scholarly journals Fatal, Fulminant and Invasive Non-Typeable Haemophilus influenzae Infection in a Preterm Infant: A Re-Emerging Cause of Neonatal Sepsis

2020 ◽  
Vol 5 (1) ◽  
pp. 30 ◽  
Author(s):  
Sudipta Roy Chowdhury ◽  
Srabani Bharadwaj ◽  
Suresh Chandran
Keyword(s):  
Haemophilus Influenzae ◽  
Preterm Infant ◽  
Neonatal Sepsis ◽  
Group B Streptococcus ◽  
Invasive Disease ◽  
Preventative Measures ◽  
Increased Risk ◽  
Extremely Preterm ◽  
Serotype B ◽  
Group B

Early-onset neonatal sepsis (EOS) is a major cause of neonatal death and long-term neurodevelopmental disabilities among survivors. The common pathogens causing EOS are group B streptococcus (GBS) and Escherichia coli. Haemophilus influenzae (H. influenzae) is a Gram-negative coccobacillus that can cause severe invasive disease and can be divided into either typeable or non-typeable strains. H. influenzae serotype b (Hib) is the most virulent and the major cause of bacterial meningitis in young children prior to routine immunization against Hib. Hib infection rates have dramatically reduced since then. However, a number of studies have reported an increasing incidence of non-typeable H. influenzae (NTHi) sepsis in neonates worldwide and concluded that pregnant women may have an increased risk to invasive NTHi disease with poor pregnancy outcomes. We present a case of fulminant neonatal sepsis caused by NTHi in an extremely preterm infant and discuss potential preventative measures to reduce its re-emergence.

scholarly journals Aetiologies and risk factors for neonatal sepsis and pneumonia mortality among Alaskan infants

2005 ◽  
Vol 133 (5) ◽  
pp. 877-881 ◽  
Author(s):  
B. D. GESSNER ◽  
L. CASTRODALE ◽  
M. SORIANO-GABARRO
Keyword(s):  
Risk Factors ◽  
Neonatal Sepsis ◽  
Rate Ratio ◽  
Neonatal Period ◽  
Group B Streptococcus ◽  
Sepsis Mortality ◽  
Term Infants ◽  
Gram Positive Bacteria ◽  
Increased Risk ◽  
Group B

We evaluated all fatal neonatal sepsis and pneumonia cases occurring in Alaska during 1992–2000. Risk factors were evaluated using a database of all births occurring during the study period. Of 32 cases, group B streptococcus (GBS) was isolated from 21% (all <7 days of age), Candida spp. from 19% (all >7 days of age), non-GBS Gram-positive bacteria from 50% (53% <7 days of age), and Gram-negative infections from 38% (58% <7 days of age). Infants born at <37 weeks gestation accounted for 72% of cases and had an increased risk of GBS [rate ratio (RR) 9·1, 95% confidence interval (CI) 2·0–41] and non-GBS (RR 40, 95% CI 16–101) disease. Neonatal sepsis mortality has become an outcome concentrated among pre-term infants. Aetiologies include GBS during the early neonatal period, Candida spp. during the late neonatal period, and other bacteria during both periods.

Approach to the Febrile Patient with No Obvious Focus of Infection

1984 ◽  
Vol 5 (10) ◽  
pp. 305-315
Author(s):  
Sarah S. Long
Keyword(s):  
Antimicrobial Agents ◽  
Group B Streptococcus ◽  
Invasive Disease ◽  
Chemotherapeutic Agents ◽  
The Body ◽  
Therapeutic Modalities ◽  
Body Of Knowledge ◽  
Age Related ◽  
Focus Of Infection ◽  
Group B

The summary in Table 1 could be used as a mental checklist for the pediatrician who examines a child with fever. Whether the pediatrician opts to "keep the rules" or appropriately decides to "break the rules," knowledge of the guidelines will help him to focus his approach and to adopt attitudes of caution in certain circumstances. The body of knowledge of infectious agents chemotherapeutic agents has burgeoned over the past 40 years; the rules have changed very little. Thus, the rules might also serve as standards against which "new discoveries" that dictate departure from an established mode of clinical practice would have to be weighed. The adage, "Name the bug before you choose a drug," is especially germaine to pediatrics. Potential pathogens or "bugs" continually change as the patient's age, exposure, and immunity change. The serious diseases they cause mandate that initial treatment be given with the best "drugs." The age-related causes of bacterial meningitis presented in Table 2 could serve as a primer for age-related causes of other invasive disease as well. For bone, joint, and soft tissue infection as well as for septicemia without a focus the age line for group B Streptococcus and H influenzae would be extended upward and S aureus would be added for all ages. Although the relative importance of each pathogen for each clinical entity might vary, therapeutic considerations would be appropriately served by a schema such as this. Unfortunately, the susceptibility of pathogens to antimicrobial agents will continue to change. Fortunately, new and potentially better therapeutic agents will continue to be discovered or invented. When new problems of antibiotic resistance emerge or when superior therapeutic modalities are proved, the pediatrician must be knowledgeable of such events and be prepared for change.

