ABSTRACT
Background: Streptococcal Toxic Shock Syndrome (STSS) is a serious condition that can arise from streptococcal postpartum endometritis. It is associated with a substantial increase in mortality rate and can rarely result in multiorgan infarction. Early recognition plays a vital role in patients' outcome. Objective: To report a case of complicated STSS and review the literature for previous case reports of streptococcal postpartum endometritis to determine if STSS diagnostic criteria (published by the Centers for Disease Control and Prevention) were fulfilled. Case presentation: This is a 41-year-old woman who presented 5 days after an uncomplicated vaginal delivery with endometritis complicated by invasive group A ß-hemolytic streptococcus (GAS) infection and confirmed toxic shock syndrome. The patient was initially admitted to the critical care unit due to hemodynamic compromise requiring intravenous (IV) fluids, IV antibiotic therapy with penicillin and clindamycin, and IV immunoglobulin therapy. The patient subsequently developed multi-organ infarctions, acute respiratory distress syndrome requiring noninvasive respiratory support, and severe reactive arthritis. Literature review revealed 15 case reports of GAS postpartum endometritis, five met criteria for confirmed STSS. One patient died from severe septic shock leading to cardiopulmonary arrest. Thirteen out of 15 cases of postpartum endometritis occurred after uncomplicated vaginal delivery. Conclusion: STSS is a serious and possibly fatal medical condition that requires early diagnosis and treatment to prevent poor patient outcomes and death. Careful consideration to the patient's postpartum clinical presentation with the implementation of an intradisciplinary approach should be utilized.
Subject(s)
Anti-Bacterial Agents , Arthritis, Reactive , Endometritis , Kidney , Puerperal Infection , Splenic Infarction/diagnostic imaging , Streptococcal Infections , Streptococcus pyogenes/isolation & purification , Adult , Anti-Bacterial Agents/administration & dosage , Anti-Bacterial Agents/classification , Arthritis, Reactive/etiology , Arthritis, Reactive/therapy , Endometritis/microbiology , Endometritis/physiopathology , Endometritis/therapy , Female , Fluid Therapy/methods , Humans , Kidney/blood supply , Kidney/diagnostic imaging , Oxygen Inhalation Therapy/methods , Puerperal Infection/microbiology , Puerperal Infection/physiopathology , Puerperal Infection/therapy , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/therapy , Shock, Septic/microbiology , Shock, Septic/physiopathology , Streptococcal Infections/etiology , Streptococcal Infections/physiopathology , Streptococcal Infections/therapy , Tomography, X-Ray Computed/methods , Treatment OutcomeABSTRACT
INTRODUCTION: Digital three-dimensional models are widely used for orthodontic diagnosis. The purpose of this study was to appraise the accuracy of digital models obtained from computer-aided design/computer-aided manufacturing (CAD/CAM) and cone-beam computed tomography (CBCT) for tooth-width measurements and the Bolton analysis. MATERIALS AND METHODS: Digital models (CAD/CAM, CBCT) and plaster model were made for each of 50 subjects. Tooth-width measurements on the digital models (CAD/CAM, CBCT) were compared with those on the corresponding plaster models. The anterior and overall Bolton ratios were calculated for each participant and for each method. The paired t-test was applied to determine the validity. RESULTS: Tooth-width measurements, anterior, and overall Bolton ratio of digital models of CAD/CAM and CBCT did not differ significantly from those on the plaster models. CONCLUSION: Hence, both CBCT and CAD/CAM are trustable and promising technique that can replace plaster models due to its overwhelming advantages.