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Case Reports: Unusual presentation of more common disease/injury
Recurrent group B streptococcus infection in an extremely premature infant: as a preterm neonate, infant and toddler
  1. Ina Schim van der Loeff1,2,
  2. Christo Tsilifis1,2,
  3. Khalid Abdelhafiz3 and
  4. Eleri J Williams1
  1. 1Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
  2. 2Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
  3. 3Neonatalogy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
  1. Correspondence to Ina Schim van der Loeff; ina.schim{at}nhs.net

Abstract

We report five discrete episodes of group B streptococcus (GBS) bacteraemia in an extremely premature infant, extending into early childhood. The first four episodes occurred during infancy despite appropriate treatment. Breastmilk was positive for group B streptococcal 16S DNA by polymerase chain reaction. The fifth episode occurred at 17 months of age, shortly after stopping antimicrobial prophylaxis.

Radiological investigations did not identify a focus for recurrence of GBS bacteraemia, and immunological investigations and targeted whole genome sequencing yielded only transient hypogammaglobulinaemia of infancy, which resolved.

This case highlights invasive GBS infection as a cause of infant morbidity. Premature infants are at particular risk of invasive as well as recurrent disease. GBS is typically a sensitive organism and each episode of GBS in our patient was effectively treated with penicillin. The role of breastmilk in recurrent GBS is controversial; in this case infant and mother isolated identical GBS serotypes and were concurrently treated with rifampicin.

  • Neonatal and paediatric intensive care
  • Infectious diseases
  • Neurology (drugs and medicines)

https://doi.org/10.1136/bcr-2023-255216

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    Footnotes

    • ISvdL and CT are joint first authors.

    • Twitter @christotsilifis

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: ISvdL, CT, KA and EW. ISvdL and CT contributed equally to this manuscript and are joint first authors. The following authors gave final approval of the manuscript: ISvdL, CT, KA and EW.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.