title: Maternal and Fetal Death following Group A Streptococcal Meningitis in Mid-Term Pregnancy.
abstract: Background. Group A streptococcal (GAS) meningitis is rarely seen in the antenatal period, but it is associated with significant mortality. We present a case of a mid-trimester woman who developed fulminant meningitis following a rapid onset atypical presentation of infection with this organism. Case. A multiparous 23(+5)-week woman presented with a 10-day history of a non-productive cough associated with pyrexia. Within minutes of her admission she collapsed and lost consciousness; sepsis was suspected and cross-specialty care was initiated. She was managed empirically in extremis with broad-spectrum antibiotics and mannitol with 3% hypertonic saline for suspected infection and raised intracranial pressure, respectively. Despite intensivist management, a CT head revealed diffuse oedema with coning of the cerebellar tonsils. Brainstem death was certified within 19 hours of admission and fetal death ensued. Postmortem bacteriology confirmed GAS meningitis. Conclusion. Through raising awareness of this patient and her disease course, we hope that future policy decisions, primary care, and hospital level management will be informed accordingly for treatment of pregnant women with suspected GAS infection.
authors.affiliation: Imperial College School of Medicine, Imperial College London, London SW7 2AZ, UK.
authors.forename: Sayinthen
authors.identifier: 0000-0002-1506-5128
authors.initials: S
authors.lastname: Vivekanantham
authors.affiliation: Imperial College School of Medicine, Imperial College London, London SW7 2AZ, UK.
authors.forename: Nadeesha
authors.identifier: 0000-0003-3873-4213
authors.initials: N
authors.lastname: Mudalige
authors.affiliation: The Devonshire Lodge Practice, 12A Abbotsbury Gardens, Eastcote, London HA5 1TG, UK.
authors.forename: Venothan
authors.identifier: 0000-0003-4741-1619
authors.initials: V
authors.lastname: Suri
authors.affiliation: King's College London, Strand Campus, London WC2R 2LS, UK.
authors.forename: Abderahman
authors.initials: A
authors.lastname: Kamaledeen
authors.affiliation: The Hillingdon Hospital, Uxbridge, London UB8 3NN, UK.
authors.forename: Penelope
authors.initials: P
authors.lastname: Law