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Group A Strep Following Birth

Last post 05-31-2012 5:09 PM by pjm. 8 replies.
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  • 07-14-2010 4:17 AM

    Group A Strep Following Birth

    I have a client/student who had a very difficult postpartum period with her last pregnancy about 2 years ago due to complications from Group A strep.  She returned home from the hospital and 3 days later had to be re-admitted with very high fever and was very sick.  After a 48 hr stint, they sent her home on penicillin which she had major reactions to but was told by her doc to stay on it, that the symptoms she was having--diarrhea, vomitting, skin peeling--was not from the antiobiotic but from the Strep A itself. She says that the MD didn't want to see her and that they told her to ride out her symptoms. She was told that they don't know why/how she contracted Strep A and nobody in the household was sick either.  They said that some people carry Strep A just as some carry Strep B and that the stress of labor (it was 36 hrs) was responsible for her immune system to be run down and the Strep to run wild. Breastfeeding was very difficult and her milk supply was almost non-existent for the first 6 weeks.  She nursed successfully from 6 weeks on; still nursing through pregnancy.

    I've looked at the CDC and "normal" sites for info about Strep A and just wonder if she also had the kind of toxic shock that accompanies Strep A.  It blows my mind (that phrase dates me) that her doc did not want to see her and told her to continue with the penicillin despite the side effects. Her husband is a vet and he said that if a dog had those kind of reactions, he would've stopped the antibiotic and tried another one.

    When she asked her doc if this could happen again, the doc nonchalantly said, "Yes, probably.  You probably carry group A strep."  She is traumatized by her first experience and wants to know if there's anything she can do now to reduce the risk of her getting strep A this time around.  I'm not seeing anything on the internet specific to pregnancy; only Group B when I put in a search for A.

    Anyone hear of this kind of thing?  Recurrence likely during posptartum?  Prophylactics?

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 07-15-2010 1:28 AM In reply to

    Re: Group A Strep Following Birth

    I really can't answer your questions, but felt I had to comment on this Group A strep infection because of a maternal death after a home birth about 2 years ago in an Indiana Mennonite community.  Approximately 2 days after giving birth at home a woman came down with flu-like symptoms (many of her children were sick with the same flu) severe enough to go to the hospital.  At that time, all her organ systems were shutting down and she died.  Her autopsy showed a uterine Strep A infection.  I spoke with the midwife involved in this case and received a letter from her after the autopsy.  I don't think this Strep A infection is something to ignore.  Coincidentally, in the same month, in the same community,  another Amish woman died after a home birth of pneumonia. 

  • 07-15-2010 6:30 AM In reply to

    Re: Group A Strep Following Birth

    Wow. Scary stuff!  Docs told this mama she is a carrier and that she couldn't have gotten the infection from the hospital itself and will most likely have it again which is scaring the patooty out of her.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 07-15-2010 12:26 PM In reply to

    • midwifea
    • Top 10 Contributor
    • Joined on 02-12-2009
    • Kailua Kona, HI
    • Posts 475

    Re: Group A Strep Following Birth

    Group A strep is rare and virile and her best chance for a non repeat of her first postpartum is to support her immune sytem, heavily, and reduce stress and intervention during her birth.  Calm, sweet birthing and nursing.  What are her birth plans?

    Blessings,
    April
    moderator

    "The Voice

    There is a voice inside of you
    That whispers all day long,
    "I feel this is right for me,
    I know that this is wrong."
    No teacher, preacher, parent, friend
    Or wise man can decide
    What's right for you--just listen to
    The voice that speaks inside."
    — Shel Silverstein
  • 07-15-2010 9:36 PM In reply to

    Re: Group A Strep Following Birth

    She's planning another hospital birth and staying home as long as possible.  She has chosen to stay with a fairly aggressive obstetrical group and "calm, sweet birthing" isn't what they're all about.  Most of my students get more confident and calmer as they near the end of the class, but this mama is getting more anxious and fidgety.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 07-21-2010 4:58 AM In reply to

    Re: Group A Strep Following Birth

    My midwife talked about a strep A postpartum death - it could have been the same one though, probably not as we're in the UK, but she's an IM and definitely keeps her finger on the pulse so it's possible.  She also said Strep A seems to be becoming more prevalent for some reason.

