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Neonatal meningitis and septicemia due to a Lancefield untypable beta hemolytic streptococcus
676
Clinical notes
The Journal of Pediatrics April 1978
Neonatal meningitis and septicemia due to a Lancefield untypable beta hemolytic streptococcus In recent years much attention has been given to the increased incidence of neonatal sepsis and meningitis caused by group B streptococci? Group B streptococcal infections can present as two types of syndromes-one of sudden onset and one of delayed onset.2 Recently, there have been reports of neonatal sepsis or meningitis caused by streptococci of Lancefield groups other than groups A or B?, ~ We describe a case of sepsis and meningitis of sudden onset caused by a Lancefield untypable beta hemolytic streptococcus.
cereix of the mother, and onset of the sepsis occurred so soon after birth, would point strongly to maternal transmission during delivery. It also appears that routine serologic grouping of beta hemolytic streptococci will probably show the potential pathogenicity of non-group A or B streptococci in neonatal infection. Bernard Rudensky, Ph.D. Moshe Finalt, M.D. Meir Isaacson, M.D. The Departments of Clinical Microbiology and Pediatrics Shaarei Zedek Hospital Jaffa Road Jerusalem, Israel REFERENCES
CASE REPORT
A 3,230-gm boy was delivered after an uncomplicated pregnancy. The birth at term occurred 5 hours after rupture of membranes. Apgar score was 9 at one and ten minutes. The infant was examined 18 hours after birth and appeared perfectly healthy. Thirty-six hours after birth the infant appeared pale and hypotonic, and had feeding difficulties. There was no fever, vomiting, diarrhea, or shortness of breath. The white blood count was normal, but blood cultures were taken and a lumbar puncture was performed. The cerebrospinal fluid (CSF) showed 14,000 white cells/ram ~ (90% polymorphonuclear), glucose concentration 15 mg/dl, and protein 200 mg/dl. Gram stain of the CSF showed numerous gram-positive cocci which were identified as streptococci. Before laboratory results were obtained, treatment was initiated with penicillin intravenously (150,000 U/kg/24 hours) and gentamicin (6 mg/kg/24 hours). The following day the previous blood and CSF cultures, as well as a vaginal swab obtained from the mother, were all positive for hemolytic streptococci, sensitive to penicillin, ampicillin, erythromycin, cotrimoxazole, and chloramphenicol, and resistant to kanamycin and gentamicin. Upon isolation and identification of the organism, treatment was changed to penicillin G only. The organism was found by the National Streptococcal Reference Laboratory to be Lancefield untypable. During the first two days of therapy, convulsions were observed and treated with phenobarbital, valium, and paraldehyde. The convulsions stopped on the third day. During this episode, blood glucose, serum calcium, and electrolyte concentrations were normal. CSF on the fifth day was sterile and showed 120 white cells/mm3, glucose 35 mg/dl, and protein 126 mg/dl. Repeat lumbar tap on the twelfth day was again sterile with 30 white cells/mm~ and normal chemical values. By the sixteenth day of life, when treatment was terminated, the infant was gaining weight. Neurologic examination was normal. An electroencephalogram done toward the end of treatment showed an abnormal pattern due to asymmetry and also low voltage activity in the posterior left brain. Echoencephalogram showed no abnormalities. Head circumference was normal for the age. The infant was discharged in apparent good health.
1. Wilkinson HW, Facklam RR, and Wortham EC: Distribution by serological type of group B streptococci isolated from a variety of clinical material over a 'five-year period (with special reference to neonatal sepsis and meningitis), Infect Immnn 8:228, 1973 2. Franciosi RA, Knustman JD, and Zimmerman RA: Group B streptococcal neonatal and infant infections, J PED1ATR 82:707, 1973 3. Baker CJ: Unusuai occurrence of neonatal septicemia due to group G streptococcus, Pediatrics 53:568, 1974 4. Stewardson-Krieger P, and Gotoff SP: Neonatal meningitis due to group C beta hemolytic streptococcus, J PEDIATR 90:103, 1977
Neonatal septicemia and meningitis due to Aeromonas shigelloides Aeromonas group organisms are found in specimens from human beings and lower animals, as well as in soil, water, foods, and other environmental sources1; they may be opportunistic pathogens especially in debilitated hostsY Most reports of clinical infections due to Aeromonads have centered on Aeromonas hydrophila ~ and scant attention has been paid to Aeromonas shigelloide~, which has been implicated in enteritis,~ septicemia,~ and cellulitis. 4This communication describes the first ease known to us of septicemia and meningitis due to A. shigelloides in a newborn infant. CASE R E P O R T The patient was a 2.2 kg female delivered to a 34-year-old multigravida whose pregnancy was uneventful apart from cellulitis of the right leg, present for an undetermined period prior to delivery. The Apgar score was 7 and 8 at one and four minutes, respectively; her gestational age was estimated at 35
DISCUSSION Our case report illustrates another example of neonatal sepsis; the fact that the organism was cultured both f/'0m the infant and
0022-3476/78/0492-0676500.10/0
9 1978 The C.V. Mosby Co.
Supported in part by a grant from the South African Medical Research Council
0022-3476/78/0492-0676500.20/0
9 1978 The C.V. Mosby Co.
