Journal List > Korean J Perinatol > v.24(3) > 1013675

Cheong, Byun, and Kim: Group B Streptococcal Meningitis in Neonate: 2001-2011

Abstract

Purpose :

Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis. Little is known about neonatal GBS infection in Korea. We investigated the clinical characteristics of GBS meningitis in neonate.

Methods :

We retrospectively analyzed 15 medical records of patients who diagnosed neonatal GBS meningitis admitted to two tertiary centers from January 2001 to December 2011. We analyzed the patient's characteristics, clinical symptoms and signs at admission, laboratory findings, and short-term outcomes at discharge.

Results :

Among a total of 15 patients, five patients had early GBS meningitis and ten patients had late GBS meningitis. The most frequent clinical onset time was after three weeks of age. The major clinical symptom was respiratory difficulty in early GBS meningitis and fever in late GBS meningitis. The mortality rate was 6.7%. Among 15 patients, eight patients (53.3%) had abnormalities on neuroimaging studies at discharge and most of these patients were late GBS meningitis.

Conclusion :

Late GBS meningitis was the majority of neonatal GBS meningitis and had poor short-term neurological outcomes. To prevent the late GBS meningitis, we need to nation-wide preventive study including the incidence, mortality, and long-term outcomes of neonatal GBS meningitis.

REFERENCES

1). Shim GH., Kim SD., Kim HS., Kim ES., Lee HJ., Lee JA, et al. Trends in epidemiology of neonatal sepsis in a tertiary center in Korea: A 26-year longitudinal analysis, 1980-2005. J Korean Med Sci. 2001. 26:284–9.
crossref
2). Matsubara K., Yamamoto G. Invasive group B streptococcal infections in a tertiary care hospital between 1998 and 2007 in Japan. Int J Infect Dis. 2009. 13:679–84.
crossref
3). Lee JH. Recent change of GBS infection in neonate. Korean J Pediatr Infect Dis. 2007. 14:1–5.
4). Bizzarro MJ., Raskind C., Baltimore RS., Gallagher PG. Seventy-five years of neonatal sepsis at Yale: 1928-2003. Pediatrics. 2005. 116:595–602.
crossref
5). Rønnestad A., Abrahamsen TG., Gaustad P., Finne PH. Blood culture isolates during 6 years in a tertiary neonatal intensive care unit. Scand J Infect Dis. 1998. 30:245–51.
6). Phares CR., Lynfield R., Farley MM., Mohle-Boetani J., Harrison LH., Petit S, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA. 2008. 299:2056–65.
crossref
7). Levent F., Baker CJ., Rench MA., Edwards MS. Early outcomes of group B streptococcal meningitis in the 21st century. Pediatr Infect Dis J. 2010. 29:1009–12.
crossref
8). Wald ER., Bergman I., Taylor HG., Chiponis D., Porter C., Kubek K. Long-term outcome of group B streptococcal meningitis. Pediatrics. 1986. 77:217–21.
crossref
9). Park HW., Lim GN., Koo SE., Lee BS., Kim KS., Pi SY, et al. Causative agents and antimicrobial sensitivity of neonatal sepsis: ten-year experience in one neonatal intensive care unit. J Korean Soc Neonatol. 2009. 16:172–81.
10). Chun P., Kong SG., Byun SY., Park SE., Lee HD. Analysis of neonatal sepsis in one neonatal intensive care unit for 6 years. Korean J Pediatr. 2010. 53:495–502.
crossref
11). Kim SH., Park HJ., Park SE., Hong YR., Lee YA., Shin JB. The etiology of neonatal bacterial meningitis in Busan, Korea. Korean J Pediatr Infect Dis. 2007. 14:43–6.
crossref
12). Lee SY., Yon SJ., Kim DS., Ko TS. Clinical study of group B β-hemolytic streptococcal meningitis. J Korean Pediatr Soc. 2003. 46:1224–9.
13). Anthony BF., Okada DM., Hobel CJ. Epidemiology of group B Streptococcus: longitudinal observations during pregnancy. J Infect Dis. 1978. 137:524–30.
crossref
14). Choi KU., Koh SK., Lee JY., Park JH., Hwang SO., Lee BI, et al. Clinical significance of group B streptococcal infection in pregnant women. Korean J Obstet Gynecol. 2002. 45:811–5.
15). Kim MW., Jang HO., Chang DY., Cho JR., Kim YA., Choi HM, et al. Group B streptococcal colonization rate in Korean pregnant women. Korean J Obstet Gynecol. 2006. 49:337–44.
16). Ziai N., Haggerty RJ. Neonatal meningitis. N Engl J Med. 1958. 259:314–20.
crossref
17). Hoshina K., Suzuki Y., Nishida H., Kaneko K., Matsuda S., Kobayashi M, et al. Trend of neonatal group B streptococcal infection during the last 15 years. Pediatr Int. 2002. 44:641–6.
crossref
18). Lee JH., Kim SM., Lee HS., Kim SY., Choi SD., Sung IK, et al. A clinical study of group B streptococcal infection: five years experience. J Korean Soc Neonatol. 2003. 10:226–34.
19). Health PT., Nik Yusoff NK., Baker CJ. Neonatal meningitis. Arch Dis Child Fetal Neonatal Ed. 2003. 88:F173–8.
20). Anthony BF., Okada DM. The emergence of group B streptococci in infections of the newborn infant. Annu Rev Med. 1977. 28:355–69.
crossref

