14th ICID - Poster Abstracts - International Society for Infectious ...

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When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 79.006 Session: Obstetrical-Gynecological, Surgical and Sexually Transmitted Infections Date: Friday, March 12, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Puerperal group A streptococci (GAS) infection: Re-emergence of a dreaded disease - A case series M. T. Busowski 1 , M. Lee 2 , J. D. Busowski 1 , K. Akhter 1 , M. R. Wallace 1 1 Orlando Health, Orlando, FL, USA, 2 Winnie Palmer Hospital for Women and Babies, Orlando, FL, USA Background: Puerperal sepsis due to GAS was responsible for two-thirds of deaths among childbearing women in the 18th and 19th centuries. This once feared complication of childbirth has declined throughout the twentieth century. Infection by GAS is now a rare cause of maternal morbidity and mortality. Recent sporadic reports in the literature indicate there may be a resurgence of serious infections caused by GAS. Methods: We report on four late term pregnancies complicated by GAS infection resulting in either necrotizing infection or sepsis and profound multiorgan system failure (MOF). Results: A 19 year old primagravida presented at 27 weeks with severe abdominal pain and vaginal discharge. Exam revealed extensive posterior cervical necrosis with culture confirmed GAS. She was treated successfully with penicillin. A 27 year old woman developed severe sepsis one day following a vaginal delivery. Vaginal and blood cultures were positive for GAS. She required massive volume resuscitation and pressor support. She was treated with ampicillin-sulbactam and clindamycin and recovered without sequela. A 31 year old woman presented seven days after an uneventful vaginal delivery complaining of burning abdominal pain. She was found to be hypotensive with profound sepsis. Emergent laporatomy revealed extensive myometrial infarction and necrosis with confirmed GAS infection. Her ICU course was complicated by MOF with acute renal and hepatic insufficiency and thrombocytopenia. A forth, and nearly fatal puerperal GAS infection involved a young woman who presented five days after a vaginal delivery with fever, chills, and abdominal pain. Her prolonged hospital course was complicated by MOF and peripheral necrosis, with loss of limbs. Conclusion: This report highlights the return of serious GAS puerperal sepsis. The fulminant nature of GAS sepsis poses important diagnostic and therapeutic challenges. Recent reports suggest GAS remains a formidable pathogen late in pregnancy and raises the question of whether GAS should be included in antenatal screening programs. The presence of GAS in vaginal culture may have significant clinical implications. The pathogenicity and capacity of this organism to cause overwhelming, life-threatening infection warrants further study to determine the true incidence of vaginal contamination in late pregancny and the potential efficacy of antibiotic prophylaxis.
When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 79.007 Session: Obstetrical-Gynecological, Surgical and Sexually Transmitted Infections Date: Friday, March 12, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Potential impact of spouse’s circumcision on herpes simplex virus type 2 prevalence among antenatal women in five northeastern states of India B. Borkakoty 1 , D. Biswas 1 , K. Walia 2 , J. Mahanta 1 1 Regional Medical Research Centre for NE Region, ICMR, Dibrugarh, Assam, India, 2 INDIAN COUNCIL OF MEDICAL RESEARCH , NEW DELHI - 110029, Delhi, India Background: Herpes simplex virus type 2 (HSV-2), the most common cause of genital ulcer disease worldwide has shown increasing evidence to have synergistic activity on human immunodeficiency virus (HIV) acquisition by two fold or more. So, there was a need to know the prevalence of HSV-2 to develop intervention strategy especially in the high HIV prevalent states of northeast India. A study was therefore conducted among antenatal women to assess the prevalence of HSV-2 infection as well the role of spouse's circumcision on HSV-2 prevalence. Methods: A total of 1640 antenatal women from five different northeastern states of India, namely Assam, Arunachal Pradesh, Manipur, Meghalaya and Mizoram with diverse ethnic background were enrolled after informed consent. They were screened for IgG antibody status against HSV-2 using HerpeSelect 2 ELISA IgG kits form Focus Diagnostics, USA. A structured questionnaire was used to evaluate different risk variables. Results: The median age of the subjects was 24 years (SD±4.8) with inter quartile age of 22-28 years. The overall prevalence of HSV-2 (IgG) positive was 8.6%, while prevalence was highest in Arunachal Pradesh (15%) and was lowest in Manipur (2.74%). There was a significant association of HSV-2 infection with history of vaginal discharge with pelvic pain (p=0.0001) and genital ulcer (p=0.02). Regular condom user’s had a low HSV-2 prevalence of 1 % compared to 10.3 % in infrequent or non-condom users (OR=11.1, 95% C.I.= 3.5 – 35.2, p
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