Postnatal infection due to short-chain hemolytic streptococci

POSTNATAL

INFECTION

DUE

TO SHORT-CHAIN

HEMOLYTtC

STREPTOCOCCI* BY DR. LESTER E. FRANHENTIIAL~

JR., CIIEAGO

M

RS. L. S., twenty-two years of age, para iii, at term, entered the Michael Reese Hospital Maternity Jan. 3, 1933, at 3 : 00 P.M. in active labor. She had been attending the Prenatal Clinic, her last visit being Dec. 19, 3932. Subjectively and objectively she had been normal on all v-isits. One vaginal examination was made upon admission and at 7:40 P.&r. a 2915 gm. male was born spontaneously. There were no lacerations. The placenta was expressed intact at. 7:4G P.M. Noderate postpartum hemorrhage was controlled with one ampule of obstetric pituitrm. At 5 A.M., January 4 the patient had a chill lasting thirty minutes. At 32 noon her temperature was 102.6”, pulse 132, respirations 26. White blood count was 36,500 and urine negative. A blood culture at this time was posit.ive for a shortchain hemolytic streptococcus. Complete physical examination was negative. On January 6 her temperature rose to 104.8”, pulse 144, respirations 36. Red blood count was 4,130,000, hemoglobin 60 per cent, and white cc;unt 24,400 with ‘30 per cent polymorphonuclear leucocytes and 10 per cent lymphocytes. Sedimentation time was twenty minutes. At this time 250 KC. of whole biood were given. Patient had two other transfusions of 250 and 500 C.C. respectively, on January 19 and February 26. A vaginal examination on January 20 revealed a “frozen” pelvis with masses on both sides of the uterus extending halfway up to the umbilicus. She ran a typical septic course but finally became afcbrile. She was discharged from the hospital on March 14, seventy-two days after admission, at which time the only finding of note was a slight thickening of the right adnexa. The baby was breast fed the first day and was then put on artificial feedings. He ran a normal course for two weeks (Jan. 15, 1933), at which time a slight serous discharge was noted from the umbilicus. The following day he began to vomit, became listless, refused his feedings ant1 his temperature rose to 102.4”. The following day he died. Postmortem revealed an acute omphalitis; infected thrombi of generalized acute fibrino-purulcnt umbilical arteries and portal and splenie veins; peritonitis; hyperplasia of the intestinal and mesenteric lymph nodes. Rlood culture from the heart and culture from the peritoneum revealed a short-chain hemolytic streptococcus. On Jan. 20, 1933, the fourteen-month-old son was admitted to the Pediatric Division complaining of cough, pain in the left chest, discharge from the left ear, and temperature, which had been present for three weeks, two days before the mother entered the hospital. Blood cultures taken the next day revealed a shortThe child ran a septic course requiring three blood chain hemolytic streptococcus. transfusions, but was finally discharged from the hospital on March 7, 1933, well on the road to recovery. COSCLUSIONS 1. Very similar short-chain hemolytie streptococci 2. The fourteen-month-old child was coughing two the hospital. 3. Assuming that the infection originally passed we explain the long interval in the newborn before *Presented

at a meeting

of the

Chicago

Gynecological

910

isolated in days before through the the symptoms Society,

each case. the mother

entered

placenta, hOW developed’9 March

17, 1933.

can