\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...