scholarly journals CLINICAL AND MICROBIOLOGICAL FEATURES OF EARLY-ONSET NEONATAL SEPSIS IN PRETERM INFANTS

2020 ◽  
Vol 3 ◽  
pp. 13-19
Author(s):  
Tetiana Klymenko ◽  
Kateryna Kosenko
Keyword(s):  
Preterm Infants ◽  
Neonatal Sepsis ◽  
Early Onset ◽  
Group B Streptococcus ◽  
Blood Cultures ◽  
Coagulase Negative Staphylococcus ◽  
Klebsiella Pneumonia ◽  
Epidemiological Monitoring ◽  
Sources Of Infection ◽  
Group B

Early-onset neonatal sepsis (EONS) remains the leading cause of morbidity and mortality, especially among premature infants. Conducting high-quality epidemiological monitoring is an important condition for effective tactics treatment neonatal infections and improving the quality of medical care for this category of newborn. The aim. Determination of the value of microbiological triggers in the blood in various clinical options for EONS in preterm infants. Materials and methods. Clinical and microbiological data on 50 prematurely born newborns with EONS were selected. The analysis of the frequency of detected bacteremia, the distribution of pathogenic microorganisms and the clinical characteristics of neonatal sepsis. Results. In the study, sources of infection were detected in 94 % of cases. Positive blood cultures were obtained in 17 (34 %) newborns with EONS. 61.5 % of all cases of bacteremia were caused by coagulase-negative staphylococcus (CoNS). Gram-negative pathogens were detected in 23.5 % of positive blood cultures, representatives of this group were Escherichia coli and Klebsiella pneumonia. The overall mortality rate from EONS was 30 %. Conclusions. The incidence of sepsis confirmed by a positive blood culture was 34 %. The most common cause of EONS is CoNS, low incidence of group B Streptococcus sepsis has been established. The most frequent septicopymic sources of infection were the lungs, which is expressed in the high incidence (94 %) of X-ray pneumonia in the structure of the EONS.

scholarly journals A ten-year review of neonatal bloodstream infections in a tertiary private hospital in Kenya

2011 ◽  
Vol 5 (11) ◽  
pp. 799-803 ◽  
Author(s):  
Ruchika Kohli-Kochhar ◽  
Geoffrey Omuse ◽  
Gunturu Revathi
Keyword(s):  
Developing Countries ◽  
Neonatal Sepsis ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Bloodstream Infections ◽  
Empiric Therapy ◽  
Gram Positive ◽  
Late Onset Sepsis ◽  
Group B ◽  
The Right

Introduction: Neonatal mortality in developing countries is usually due to an infectious cause.  The gold standard of investigation in developing countries is a positive blood culture.  It is important to know the aetiology of neonatal bloodstream infections so that empiric treatment can be effective.  Methodology: We conducted a retrospective clinical audit over ten years between January 2000 until December 2009, looking at the aetiology of both early and late onset neonatal sepsis.  We analysed data from 152 (23%) patient isolates out of 662 suspected cases of neonatal sepsis.  Results: Our study revealed that Gram-positive organisms were the predominant cause of both early and late onset sepsis; the common isolates were Staphylococcus epidermidis (34%) and Staphylococcus aureus (27%).  There were no isolates of group B Streptococcus.  Candida species was isolated only in patients with late onset sepsis (6.9%).  Bacterial isolates were relatively sensitive to the commonly used first- and second-line empiric antibiotics. Conclusion: Gram-positive organisms remain the major cause of neonatal bloodstream infections in our setup.  The findings of this study will guide clinicians in prescribing the right empiric therapy in cases of suspected neonatal sepsis before the definitive culture results are obtained.

Human Immunoglobulins for Intravenous Use: Comparison of Available Preparations for Group B Streptococcal Antibody Levels, Opsonic Activity, and Efficacy in Animal Models

PEDIATRICS ◽  
1990 ◽  
Vol 86 (6) ◽  
pp. 955-962
Author(s):  
Laurence B. Givner
Keyword(s):  
Animal Models ◽  
Neonatal Sepsis ◽  
Protective Efficacy ◽  
Group B Streptococcus ◽  
Igg Antibody ◽  
Opsonic Activity ◽  
Immunoglobulin Preparations ◽  
Group B ◽  
Antibody Levels

Currently available human immunoglobulin preparations for intravenous use (IVIGs) are being used (with antibiotics) by some physicians for therapy of sepsis in newborns. Most neonatal sepsis and/or meningitis in this country is caused by group B Streptococcus (GBS), and most of these cases are due to type III GBS (III-GBS). The killing of III-GBS in vitro is dependent on specific IgG antibody. Adequate serum levels of specific III-GBS antibody protect the exposed newborn from the development of invasive disease. Therefore, III-GBS was used as a model to evaluate the activity of three IVIG preparations available for clinical use. Specific antibody levels, in vitro opsonophagocytic killing, and protective efficacy in animal models revealed differences in activity for III-GBS between the three IVIG preparations as well as between IVIG lots from the same manufacturer. Furthermore, it was found that the effect of IVIG using one of the assay methods may not reliably predict activity obtained using the other assays. These data document the inability to predict functional activity against a specific pathogen such as GBS on the part of a lot of IVIG chosen at random. In view of these findings and of the limited data evaluating clinical efficacy, IVIG cannot be recommended at this time for use in the therapy of infectious diseases such as neonatal sepsis.