    Her anxiety doesn't sound good- stress is NOT good for the immune system!  Would she consider a homebirth?  Or a midwife supported birth?  Will you be doula-ing her?

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 07-21-2010 6:39 PM In reply to

    Re: Group A Strep Following Birth

    No, they will not consider birthing at home. Sad And no, the stress is not good and another no for doula support.  She hasn't asked me and I don't want to push the issue.

    Susan
    Moderator

    I get up every morning determined to both change the world and have one hell of a good time. Sometimes this makes planning my day difficult. --E.B. White
  • 07-22-2010 12:36 PM In reply to

    Re: Group A Strep Following Birth

    Hugs to you.  Bless you for trying to help this lady.  Sometimes all we can really do is support and listen as much as others want.  You're wonderful for doing this research for her.

    Me 32, DH 41, DD 2006, DD 2010, DS 2013
  • 05-31-2012 5:09 PM In reply to

    • pjm
    • Not Ranked
    • Joined on 05-31-2012
    • Posts 1

    Strep Problems Following Birth

    Hello -

    My children are now in their twenties, but at the time of my pregnancies, I encountered rare strep related problems during the months following each pregnancy. Although I did (and still do) follow a healthy lifestyle that includes moderate exercise and a non-meat diet supplemented by vitamins, each pregnancy seemed to reduce my immune system to a level that could not balance the strep bacteria that normally reside in and on the human body. As a result, I developed persistent strep throat and skin infections that required repeated antibiotic treatment.

     

    The strep throat appeared after birth of my first child. I had never had strep throat previously. The infection was treated with normal course of antibiotic, but within 48 hours of taking the last pill, the sore throat and white spots came back. I'd had to wait a couple days to get another appointment with the doctor. By then, the infection was raging ahead. This same cycle repeated itself for about four months, with each occurrence much worse than the previous, leaving me totally exhausted. I realized the prescription wasn't fully killing off the bacteria .... that I either needed a different, stronger antibiotic OR a longer cycle of taking it. Finally I was able to receive the requested longer prescription, which kept me on the antibiotic for 4 cycles. That DID succeed! Thus, by the time my child was a year old, I did finally beat strep throat.

     

    Skin infections occurred during the six-months nursing period that followed each pregnancy. My pores seemed to become inflamed for no apparent reason, advancing within a day or two into oozing enlarged cysts with pore openings of 1/4-1/2 inch, surrounded by pealing, inflamed skin. The infection traveled very quickly. One day I'd notice a small painful bump on my leg, or under my arm. The next day it would be worse, with pore opening at 1/4 in wide. By the following day, it would be unbelievably painful, with visible sight of the infection travel line as it advanced forward in my body.

     

    It was very painful and frightening. Doctors didn't know what it was, so they simply prescribed antibiotic treatment. One actually accused me of creating the wounds myself, which beyond being absurd, was heartbreaking, for what chance did I have of finding a cure if the doctor erroneously believed it to be self-inflicted! In one case, the infection happened on a weekend, when doctor's offices were closed. The infection spread so quickly that I could not wait until Monday. The over-crowded hospital emergency room had a three hour wait time. I waited for a while, but the inflamed leg was much too sore, so I attempted to go home where I could lay down. As I exited, the emergency room nurse ran out the door after me, telling me the leg was turning gangrene and I could not leave. I explained that I could not stand on it any longer. She asked me to wait. She ran back into the emergency room, and emerged a few minutes later with a script for an antibiotic, instructing that I begin taking it right away, and get to a doctor on Monday.

     

    The antibiotics did help, but I was unhappy taking so many antibiotics, which throw off the normal flora of one's healthy body. Rather than treat the symptom, I wanted to find someone who would diagnose the problem, which would allow a solution without need of antibiotics. With that in mind, I saw many different doctors during the many reoccurances, including my GYN, dermatologists, general practitioners, emergency room specialists, etc. No one knew what it was. It was a very frustrating time period; the constant illness and pain drained my energy, which ruined ability to enjoy being a new mother period.

