Pregnancy-related group a streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome

Abstract

Puerperal sepsis caused by group A Streptococcus (GAS) remains an important cause of maternal and infant mortality worldwide, including countries with modern antibiotic regimens, intensive care measures and infection control practices. To provide insights into the genesis of modern GAS puerperal sepsis, we reviewed the published cases and case series from 1974 to 2009, specifically seeking relationships between the likely source of pathogen acquisition, clinical signs, and symptoms at infection onset and patient outcomes that could provide clues for early diagnosis. Results suggest that the pathogenesis of pregnancy-related GAS infections in modern times is complex and not simply the result of exposure to GAS in the hospital setting. Additional research is needed to further explore the source of GAS, the specific M types involved, and the pathogenesis of these pregnancy-related infections to generate novel preventative and therapeutic strategies.

Keywords: Streptococcus pyogenes; postpartum sepsis; pregnancy.

Figure 1.

Distribution of cases of pregnancy-associated Group A Streptococcus (GAS) infection. A literature search was performed for clinical reports of pregnancy-related GAS infections occurring either during pregnancy or the postpartum period using the PubMed database for the period 1974–2009. The search produced 43 reports describing 67 patients. Ten of these 67 patients (15%) developed GAS infection during pregnancy, 9 of whom were in the third trimester (weeks 28–42). Of the remaining 57 postpartum cases, the time of onset was reported in 51 cases.