Clinical notes
The Journal of Pediatrics April 1978
Neonatal meningitis and septicemia due to a Lancefield untypable beta hemolytic streptococcus In recent years much attention has been given to the increased incidence of neonatal sepsis and meningitis caused by group B streptococci? Group B streptococcal infections can present as two types of syndromes-one of sudden onset and one of delayed onset.2 Recently, there have been reports of neonatal sepsis or meningitis caused by streptococci of Lancefield groups other than groups A or B?, ~ We describe a case of sepsis and meningitis of sudden onset caused by a Lancefield untypable beta hemolytic streptococcus.
cereix of the mother, and onset of the sepsis occurred so soon after birth, would point strongly to maternal transmission during delivery. It also appears that routine serologic grouping of beta hemolytic streptococci will probably show the potential pathogenicity of non-group A or B streptococci in neonatal infection. Bernard Rudensky, Ph.D. Moshe Finalt, M.D. Meir Isaacson, M.D. The Departments of Clinical Microbiology and Pediatrics Shaarei Zedek Hospital Jaffa Road Jerusalem, Israel REFERENCES
CASE REPORT
A 3,230-gm boy was delivered after an uncomplicated pregnancy. The birth at term occurred 5 hours after rupture of membranes. Apgar score was 9 at one and ten minutes. The infant was examined 18 hours after birth and appeared perfectly healthy. Thirty-six hours after birth the infant appeared pale and hypotonic, and had feeding difficulties. There was no fever, vomiting, diarrhea, or shortness of breath. The white blood count was normal, but blood cultures were taken and a lumbar puncture was performed. The cerebrospinal fluid (CSF) showed 14,000 white cells/ram ~ (90% polymorphonuclear), glucose concentration 15 mg/dl, and protein 200 mg/dl. Gram stain of the CSF showed numerous gram-positive cocci which were identified as streptococci. Before laboratory results were obtained, treatment was initiated with penicillin intravenously (150,000 U/kg/24 hours) and gentamicin (6 mg/kg/24 hours). The following day the previous blood and CSF cultures, as well as a vaginal swab obtained from the mother, were all positive for hemolytic streptococci, sensitive to penicillin, ampicillin, erythromycin, cotrimoxazole, and chloramphenicol, and resistant to kanamycin and gentamicin. Upon isolation and identification of the organism, treatment was changed to penicillin G only. The organism was found by the National Streptococcal Reference Laboratory to be Lancefield untypable. During the first two days of therapy, convulsions were observed and treated with phenobarbital, valium, and paraldehyde. The convulsions stopped on the third day. During this episode, blood glucose, serum calcium, and electrolyte concentrations were normal. CSF on the fifth day was sterile and showed 120 white cells/mm3, glucose 35 mg/dl, and protein 126 mg/dl. Repeat lumbar tap on the twelfth day was again sterile with 30 white cells/mm~ and normal chemical values. By the sixteenth day of life, when treatment was terminated, the infant was gaining weight. Neurologic examination was normal. An electroencephalogram done toward the end of treatment showed an abnormal pattern due to asymmetry and also low voltage activity in the posterior left brain. Echoencephalogram showed no abnormalities. Head circumference was normal for the age. The infant was discharged in apparent good health.
1. Wilkinson HW, Facklam RR, and Wortham EC: Distribution by serological type of group B streptococci isolated from a variety of clinical material over a 'five-year period (with special reference to neonatal sepsis and meningitis), Infect Immnn 8:228, 1973 2. Franciosi RA, Knustman JD, and Zimmerman RA: Group B streptococcal neonatal and infant infections, J PED1ATR 82:707, 1973 3. Baker CJ: Unusuai occurrence of neonatal septicemia due to group G streptococcus, Pediatrics 53:568, 1974 4. Stewardson-Krieger P, and Gotoff SP: Neonatal meningitis due to group C beta hemolytic streptococcus, J PEDIATR 90:103, 1977
Neonatal septicemia and meningitis due to Aeromonas shigelloides Aeromonas group organisms are found in specimens from human beings and lower animals, as well as in soil, water, foods, and other environmental sources1; they may be opportunistic pathogens especially in debilitated hostsY Most reports of clinical infections due to Aeromonads have centered on Aeromonas hydrophila ~ and scant attention has been paid to Aeromonas shigelloide~, which has been implicated in enteritis,~ septicemia,~ and cellulitis. 4This communication describes the first ease known to us of septicemia and meningitis due to A. shigelloides in a newborn infant. CASE R E P O R T The patient was a 2.2 kg female delivered to a 34-year-old multigravida whose pregnancy was uneventful apart from cellulitis of the right leg, present for an undetermined period prior to delivery. The Apgar score was 7 and 8 at one and four minutes, respectively; her gestational age was estimated at 35
DISCUSSION Our case report illustrates another example of neonatal sepsis; the fact that the organism was cultured both f/'0m the infant and
0022-3476/78/0492-0676500.10/0
9 1978 The C.V. Mosby Co.
Supported in part by a grant from the South African Medical Research Council
0022-3476/78/0492-0676500.20/0
9 1978 The C.V. Mosby Co.