Table 1.
Clinical Characteristics of the Study Patients
Variables EOD, N=5 (%) LOD, N=10 (%) Total, N=15 (%)
Gestational age, weeks 34.4±6.2 38.0±6.7 37.3±1.9
Birth weight, g 2,568.0±1,238.4 2,958.0±397.2 2,828.0±758.9
Male 3 (60.0) 6 (60.0) 9 (60.0)
NSVD 4 (80.0) 5 (50.0) 9 (60.0)
AS1 7.0±1.9 8.9±0.3 8.3±1.4
AS5 8.2±1.8 9.8±0.4 9.3±1.3
Age at onset, days 1±0.5 31.9±14.4 21.5±19.2
≤7 days 5 (100.0) 0 5 (33.3)
1-2 weeks 0 0 0
2-3 weeks 0 1 (10.0) 1 (6.7)
3-4 weeks 0 5 (50.0) 5 (33.3)
>4 weeks 0 4 (40.0) 4 (26.7)
Admission weight, g 2,556.0±1228.9 4,426.0±846.7 3,802.7±1,313.4
Hospital duration, days 39.8±37.9 21.1±9.7 27.3±23.5
Death 0 1 (10.0) 1 (6.7)

Abbreviations : EOD, early-onset disease; LOD, late-onset disease; NSVD, normal spontaneous vaginal delivery; AS1, apgar score at one minute; AS5, apgar score at five minutes.

Table 2.
Clinical Manifestations of Group B Streptococcus Meningitis
Variables EOD, N=5 (%) LOD, N=10 (%) Total, N=15 (%)
Poor feeding 3 (60.0) 9 (90.0) 12 (80.0)
Fever 0 10 (100.0) 10 (66.7)
Respiratory difficult ty 5 (100.0) 4 (40.0) 9 (60.0)
Ventilator care 3 (60.0) 4 (40.0) 7 (46.7)
Lethargy 1 (20.0) 8 (80.0) 9 (60.0)
Pallor 3 (60.0) 3 (30.0) 6 (40.0)
Irritability 2 (40.0) 3 (30.0) 5 (33.3)
Hypotonia 1 (20.0) 3 (30.0) 4 (26.7)
Hypotension 1 (20.0) 3 (30.0) 4 (26.7)
Seizure 0 2 (20.0) 2 (13.3)

Abbreviations : EOD, early-onset disease; LOD, late-onset disease.

Table 3.
Laboratory Findings of the Study Patients
Variables EOD, N=5 LOD, N=10 Total, N=15
CSF analysis      
WBC, /mm3 19.6±34.4 1151.1±1239.9 893.0±1,180.6
PMN, % 10.6±18.6 60.3±35.1 65.6±26.6
RBC, /mm3 13,200.0±29,516.1 239.7±724.5 4,559.8±17,007.2
Protein, mg/dL 122.8±137.1 448.7±451.8 392.4±408.2
Glucose, mg/dL 40.8±38.9 27.5±20.0 36.8±25.6
Blood analysis      
WBC, /mm3 12,980.0±10,075.4 7,461.1±6,840.4 9,300.7±8,144.7
PMN, % 71.4±13.0 39.9±17.9 50.4±22.2
PLT, ×103 235.6±82.1 356.8±168.8 316.4±154.1
Hb, mg/dL 15.0±2.9 10.9±1.7 12.2±2.9
CRP, mg/dL 2.4±4.5 7.1±7.4 5.5±6.8

Abbreviations: EOD, early-onset disease; LOD, late-onset disease; PMN, polymorphoneuclear leukocyte; RBC, red blood cell; PLT, platelet; CRP, C-reactive protein.

Table 4.
Neuroimaging Abnormalities of Group B Strep tococcus Meningitis
  EOD, N=5 (%) LOD, N=10 (%) Total, N=15 (%)
Normal 4 (80.0) 3 (30.0) 7 (46.7)
Abnormal 1 (20.0) 7 (70.0) 8 (53.3)
Cerebromalacia a 1 2 3 (20.0)
Cerebral infarcti ion 0 2 2 (13.3)
Subdural effusio n 0 2 2 (13.3)
Brain abscess 0 1 1 (6.7)
Hydrocephalus 1 0 1 (6.7)

Abbreviations: GBS, Group B Streptococcus; EOD, early onset disease; LOD, late-onset disease.

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