     

    Years later, while waiting in line at a grocery store, I picked up a magazine to fill time. An article was titled "What they don't tell you about pregnancy". The article was only half page, but described discovery of a strep related auto-immune syndrome that occurs after pregnancy in some (not all) women. The syndrome causes strep related infections ranging from skin disturbances, to strep throat, to rapid tooth decay, etc. All are caused by overgrowth of strep A and B bacteria. That overgrowth does occurs during and after pregnancy. For some women, pregnancy, delivery, and nursing cause enough stress to lower the immune system, which opens the door to the strep related problems.

     

    I now realize I was very lucky. My experience was not pleasant, but at least the bacteria DID respond to antibiotic treatment. In recent years, research has revealed overuse of antibiotics has caused infectious mutations, with new strains of bacteria that are resistant to antibiotics. That includes the strep based necrotizing fasciitis (flesh eating disease), which does not respond to antibiotic treatment.

     

    Pregnant women and women who have recently given birth are more susceptible to necrotizing fasciitis. Although it is still rare, it is a condition that has emerged as a new and growing problem following childbirth.

     

    That is why your client's doctor did not want to see her. No doubt, the doctor knew of these developments and feared her symptoms might be  necrotizing fasciitis. (See links below, which show medical reports on this condition for over a decade!) He obviously feared contact with the contagious bacteria, or perhaps feared litigation if things went bad with treatment of it.

     

    The disease does not actually consume flesh. It separates the connecting layers that underlie human skin, which cuts off blood flow and causes tissue to die. It spreads very quickly.

     

    More information is provided in the links below. The links cover information on both A and B types.

     

    Strep bacteria - http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_g.htm

     

    Necrotizing Fasciitis -

    http://www.nnff.org/nnff_what.htm

    http://www.medicinenet.com/necrotizing_fasciitis/page7.htm

    http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002415/

    http://www.nejm.org/doi/full/10.1056/NEJM199712043372318

     

    Necrotizing Fasciitis in Pregnant Women - http://www.healthline.com/health/pregnancy/infections-necrotizing-fasciitis

    2003 - Higher Risk Groups for Necrotizing Fasciitis  - http://www.nnff.org/nnff_higherrisk.htm

    1997 - Incidents of Necrotizing Fasciitis -  http://journals.lww.com/greenjournal/Abstract/1997/03000/Necrotizing_Fasciitis_After_Cesarean_Delivery.18.aspx

     

    JAMA medical journal - March 1988 - Note the statement that says it occurs most often in diabetics, pregnant women, and infants.

    "Group B streptococcal infections occur disproportionately in diabetics and pregnant women. Although fasciitis secondary to group B streptococcus has been described in infants and adult women in the postpartum period, we report the first case, to our knowledge, of group B streptococcal necrotizing fasciitis in an adult diabetic unrelated to obstetric complications."

    http://archinte.jamanetwork.com/article.aspx?volume=148&issue=3&page=727

     

    Recent cases:

    Multiple people - http://www.msnbc.msn.com/id/47513691/ns/local_news-houston_tx/t/what-causes-flesh-eating-bacteria-cases/#.T8gHNb-Rk3Y

     

    May 2012 - South Carolina Woman

    http://todayhealth.today.msnbc.msn.com/_news/2012/05/17/11745825-early-notice-of-flesh-eating-bacteria-may-have-saved-mom?lite

    http://www.cbsnews.com/8301-504763_162-57436196-10391704/new-case-of-flesh-eating-bacteria-reported-in-s.c-mom/

     

    June 2012 - England

    http://www.dailymail.co.uk/health/article-7784/I-beat-flesh-eating-disease.html

     

    2011 - Katy Hayes Story

    http://www.huffingtonpost.com/2012/05/30/katy-hayes-double-arm-transplant-flesh-eating-bacteria_n_1556021.html?icid=maing-grid7|main5|dl19|sec1_lnk3%26pLid%3D165364#s=1035007

     

    2012 - Amy Copeland

    http://www.cnn.com/2012/05/17/health/flesh-eating-bacteria-explainer/index.html

    .

     

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