Variations in the expression of virulence factors by the pathogen were found to be responsible for the reduction in the incidence and severity of streptococcal infections in the Ruxolitinib supplier late 1980s [2], [3] and [4]. However, S.

pyogenes re-emerged with renewed virulence and has posed a global public health problem [5] and [6]. Sporadic outbreaks of S. pyogenes were predominantly characterized by a rapidly progressive disorder that was often associated with severe suppurative soft tissue infections [6]. In some studies involving women of childbearing age, the prevalence of vaginal colonization with GAS was less than 1%, suggesting that endogenous sources are uncommon and that clustering of cases or outbreaks associated with health care facilities can usually be traced to a single carrier. These carriers are usually health care workers colonized with the organism in a skin lesion or in the throat, vagina or rectum [7] and [8]. The causes of colonization with GAS and, in some cases, its subsequent transmission are unknown. There are a few published

reports on attempts to eradicate the GAS carrier state; in most of these reports, the treatment modality, extent and duration of follow-up varied, offering little information to guide physicians in the management of these carriers [9], [10] and [11]. We present two cases of post-laparoscopic invasive GAS TSS occurring in a busy tertiary care center (334 beds and over 22,830 admissions learn more in 2009). Two cases of invasive GAS disease were diagnosed within 48 h of each other, activating intervention by the infection prevention and control program of the

hospital. These cases and a review of the literature are presented with respect to both the Exoribonuclease possible mode of transmission of GAS and the importance of an infection control role in preventing and/or controlling similar outbreaks. Case 1 (index patient): A 39-year-old female, para 2 + 0, was brought to the Women’s Hospital emergency room with a history of amenorrhea lasting 10 weeks, vaginal bleeding for 9 days and severe lower abdominal pain for 1 day. Her medical history was uneventful. On arrival at the emergency room, the physical examination was unremarkable, except for localized tenderness on the left iliac fossa. Abdominal ultrasonography revealed a turbid fluid in the left para-ovarian space and a left adnexial mass, suggestive of ectopic pregnancy. Laboratory investigations revealed a positive urine pregnancy test, beta human chorionic gonadotrophin of 473.8 IU/l and an elevated white blood cell count of 15,500/μl. A diagnosis of ectopic pregnancy was made, and the patient underwent a laparoscopic left salpingectomy. The patient did not receive a prophylactic antibiotic, and she had an uneventful recovery and was transferred to the ward in stable condition. However, 6 h postoperatively, she developed abdominal pain, with a temperature spike of 38 °C.