Successful Treatment of Both Mother and Infant in Pregnancy-Associated Group A Streptococcal Toxic Shock Syndrome

Abstract

All perinatal cases of group A streptococcal toxic shock syndrome (STSS) previously documented in English literature have been fatal for the mother, the fetus or both. We present the first report of successful treatment of a mother-infant pair with perinatal STSS. A pregnant woman developed STSS at 34 weeks’ gestation 3 h after delivery, following a 25-h history of fever and sore throat. The patient received intravenous penicillin, clindamycin and immnoglobulins and continuous hemodialysis, along with numerous supportive agents during early clinical course. The newborn infant was born with mild asphyxia and developed transient tachypnea. Both mother and infant survived without any sequelae. Streptococcus pyogenes was isolated from the patient’s blood, nasopharynx of the infant and throat of two family members. These strains were identically type T1M1 (emm1) and produced streptococcal pyrogenic exotoxins A (SPEA) and B. SPEA was remarkably elevated in the maternal blood, but not in the infant’s blood. Extremely low serum anti-SPEA antibody levels might have predisposed the mother to severe invasive infection. This case highlights the importance of early recognition, prompt and intensive multimodal therapy and rapid delivery before a transfer of pathogen and its toxin to the fetus.