Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. Methods GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. Results Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons. Conclusions A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.
Background: Streptococcus agalactiae (group B streptococcus, GBS) is the leading cause of invasive neonatal infections in the developed world. We present epidemiological and clinical characteristics of invasive GBS disease among Slovenian neonates between 2003 and 2013.Methods: A retrospective cohort study was performed. Children aged 0–90 days with invasive GBS disease, born in Slovenia and hospitalized in the University Medical Centre Ljubljana were included. Cases were identified concurrently from (i) hospital and (ii) microbiological databases. Medical records from mothers and children were reviewed and relevant data extracted. The incidence rate was calculated based on the national vital statistics data and expressed per 1000 live births.Results: Altogether, 144 children were included in the analysis, 72.9 % (n = 105) based on hospital database and 27.1 % (n = 39) based on microbiological database. Among them, 47.9 % (n = 69) were girls and 52.1 % (n = 75) boys. Among the cases with available data, 54.5 % (n = 73) were born at term and 45.5 % (n = 61) were preterm. Early-onset disease (0–6 days) was present in 74.3 % (n = 107) of patients; 95.3 % (n = 102) of them became ill during the first 3 days of life. Late-onset disease (7–90 days) was present in 25.7 % (n = 37) of patients. Outcome data was available for 134 children. Neonatal mortality rate was 4.5 % (n = 6). Periventricular leukomalacia (PVL) or intraventricular haemorrhages Grade III/IV (IVH 3/4) were detected in 17.9 % (n = 24). Severe outcomes (death or PVL or IVH 3/4) were detected in 22.4 % (n = 30) children. Cumulative incidence rate was 0.72/1000 live births; 0.53/1000 for early-onset and 0.18/1000 for late-onset disease. Risk factors for early-onset disease were present in 47.9 % (n = 68) mothers in labour. Intrapartum antibiotic prophylaxis was delivered to 16.9 % (n = 24) of mothers.Conclusions: High incidence of invasive neonatal GBS disease was detected in Slovenia. Although low mortality was observed, brain pathology concordant with long-term adverse outcome was confirmed in a high proportion of patients. The application of intrapartum antibiotic prophylaxis in cases of known risk factors was suboptimal, especially among preterm deliveries. Approximately half of the patients were born to mothers without any risk factors. A comprehensive national strategy for the prevention of invasive GBS disease is warranted in Slovenia.
Hepatic hemangiomas (HH) – classified into congenital hepatic hemangiomas (CHH) or infantile hepatic hemangiomas (IHH) – are benign vascular tumors that are mainly asymptomatic, but may cause clinical problems that require treatment. While focal, multifocal, and diffuse IHH are responsive to propranolol treatment, CHH is mainly focal and thought to be resistant to treatment with propranolol. The clinical and imaging distinctions between CHH and IHH in cases of focal lesions can be challenging, while histopathological distinction is mostly lacking in the clinical setting. We report 4 neonatal symptomatic cases of focal HH treated with propranolol, with partial or complete resolution of the tumor, and the positive hemodynamic effect of propranolol in one case. We believe that although clear differentiation cannot be achieved between CHH and IHH without histopathological examination in cases of focal HH in neonates, propranolol treatment should be attempted in symptomatic cases since its benefits outweigh the possible small risk of side effects of propranolol.
Carboxyhemoglobin (COHb) is an index of endogenous carbon monoxide formation during the hem degradation process and could be used to confirm hemolysis in neonates. The influence of other clinical factors on COHb values in neonates has not been fully investigated. We aimed to evaluate the influence of hemolysis, sepsis, respiratory distress, and postnatal age on COHb values. We retrospectively analyzed COHb measurements determined with a carbon monoxide-oximeter in 4 groups of term neonates: A—sepsis, B—respiratory distress, C—hemolysis, and D—healthy neonates. The mean COHb values were 1.41% (SD: 0.26), 1.32% (SD: 0.27), 2.5% (SD: 0.69), and 1.27% (SD: 0.19) (P<0.001) in groups A (n=8), B (n=37), C (n=16), and D (n=76), respectively. COHb in group C was significantly higher than in the other groups. There was a negative correlation between postnatal age and COHb in healthy neonates. A cut-off level of 1.7% had 93% (95% confidence interval [CI]: 89%-97%) sensitivity and 94% (95% CI: 90%-98%) specificity for diagnosis of hemolysis. COHb values were higher during the first days of life. We found that COHb levels in neonates with hemolysis were significantly higher and that the influence of sepsis and respiratory distress on COHb values was insignificant.
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