2019 Research Forum

Applicant: Christina Sugirtharaj MPH MS IV Principal Investigator: Arash Heidari MD Faculty Sponsor: Greti Petersen MD

Group A Streptococcus Puerperal Sepsis after Spontaneous Abortion

Christina Sugirtharaj MPH MS IV, Andre Sahakian MS IV, Simmer Deep Kaur MD R2, Mandakini Patel MD R3, Greti Petersen MD, Fowrooz Joolhar MD, Arash Heidari MD

INTRODUCTION Group A streptococcal (GAS) puerperal sepsis is a serious and life threatening condition that affects 3 cases per 100,000 population worldwide. The incidence has decreased but at one time it was the leading cause of maternal death. We are describing a case of GAS sepsis post abortion associated with use of sex toy.

PURPOSE We are presenting a case of severe group A septicemia.

DISCUSSION Patient is a 44 year old African American female with hypertension and multiple spontaneous abortions and a stillbirth, presented to the emergency room with fever diarrhea and abdominal pain. She had a spontaneous abortion 3 days earlier. Upon arrival, she was found to be febrile to 102.4 F. CT scan showed a retro uterine abscess of 7 x 4.2 x 5.4 cm. Ultrasound was negative for retained conception products. Blood cultures were obtained and due to allergy to penicillin she was started empirically on Vancomycin and Meropenam. Six out of the eight blood culture bottles subsequently grew Group A Streptococcus. Upon further questioning she confirmed vaginal use of dildo during a sexual encounter a day after her spontaneous abortion while she still had vaginal secretions. This lead to hypothesis of group A strep ascending infection from external genitalia or vagina to produce endometritis with further complication to a retro uterine abscess with adjacent enterocolitis and septicemia. Her abscess was drained by interventional radiology. The fluid gram stain showed many white blood cells with no organisms and cultures did not grow any organism. When blood culture sensitivity came back her antibiotic regimen was narrowed to Levofloxacin 750mg daily to finish 3 weeks course. A repeat CT scan a week later indicated a decrease in size of the abscess. The drain was then subsequently removed due to resolution of the symptoms. Her work up for multiple spontaneous abortions and stillbirth was negative. A follow up clinic visit was made for continuous monitoring of patient. CONCLUSION Group A streptococcus is a life-threatening infection that can lead to maternal mortality. Clinicians should be aware of any ascending route of infection to prevent and treat accordingly.

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