妊娠中のGBS感染による母体敗血症の死産児に劇症型溶血性連鎖球菌感染症様所見を認めた一例
GBSを原因とする妊産婦敗血症は，大腸菌に次ぐ頻度で生じ分娩中の発症が最も多いが妊娠中に生じることは少ない．また妊娠中の母体敗血症はIUFDの原因となり得るが，GBSの胎内感染を伴うIUFDは稀であり，その臨床像に関する詳細な報告はほとんどない．今回基礎疾患のない妊婦で腟内GBSの上行性感染から母体敗血症，絨毛膜羊膜炎，IUFDに至り，児に胎内感染とSTSS様の病態を生じた症例を経験したので報告する． 症例は3妊1産の24歳女性で，妊娠27週に発熱と感冒様症状が出現し発熱後8時間でIUFDに至った．腟分泌物，母体血液，胎盤絨毛膜，臍帯静脈血からGBSが検出され，死産児には紅斑性皮膚病変，胸腹水...
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| Published in | 日本周産期・新生児医学会雑誌 Vol. 56; no. 3; pp. 496 - 500 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本周産期・新生児医学会
2020
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1348-964X 2435-4996 |
| DOI | 10.34456/jjspnm.56.3_496 |
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| Abstract | GBSを原因とする妊産婦敗血症は，大腸菌に次ぐ頻度で生じ分娩中の発症が最も多いが妊娠中に生じることは少ない．また妊娠中の母体敗血症はIUFDの原因となり得るが，GBSの胎内感染を伴うIUFDは稀であり，その臨床像に関する詳細な報告はほとんどない．今回基礎疾患のない妊婦で腟内GBSの上行性感染から母体敗血症，絨毛膜羊膜炎，IUFDに至り，児に胎内感染とSTSS様の病態を生じた症例を経験したので報告する． 症例は3妊1産の24歳女性で，妊娠27週に発熱と感冒様症状が出現し発熱後8時間でIUFDに至った．腟分泌物，母体血液，胎盤絨毛膜，臍帯静脈血からGBSが検出され，死産児には紅斑性皮膚病変，胸腹水といったSTSS様の所見を認めた． 腟内GBSの保菌妊婦では分娩時の垂直感染だけではなく，稀に妊娠中の母体敗血症や胎内感染を伴うIUFDを生じ，さらには児にSTSS様の病態を生じ得ることが示された． |
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| AbstractList | GBSを原因とする妊産婦敗血症は，大腸菌に次ぐ頻度で生じ分娩中の発症が最も多いが妊娠中に生じることは少ない．また妊娠中の母体敗血症はIUFDの原因となり得るが，GBSの胎内感染を伴うIUFDは稀であり，その臨床像に関する詳細な報告はほとんどない．今回基礎疾患のない妊婦で腟内GBSの上行性感染から母体敗血症，絨毛膜羊膜炎，IUFDに至り，児に胎内感染とSTSS様の病態を生じた症例を経験したので報告する． 症例は3妊1産の24歳女性で，妊娠27週に発熱と感冒様症状が出現し発熱後8時間でIUFDに至った．腟分泌物，母体血液，胎盤絨毛膜，臍帯静脈血からGBSが検出され，死産児には紅斑性皮膚病変，胸腹水といったSTSS様の所見を認めた． 腟内GBSの保菌妊婦では分娩時の垂直感染だけではなく，稀に妊娠中の母体敗血症や胎内感染を伴うIUFDを生じ，さらには児にSTSS様の病態を生じ得ることが示された． |
| Author | 田丸, 俊輔 難波, 聡 鷹野, 夏子 三木, 明徳 亀井, 良政 |
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| References | 2) Miyata A, Takahashi H, Kubo T, et al.：Early‒onset group B streptococcal disease following culture‒based screening in Japan：A single center study. J Obstet Gynaccol Res 2012；38：1052-1056 4) Bone RC, Balk RA, Cerra FB, et al.：Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101；1992：1644-1655 6) Page JM, Bardsley T, Thorsten V, et al.：Stillbirth Associated With Infection in a Diverse U.S. Cohort. Obstetrics & Gynecology 2019；134（6）：1187-1196 11) Ikebe T, Chiba K, Shima T, et al.：Evaluation of streptococcal toxic shock-like syndrome caused by group B streptococcus in adults in Japan between 2009 and 2013. J infect Chemother 2015；21（3）：207-11 3) Knowles SJ, O’Sullivan NP, Meenan AM, et al.：Maternal sepsis incidence, aetiology and outcome for mother and fetus：a prospective study. BJOG 2014；121（13）：1755-6 7) Bae GE, Yoon N, Choi M, et al.：Acute Placental Villitis as Evidence of Fetal Sepsis：An Autopsy Case Report. Pediatric and Developmental Pathology 2016；19：165-168 12) Randis TM, Gelber SE, Hooven TA, et al.：Group B Streptococcus β-hemolysin/cytolysin breaches maternal-fetal barriers to cause preterm birth and intrauterine fetal demise in vivo. J infect Dis 2014；210（2）：265-73 8) Wojtera M, Cheng H, Fiorini K, et al.：Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants A Systematic Review. The Pediatric Infectious Disease Journal 2018；37（9）：e241-e245 10) Tang WM, Ho PL, Tau WP, et al.