An animal model for group B streptococcal vaginal colonization and neonatal acquisition was developed with albino rats. Intravaginal inoculation of genital isolates of group B streptococci of serotypes Ia, II, and III either once or on 3 successive days resulted in carriage of the organisms for 7 days or longer in 26% of the virgin animals and 43% of the pregnant animals. Throat and perianal cultures of the offspring of pregnant rats revealed that 51% of the rat pups acquired the organisms at some time. Litter exchange studies were done to explore the contributions of environmental and intralitter spread. Significantly more infants born to mothers with positive vaginal cultures acquired the organisms than infants of culture-negative mothers who were suckled by positive adoptive mothers. However, 13% of the offspring of vaginal-culture-negative rats who were suckled by animals with positive genital cultures acquired group B streptococci. This model may be valuable in understanding the dynamics of vaginal carriage and mother-infant transmission of group B streptococci.
\s=b\ In a 20-day-old female infant, bacteremia, osteomyelitis, and pyogenic arthritis developed due to infection with group B streptococcus, type Ic. She had an unusual clinical presentation with overwhelming sepsis and acute congestive heart failure.(Am J Dis Child 133: [919][920] 1979) The clinical manifestations of in¬ fections with group streptococ¬ ci are protean.'-7 Pneumonia with sepsis and meningitis are the com¬ monest forms of early-onset disease in the newborn infant, and these infec¬ tions are frequently overwhelming and are associated with a high mortal¬ ity.--'"7 Localized bone and joint infections can occur, but usually lack evidence of systemic dissemination, as opposed to the typically severe mani¬ festations of early-onset group streptococcal disease.""' An unusual patient had group streptococcal osteomyelitis and arthritis, who at 20 days of age first had overwhelming sepsis complicated by acute cardiac and renal failure. REPORT OF A CASEA 4.5-kg girl was the product of an uneventful full-term pregnancy. Labor was complicated by a prolonged second stage and delivery was performed with low forceps through meconium-stained fluid. The trachea was suctioned, but no meconium was noted. Apgar scores were 8 and 9 at one and five minutes of age. The chest roentgenogram was normal and the pa¬ tient was discharged at 5 days of age. The only abnormality noted after discharge was failure to move the left arm.On the day prior to admission, at 19 days of age, the patient suddenly became tachypneic and cyanotic. She was exam¬ ined by her physician, who diagnosed congestive heart failure, initiated positivepressure ventilation via an endotracheal tube, and arranged transport to the University of Minnesota Hospitals, Min¬ neapolis.On admission, the infant's heart rate was 156 beats per minute, systolic blood pressure was 52 mm Hg, and axillary temperature was 36.7°C The anterior fontanelle was flat and soft. Examination of the lungs showed rales over the right posterior lung field. There was a grade 2/6 holosystolic blowing murmur with exten¬ sion into diastole at the upper sternal border. The liver was palpable 6 to 7 cm below the right midcostal margin; the spleen was not palpable. Both kidneys were palpable and the left one was enlarged. The left shoulder was swollen without erythe¬ ma or warmth. Roentgenographic examination of the chest showed a large heart and engorged pulmonary blood vessels. Extensive osteolytic changes compatible with osteomyeli¬ tis of the proximal left humérus and left seventh and eighth ribs were also noted.No evidence of fracture was seen.Results of laboratory studies at the time of admission included the following values: hemoglobin, 12.0 g/dL; WBCs 44,600/cu mm, with 36% neutrophils, 36% band forms, and 28% lymphocytes; platelets, 150,000/cu mm; BUN, 43 mg/dL; and creatinine, 2.1 mg/dL. The prothrombin time was 22.4 s, the partial thromboplastin time, 67.5 s, and the thrombin time, 32.3 s, with a control of 15.5 s. The factor V level was 9% of normal.The ECG showed biventricul...
A case of neonatal pneumonia and sepsis caused by a group G Streptococcus is described. Clinical and microbiological aspects of group G streptococci are compared with those of group B streptococci. The manifestations of infections with group G streptococci have expanded since the original identification and description by Lancefield and Hare in 1935 (14). This organism has been implicated in puerperal infections (11, 14), endocarditis (7), pharyngitis (12), empyema (7), peritonitis (13), and septicemia in adults (7, 8) and newborn infants (2). Like group B stretococci, group G streptococci can be recovered from the female genital tract (14) and were formerly felt to be avirulent. The following report describes an infant with sepsis secondary to group G streptococci. Case summary. The infant was a 2,600-g female product of a 37-week gestation, born to a 21-year-old primigravida 35 h after rupture of membranes. The Apgar score was 7 at 1 min and 9 at 5 min, and the baby was given humidified oxygen at birth. Over the first 8 h of life, the child developed progressive tachypnea, grunting, duskiness, and apnea, culminating in a respiratory arrest. At this time, a chest X ray which revealed bilateral infiltrates was obtained, and ampicillin and kanamycin treatments were begun, although no bacterial cultures were taken. Transport to the University of Minnesota Hospitals was arranged. On arrival, the heart rate was 180/min, the blood pressure was 47/24 mmHg, and the temperature was 100°F (ca. 37.8°C) rectally. An examination of the chest revealed rales and rhonchi in all lung fields.
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