Infections caused by Streptococcus pyogenes are important in pregnant women. his organism is the most frequent bacterial cause of acute pharyngitis and is associated with several systemic and cutaneous infections. S pyogenes produces numerous toxins and enzymes responsible for its local and systemic toxicity. Pyrogenic exotoxin-producing strains are usually associated with severe disease (Shinar, 2016; Wessels, 2015). In most cases, streptococcal pharyngitis, scarlet fever, and erysipelas are not life threatening. Treatment, usually with penicillin, is similar in pregnant and nonpregnant women.
In the United States, S pyogenes infrequently causes puerperal infection. Still, it remains the most common cause of severe maternal postpartum infection and death worldwide, and the incidence of these infections is rising (Deutscher, 2011; Hamilton, 2013; Wessels, 2015). Puerperal infections are discussed in detail in Chapter 37. he early 1990s saw the emergence of streptococcal toxic shock syndrome, manifested by hypotension, fever, and evidence of multiorgan failure with associated bacteremia. Group A puerperal sepsis is seriously complicated in 20 percent of cases (Shinar, 2016). The case-fatality rate approximates 30 percent, and morbidity and mortality rates are improved with early recognition. Treatment includes clindamycin plus penicillin therapy and often surgical debridement (Chapter 47, p. 924). No vaccine for group A streptococcus is commercially available.
Streptococcus agalactiae is a group B organism that can be found to colonize the gastrointestinal and genitourinary tract in 10 to 25 percent of pregnant women (Kwatra, 2016). Throughout pregnancy, group B Streptococcus (GBS) is isolated in a transient, intermittent, or chronic fashion. Although the organism is most likely always present in these same women, their isolation is not always homologous.
he spectrum of maternal and fetal G BS efects ranges from asymptomatic colonization to septicemia. S agalactiae has been implicated in adverse pregnancy outcomes that include preterm labor, prematurely ruptured membranes, clinical and subclinical chorioamnionitis, and fetal infections (Randis, 2014). GBS can also cause maternal bacteriuria, pyelonephritis, osteomyelitis, postpartum mastitis, and puerperal infections. It remains the leading infectious cause of morbidity and mortality among infants in the United States (Centers for Disease Control and Prevention, 2010; Schrag, 2016).
Neonatal sepsis has received the most attention due to its devastating consequences and available efective preventative measures. Infection <7 days after birth is deined as eary-onset disease and is seen in 0.21/1000 live births (Centers for Disease Control and Prevention, 2015). Many investigators use a threshold of <72 hours of life as most compatible with intrapartum acquisition of disease (Stoll, 2011). We and others have also encountered unexpected intrapartum stillbirths from GBS infections (Nan, 2015). Tudela and associates (2012) reported that newborns with early-onset CBS infection often had clinical evidence of fetal infection during labor or at delivery.