High fibrin/fibrinogen degradation product and D-dimer levels for the diagnosis of invasive group A streptococcal infections during pregnancy

Abstract

High fibrin/fibrinogen degradation product and D-dimer levels for the diagnosis of invasive group A streptococcal infections during pregnancy N. Matsumoto1; , Y. Mori2 1Matsumoto Women’s Health Clinic, Saitama (Japan) 2Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo (Japan) Summary Objective: Invasive group A streptococcal (GAS) infections during pregnancy are uncommon, and, thus, their early diagnosis remains challenging. The present study was performed to assess fibrin/fibrinogen degradation product (FDP) and D-dimer levels in pregnant women with invasive GAS infections and establish whether they contribute to a diagnosis. Materials and Methods: Laboratory data, including FDP and D-dimer levels, measured between fulmination and just before delivery in 46 cases, consisting of 45 previously published cases and the present case, were examined. Results: Fetal/neonatal and maternal mortality rates were 61 and 28%, respectively. Laboratory data obtained from 24 cases just before delivery were as follows: white blood cell count 12,000/ L, 46% of cases; platelet count 100,000/ L, 55% of cases, and C-reactive protein (CRP) level 10 mg/dL, 40% of cases. These variables showed no sensitivity for the diagnosis of invasive GAS infections. However, 100% of cases were positive for FDP ( 10 g/dL) and D-dimer ( 2 g/dL), the levels of which were extremely high in many cases. Conclusion: FDP and D-dimer levels may contribute to the diagnosis of invasive GAS infections during pregnancy. Key words: Antepartum; Disseminated intravascular coagulation; Sepsis; Streptococcus pyogenes; Toxic shock syndrome.