l’année suivante.

Keywords: Endometritis; Infection control; Streptococcus pyogenes.

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Figures

Figure 1
Figure 1
Restriction enzyme analysis patterns following digestion of extracted DNA with Hind III. Lanes 1 and 2 are control group A streptococcus (GAS) strains that are not epidemiologically linked. Lanes 3 to 5 are the GAS isolates from the two cases and the rectal carrier
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