Group B Streptococcus (Streptococcus agalactiae)

2018 ◽  
Author(s):  
Kirsty Le Doare ◽  
Christine E. Jones ◽  
Paul T. Heath
Keyword(s):  
Early Onset ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Significant Risk ◽  
Neonatal Infection ◽  
Significant Risk Factor ◽  
Invasive Disease ◽  
Neurodevelopmental Outcomes ◽  
Intrapartum Antibiotic ◽  
Group B

Group B Streptococcus (GBS) is a leading cause of early neonatal infection and neonatal mortality, with long-term adverse neurodevelopmental outcomes in up to 50% of survivors of GBS meningitis. GBS has a likely underappreciated role in causing preterm birth and stillbirth. GBS colonizes the vagina and gastrointestinal tract of the pregnant woman, and transmission to the infant occurs during or just before delivery. Although the majority of these infants do not develop invasive disease, maternal colonization is a prerequisite for early onset disease (0–6 days of life, most commonly associated with sepsis and respiratory distress) and a significant risk factor for late onset disease (7–89 days of life, most commonly associated with sepsis and meningitis). The introduction of intrapartum antibiotic prophylaxis has resulted in significant declines in the incidence of early onset disease but provides no protection against late onset disease.

scholarly journals The Italian arm of the PREPARE study: an international project to evaluate and license a maternal vaccine against group B streptococcus

2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Alberto Berardi ◽  
◽  
Tiziana Cassetti ◽  
Roberta Creti ◽  
Caterina Vocale ◽  
...  
Keyword(s):  
Low Income ◽  
Pregnancy Outcomes ◽  
Group B Streptococcus ◽  
Invasive Disease ◽  
Low Income Countries ◽  
International Project ◽  
Main Body ◽  
Non Profit ◽  
Maternal Vaccination ◽  
Group B

Abstract Background Group B streptococcus (GBS) is a leading cause of sepsis, pneumonia and meningitis in infants, with long term neurodevelopmental sequelae. GBS may be associated with poor pregnancy outcomes, including spontaneous abortion, stillbirth and preterm birth. Intrapartum antibiotic prophylaxis (IAP) is currently the only way to prevent early-onset disease (presenting at 0 to 6 days of life), although it has no impact on the disease presenting over 6 days of life and its implementation is challenging in resource poor countries. A maternal vaccine against GBS could reduce all GBS manifestations as well as improve pregnancy outcomes, even in low-income countries. Main body The term “PREPARE” designates an international project aimed at developing a maternal vaccination platform to test vaccines against neonatal GBS infections by maternal immunization. It is a non-profit, multi-center, interventional and experimental study (promoted by the St George University of London. [UK]) with the aim of developing a maternal vaccination platform, determining pregnancy outcomes, and defining the extent of GBS infections in children and mothers in Africa. PREPARE also aims to estimate the protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa and to conduct two trials on candidate GBS vaccines. PREPARE consists of 6 work packages. In four European countries (Italy, UK, Netherlands, France) the recruitment of cases and controls will start in 2020 and will end in 2022. The Italian PREPARE network includes 41 centers. The Italian network aims to collect: GBS isolates from infants with invasive disease, maternal and neonatal sera (cases); cord sera and GBS strains from colonized mothers whose infants do not develop GBS infection (controls). Short conclusion PREPARE will contribute information on protective serocorrelates against the main GBS serotypes that cause diseases in Europe and Africa. The vaccine that will be tested by the PREPARE study could be an effective strategy to prevent GBS disease.

scholarly journals Intrinsic Maturational Neonatal Immune Deficiencies and Susceptibility to Group B Streptococcus Infection

2017 ◽  
Vol 30 (4) ◽  
pp. 973-989 ◽  
Author(s):  
Michelle L. Korir ◽  
Shannon D. Manning ◽  
H. Dele Davies
Keyword(s):  
Immune System ◽  
Group B Streptococcus ◽  
Host Immune System ◽  
Emerging Pathogen ◽  
Content Type ◽  
Birth Canal ◽  
Preventative Measures ◽  
Neonatal Immune System ◽  
Immune Deficiencies ◽  
Group B

SUMMARY Although a normal member of the gastrointestinal and vaginal microbiota, group B Streptococcus (GBS) can also occasionally be the cause of highly invasive neonatal disease and is an emerging pathogen in both elderly and immunocompromised adults. Neonatal GBS infections are typically transmitted from mother to baby either in utero or during passage through the birth canal and can lead to pneumonia, sepsis, and meningitis within the first few months of life. Compared to the adult immune system, the neonatal immune system has a number of deficiencies, making neonates more susceptible to infection. Recognition of GBS by the host immune system triggers an inflammatory response to clear the pathogen. However, GBS has developed several mechanisms to evade the host immune response. A comprehensive understanding of this interplay between GBS and the host immune system will aid in the development of new preventative measures and therapeutics.

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