：Report of 2 Fatal Cases of Adult Necrotizing Fasciitis and Toxic Shock Syndrome Caused by Streptococcus agalactiae. Clin infect Dis 2000；31（4）：E15-7 1) Verani JR, McGee L, Schrag SJ, et al.：Prevention of perinatal group B streptococcal disease‒revised guidelines from CDC, 2010. MMWR Recomm Rep 2010；59：1-36 9) Shimizu Y, Igarashi H, Murai T, et al.：Report of Surveillance on Streptococcal Toxic Shock Syndrome in Japan and Presentation the Criteria. Kansenshougaku Zasshi 1998；72（3）：258-265 5) Acosta CD, Kurinczuk JJ, Lucas DN, et al.：Severe Maternal Sepsis in the UK, 2011–2012：A National Case-Control Study. PLoS Med 2014；11（7）：e1001672 |
| References_xml | – reference: 11) Ikebe T, Chiba K, Shima T, et al.：Evaluation of streptococcal toxic shock-like syndrome caused by group B streptococcus in adults in Japan between 2009 and 2013. J infect Chemother 2015；21（3）：207-11 – reference: 5) Acosta CD, Kurinczuk JJ, Lucas DN, et al.：Severe Maternal Sepsis in the UK, 2011–2012：A National Case-Control Study. PLoS Med 2014；11（7）：e1001672 – reference: 12) Randis TM, Gelber SE, Hooven TA, et al.：Group B Streptococcus β-hemolysin/cytolysin breaches maternal-fetal barriers to cause preterm birth and intrauterine fetal demise in vivo. J infect Dis 2014；210（2）：265-73 – reference: 8) Wojtera M, Cheng H, Fiorini K, et al.：Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants A Systematic Review. The Pediatric Infectious Disease Journal 2018；37（9）：e241-e245 – reference: 2) Miyata A, Takahashi H, Kubo T, et al.：Early‒onset group B streptococcal disease following culture‒based screening in Japan：A single center study. J Obstet Gynaccol Res 2012；38：1052-1056 – reference: 7) Bae GE, Yoon N, Choi M, et al.：Acute Placental Villitis as Evidence of Fetal Sepsis：An Autopsy Case Report. Pediatric and Developmental Pathology 2016；19：165-168 – reference: 3) Knowles SJ, O’Sullivan NP, Meenan AM, et al.：Maternal sepsis incidence, aetiology and outcome for mother and fetus：a prospective study. BJOG 2014；121（13）：1755-6 – reference: 10) Tang WM, Ho PL, Tau WP, et al.：Report of 2 Fatal Cases of Adult Necrotizing Fasciitis and Toxic Shock Syndrome Caused by Streptococcus agalactiae. Clin infect Dis 2000；31（4）：E15-7 – reference: 4) Bone RC, Balk RA, Cerra FB, et al.：Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101；1992：1644-1655 – reference: 6) Page JM, Bardsley T, Thorsten V, et al.：Stillbirth Associated With Infection in a Diverse U.S. Cohort. Obstetrics & Gynecology 2019；134（6）：1187-1196 – reference: 1) Verani JR, McGee L, Schrag SJ, et al.：Prevention of perinatal group B streptococcal disease‒revised guidelines from CDC, 2010. MMWR Recomm Rep 2010；59：1-36 – reference: 9) Shimizu Y, Igarashi H, Murai T, et al.：Report of Surveillance on Streptococcal Toxic Shock Syndrome in Japan and Presentation the Criteria. Kansenshougaku Zasshi 1998；72（3）：258-265 |
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| Title | 妊娠中のGBS感染による母体敗血症の死産児に劇症型溶血性連鎖球菌感染症様所見を認めた一例 |
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