{
    "abstract": "To clarify the infection route in maternal death due to invasive group A streptococcal (GAS) infection and toxic shock syndrome (TSS).\nA retrospective study was conducted on maternal deaths due to GAS-TSS in Japan between January 2010 and March 2024. The final causal diagnosis of maternal death and the infection routes of GAS were analysed using medical records, laboratory data and autopsy findings.\nAmong the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023.\nMost antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.",
    "authors": [
        {
            "affiliation": "Department of Perinatal Developmental Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan. Electronic address: dr.hasejun@outlook.com.",
            "firstname": "Junichi",
            "initials": "J",
            "lastname": "Hasegawa"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.",
            "firstname": "Akihiko",
            "initials": "A",
            "lastname": "Sekizawa"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan.",
            "firstname": "Hiroaki",
            "initials": "H",
            "lastname": "Tanaka"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Miyazaki University School of Medicine, Miyazaki, Japan.",
            "firstname": "Shinji",
            "initials": "S",
            "lastname": "Katsuragi"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan.",
            "firstname": "Kayo",
            "initials": "K",
            "lastname": "Tanaka"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.",
            "firstname": "Masahiko",
            "initials": "M",
            "lastname": "Nakata"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.",
            "firstname": "Eijiro",
            "initials": "E",
            "lastname": "Hayata"
        },
        {
            "affiliation": "Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan.",
            "firstname": "Takeshi",
            "initials": "T",
            "lastname": "Murakoshi"
        },
        {
            "affiliation": "Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan.",
            "firstname": "Isamu",
            "initials": "I",
            "lastname": "Ishiwata"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan.",
            "firstname": "Tomoaki",
            "initials": "T",
            "lastname": "Ikeda"
        }
    ],
    "conclusions": "Most antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.",
    "copyrights": "Copyright \u00a9 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/j.ijid.2024.107154",
    "journal": "International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases",
    "keywords": [
        "GAS",
        "Invasive group A streptococcus",
        "Maternal death",
        "Perinatal outcomes",
        "Toxic shock syndrome"
    ],
    "methods": null,
    "publication_date": "2024-06-28",
    "pubmed_id": "38936654",
    "results": "Among the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023.",
    "title": "Infection route associated with invasive group A streptococcal toxic shock syndrome in maternal deaths: Nationwide analysis of maternal mortalities in Japan.",
    "xml": "<Element 'PubmedArticle' at 0x788502bbd030>"
}