Neonatal retroauricular cellulitis as an indicator of group B streptococcal bacteremia: a case report

Abstract

IntroductionThe relation between cellulitis and Group B streptococcus infection in newborns and small infants was first reported during the early 1980s and named cellulitis-adenitis syndrome. We report a case of a neonate with cellulitis-adenitis syndrome in an unusual location (retroauricular).Case presentationA 21-day-old Caucasian female infant was brought to the emergency department with fever, irritability and a decreased appetite. Physical examination revealed erythema and painful, mild swelling in the right retroauricular region. The blood count and C-reactive protein level were normal. She was treated with ceftriaxone. The fever and irritability were resolved after 24 hours, and the cellulitis was clearly reduced after two days of hospitalization. Blood culture yielded Group B streptococcus.ConclusionA thorough evaluation must be done, and lumbar punctures for infants with cellulitis must be considered. We emphasize the lack of data about acute phase reactants to predict bacteremia and meningitis and to adjust the duration of parenteral antibiotic therapy to address this syndrome.

Neonatal cervical group B streptococcal cellulitis

“…To our knowledge, only a few cases have been reported in the literature. Generally speaking, the clinical presentation is similar to that of our case: it is always a diagnosis delayed by at least 7 days after birth [6] with a non-specific symptomatology [7]: fever, crying, irritability, decrease in food intake. Hence the need for a careful clinical examination of any febrile presentation in infants, regardless of the epidemic context.…”

The pathogenicity of the Streptococcus genus

“… n = 100 Intravenous drug abuse, infectious metastases, purulent vein inflammation, endocarditis 6 [ 85 ] 20–40/F Streptococcus pneumoniae n = 55 Amoxicillin, clarithromycin, azithromycin, ceftriaxone, ceftibuten, cefaclor [ 86 ] 0–5 years Streptococcus pneumoniae n = 71 HIV Third-generation cephalosporins, vancomycin, or erythromycin 28 % [ 87 ] 42/M Streptococcus spp. n = 522 [ 88 ] Viridans group Streptococcus n = 79 (88 episodes) Leukemia/stem cell transplantation Piperacillin and gentamicin, piperacillin and tobramycin, or ceftazidime and tobramycin [ 89 ] <18 years of age The most often used empiric therapy: piperacillin and tobramycin (75 % of episodes) Streptococcus agalactiae 21 days/F Ceftriaxone N [ 90 ] Streptococcus anginosus 46/M Uremia, hypertension, recurrent infections Ceftriaxone, vancomycin N [ 91 ] Streptococcus viridans n = 15 Hematological cancers [ 92 ] <20 year of age Streptococcus spp. (in addition to S. pneumoniae ) n = 30 Community-acquired infections 3 [ 93 ] 59 years (average) 15/M ...…”