title: A new type of fulminant group A streptococcal infection in obstetric patients: report of two cases.
abstract: A new type of fulminant group A streptococcal infection in obstetric patients is described. The illness occurs in late stage of pregnancy, and is preceded by an episode of upper respiratory tract infection. This is followed by sudden onset of septicemia, subsequent hematogenous infection of the myometrium by the bacteria, and development of acute purulent myometritis. Shock and multiorgan failure ensue rapidly. Prognosis of both the mother and fetus is very poor, as recognition of this serious condition is difficult until the late stage of the disease. This type of infection is entirely different from classical puerperal sepsis in that the illness starts before delivery, and that there was no evidence of ascending bacterial infections of the birth canal, such as acute endometritis or chorioamnionitis, in affected mothers. The underlying mechanism for this serious infection remains unknown.
authors.affiliation: Department of Pathology and Laboratory, Medicine, and Obstetrics and Gynecology, Asahi General Hospital, Asahi City, Chiba, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Ooe
authors.forename: H
authors.initials: H
authors.lastname: Udagawa
mesh_terms: D000328:Adult; D001426:Bacterial Proteins; D002824:Chorionic Villi / Q000737:chemistry / Q000382:microbiology / Q000473:pathology; D005098:Exotoxins / Q000032:analysis; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008565:Membrane Proteins; D009215:Myometrium / Q000737:chemistry / Q000382:microbiology / Q000473:pathology; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000382:microbiology* / Q000473:pathology*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000473:pathology*; D013297:Streptococcus pyogenes; D014591:Uterine Diseases / Q000382:microbiology* / Q000473:pathology*
chemical_list: D001426:Bacterial Proteins; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin