Two Cases of Delayed Diagnosis of Postpartal StreptococcalToxic Shock Syndrome

[摘要] Background:Puerperal sepsis due to group A β-hemolytic streptococcal (GAS) toxic shock syndrome isassociated with very high morbidity and mortality. Luckily it is now rare, but diagnosis is not always easy. Thisreport demonstrates the problem of recognizing this disease, and summarizes the current knowledge on thepathomechanism and management of streptococcal toxic shock syndrome.Case:Two cases of postpartum streptococcal toxic shock syndrome due to GAS are described. In both casesthe correct diagnosis was delayed for several days. The first patient was sent home with the diagnosis of Germanmeasles; the second patient was transferred to our neurological intensive care unit with the diagnosis of meningitis.Both patients were admitted to the intensive care unit in profound shock, both developed multiple organ failure,and one patient died.Conclusions:GAS may produce virulence factors that cause host tissue pathology. Besides aggressive modernintensive care treatment, early diagnosis and correct choice of anti-streptococcal antibiotics are crucial. A possibleadverse effect of non-steroidal anti-inflammatory agents requires confirmation in a multicenter study.

[学科分类] 妇产科学