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Kim, Hong, Yang, and Oh: A Case of Late Onset Neonatal Bacteremia and Meningitis Caused by Streptococcus lutetiensis
Case Report

Korean J Pediatr Infect Dis 2014;21(3):219-224.

Published online: 20 January 2014

DOI: https://doi.org/10.14776/kjpid.2014.21.3.219

A Case of Late Onset Neonatal Bacteremia and Meningitis Caused by Streptococcus lutetiensis

Ji Sook Kim, M.D., Yoo Ra Hong, M.D., Hee Yeong Yang, M.D.∗, Chi Eun Oh, M.D.

Department of Pediatrics, Kosin University College of Medicine, Busan, Korea

∗Department of Laboratory Medicine, Kosin University College of Medicine, Busan, Korea

Received 9 May 2014       Revised 6 July 2014       Accepted 7 July 2014

Copyright © 2014 The Korean Society of Pediatric Infectious Diseases

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Invasive infection of the Streptococcus bovis group in a neonate is rare. In cases reported to date, the pathogen of neonatal S. bovis infections is usually Streptococcus gallolyticus subsp. pasteurianus (S. bovis biotype II/2). Streptococcus lutetiensis (S. bovis biotype II/1) was identified using 16S rRNA and tuf gene sequence analysis of the isolates from blood and cerebrospinal fluid (CSF) of a fever-presenting 28-day-old male. Blood culture analysis was performed using automatic equipment (VITEK 2) and identified Streptococcus infantarius supsp. infantarius, yet we were unable to get accurate results from the CSF culture. The fever subsided on the second day of hospitalization, and the patient was discharged without neurologic complication after 14 days of antibiotic therapy. In this case, we were able to accurately identify the pathogen using molecular genetic methods. To our knowledge, this is the first case of late onset neonatal bacteremia and meningitis caused by S. lutetiensis.

Keywords: Streptococcus bovis, Newborn, Bacteremia, Meningitis

References

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Table 1.
Laboratory Findings for Pathogen Identification
  Specimen or site of isolation Method Result
HD 1 CSF CSF CO-agglutination assay Negative
HD 2 CSF Gram stain Gram positive cocci
  Blood Gram stain Gram positive cocci
HD 4 Blood VITEK 2 Streptococcus infantarius
HD 8 CSF VITEK 2 Inconclusive
HD 14 CSF 16S rRNA and tuf gene sequence analysis Streptococcus lutetiensis
OPD Blood 16S rRNA and tuf gene sequence analysis Streptococcus lutetiensis

Abbreviations: HD, hospital day; CSF, cerebrospinal fluid; OPD, outpatient department; VITEK 2, the automatic VITEK 2 system (bioMé rieux, Marcy-l′Etoile, France).

Table 2.
Streptococcus bovis Invasive Infections in Infants Since 2000
Year (Reference) Age Sex Delivery Sites Methods Pathogen Outcome
2000 (6) 5 wk F NSVD CSF 16S rRNA Streptococcus bovis biotype II S
2000 (7) 4 wk M NSVD Blood, CSF API 20 Strep Streptococcus pasteurianus S
2002 (8) 2 mo M NR Blood, CSF NR Streptococcus bovis S
2002 (9) 19 d F C/sec Blood, CSF API 20 Strep Streptococcus bovis biotype II S
2002 (10) 50 d F NR Blood, CSF API 20 Strep Streptococcus bovis biotype II S
2003 (11) 3 d M NR Blood, CSF API 20 Strep Streptococcus bovis biotype II S
2006 (5) 38 d M NSVD Blood NR Streptococcus bovis S
2006 (5) 43 d M C/sec Blood, CSF NR Streptococcus bovis S
2009 (12) 5 d F NR Blood, CSF API 20 Strep Streptococcus pasteurianus S
2009 (13) 3 d NR NR Blood, CSF API 20 Strep Streptococcus pasteurianus S
2011 (14) 13 d M NSVD CSF 16S rRNA Streptococcus pasteurianus S
2011 (14) 5 d F NSVD Blood, CSF 16S rRNA Streptococcus pasteurianus S
2011 (14) 2 d M NSVD Blood, CSF 16S rRNA Streptococcus pasteurianus S
2011 (14) 5 d M NSVD Blood, CSF 16S rRNA Streptococcus pasteurianus S
2012 (15) 2 d M NSVD CSF NR Streptococcus pasteurianus S
2012 (16) 8 d M NSVD CSF API 32 Strep Streptococcus pasteurianus S
          16S rRNA    
2013 (17) 2 d M C/sec Blood, umbilicus 16S rRNA Streptococcus pasteurianus S
2013 (4) 28 d M NSVD Blood, CSF 16S rRNA Streptococcus pasteurianus S
2014 (18) 5 wk M NR Blood, CSF, stool 16S rRNA Streptococcus pasteurianus S
2014 (ours) 28 d M C/sec Blood, CSF 16S rRNA Streptococcus lutentiensis S

Abbreviations: wk, weeks; mo, months; d, days; M, male; F, female; NSVD, normal spontaneous vaginal delivery; C/sec, cesarean section; CSF, cerebrospinal fluid; 16S rRNA, 16S rRNA sequence analysis; API 20 Strep, The API 20 Strep (bioMerieux Vitek, Inc., Hazelwood, MO); API 32 Strep, API Rapid ID 32 Strep (Version 2.0; bioMerieux Japan, Tokyo, Japan); S, survived; NR, not reported.

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