title: Streptococcal toxic shock syndrome secondary to group A Streptococcus vaginitis.
abstract: Streptococcal toxic shock syndrome (TSS) is a systemic illness usually caused in the setting of infection by group A Streptococcus (GAS). The primary infections are often invasive infections of the respiratory tract or necrotizing infections of the skin and soft tissue, but some infections occur without relevant focus. GAS vaginitis is a rare condition among adult women and is accordingly thought to be uncommon as a cause of streptococcal TSS. Here we report the cases of two postmenopausal women with streptococcal TSS secondary to GAS vaginitis, one aged 55 and one aged 60. Both came to our emergency department with complaints or symptoms of abdominal pain, fever, hypotension, and multi-organ failure. In both cases, the relevant factor associated with streptococcal infection was a recent episode of GAS vaginitis. Both underwent fluid management and 14 days of antibiotic treatment and fully recovered without complications. Vaginitis was likely to be the primary infectious trigger of TSS in these two cases. Intrauterine device insertion, endometrial biopsy, and post-partum state have all been previously reported in TSS patients, and the female genital tract has been described as a portal of entry. GAS vaginitis warrants appropriate treatment as it may progress to severe systemic infection as described.
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan. Electronic address: mayuhikone@nifty.com.
authors.forename: Mayu
authors.initials: M
authors.lastname: Hikone
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Ken-Ichiro
authors.initials: K
authors.lastname: Kobayashi
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Washino
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Infectious Disease, Tokyo Metropolitan Bokutoh General Hospital, Tokyo, Japan.
authors.forename: Sentaro
authors.initials: S
authors.lastname: Iwabuchi
authors.affiliation: Tokyo Metropolitan Health and Medical Corporation Ebara Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohnishi
mesh_terms: D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D008875:Middle Aged; D012772:Shock, Septic / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification*; D016585:Vaginosis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy
keywords: Group A Streptococcus; Streptococcal toxic shock syndrome; Vaginitis