Several studies have reported that postnatally acquired cytomegalovirus (CMV) infection can cause sepsis-like syndrome in premature infants. We here report a 622-gram birth weight male infant of 23 weeks’ gestation who had sepsis-like syndrome and pneumonia. Substantial CMV loads were detected in peripheral blood cells, plasma, and urine when the patient was in crisis, but was decreased in parallel to clinical improvement without using ganciclovir. CMV DNA was not detected from his umbilical cord or Guthrie card, even by highly sensitive real-time PCR. Molecular profiles were indistinguishable between the CMV strain isolated from his urine and that from maternal breast milk, indicating postnatal acquisition of CMV through breast milk. Although he had transient hearing impairment, his neurodevelopmental outcome of 30 months of corrected age was normal. Further accumulation of clinical and virological data in postnatal CMV infection is necessary for evaluating the severity and selecting patients requiring antiviral therapy.
Suppurative sialadenitis should be remembered as a potential source of infection in preterm neonates.We recently encountered two cases of suppurative sialadenitis involving only the bilateral submandibular glands on our neonatal intensive care unit (NICU) within a 3-week period. Methicillinresistant Staphylococcus aureus (MRSA) was detected in purulent material discharged from the Wharton ducts in both cases. Acute suppurative sialadenitis in the neonatal period is an extremely rare disease. Only ®ve cases have been reported [1,2,4], four of which involved preterm newborns. In Japan, the very high frequency of MRSA contamination in NICUs is a considerable problem. We describe our two cases to alert clinicians to the need for caution.The ®rst case, aboy with a birth weight of 1815 g, was delivered spontaneously at 32 weeks of gestation. Pregnancy, labour and delivery were uncomplicated. The infant required nasal directional positive airway pressure overnight on day 0 because of transient tachypnoea of the newborn. No antibiotics were given since there was no sign of infection in the perinatal history or laboratory data. Feeding via nasogastric tube was begun on day 2. On day 7, the infant developed a temperature of 38.0°C and mild apnoea. A ®rm submandibular mass, 1´2.5 cm in diameter on the right, and a tender mass, 1 cm in diameter on the left, were noted. There was no swelling, tenderness or erythema in either parotid area. Purulent exudation from the Wharton ducts was noted when the submandibular masses were pressed on day 11 (Fig. 1). MRSA was cultured from the exudates. This exudation persisted for 7 days. The white blood cell count (WBC) was 14,500/mm 3 and the ratio of immature to total neutrophils was 0.16. Serum amylase was not increased. The submandibular masses showed a steady decrease in size after intravenous administration of vancomycin.The second case was another boy, birth weight 1560 g, born in our institute at 32 weeks of gestation by caesarean section because of suspected intra-uterine infection. However the infant's respiratory state was stable; intravenous administration of piperacillin and netilmicin was begun on day 0 due to an elevated WBC count and C-reactive protein level. Antibiotics were given for 7 days. On day 12, the infant developed mild apnoea and a ®rm submandibular mass, less than 1 cm in diameter, was found on the left. MRSA was also cultured from a purulent material squeezed from the submandibular mass. Although the WBC count was 27,000/mm 3 , serum amylase was not increased. After intravenous administration of vancomycin for 7 days, the submandibular mass promptly decreased in size.The aetiology of submandibular suppurative sialadenitis in our two cases remains unclear. Dehydration has been proposed as a predisposing factor [3]. In both of our cases, sucient feedings were given via nasogastric tube and no clinical signs of dehydration were recognised.Infections of the salivary glands are uncommon in the neonatal period and most often involve the parotid gland. We encountered ...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.