Streptococcal pharyngitis and epiglottitis in a newborn infant

We describe a newborn infant withStreptococcus sanguis septicaemia and concomitant upper airway obstruction due to epiglottitis and pharyngitis. This rare infection of the supraglottic region was treated with endotracheal intubation and antibiotics. Full recovery occurred within 4 days.     

Dynamic changes of TrkB gene expression in <Emphasis Type="Italic">Streptococcus pneumoniae</Emphasis> meningitis after treatment with antibiotics and dexamethasone

Background  

Although more and more new potent antibiotics have been used, the incidence of neurological sequelae of Streptococcus pneumoniae meningitis has not improved in children over the last decade. The expression of TrkB mRNA, a receptor of brain-derived neurotrophic factor, is associated with the incidence of neurological sequelae of Streptococcus pneumoniae meningitis.     

Streptococcus gallolyticus subsp. pasteurianus meningitis in an infant

Streptococcus gallolyticus subsp. pasteurianus was formerly classified as S. bovis biotype II/2, which is recognized as a rare cause of neonatal sepsis and meningitis. Since the taxonomy classification change, there have not been many reports of meningitis due to S. gallolyticus subsp. pasteurianus. Moreover, the pathogenesis of late onset S. gallolyticus subsp. pasteurianus meningitis in infants is unclear. Here we report a case of meningitis in a 5‐week‐old infant with preceding diarrhea. S. bovis biotype II/2 was isolated from the blood, cerebrospinal fluid and stool, and then was identified as S. gallolyticus subsp. pasteurianus on 16S rRNA gene sequencing. Isolates from all three sample types had identical profiles on pulsed‐field gel electrophoresis. The intestinal tract was thought to be the source of the infection.     

Iatrogenic IgG2 deficiency in a leukaemic child

A girl with acute non-lymphoblastic leukaemia was treated with immunosuppressive chemotherapy. After cessation of therapy she had three consecutive episodes of infection due toStreptococcus pneumoniae from which she recovered and was shown to have developed a combined deficiency of both IgG₂ and IgG₄. The patient eventually relapsed and died 3 years after the initial diagnosis. The importance of measuring IgG subclasses in patients treated with immunosuppressive chemotherapy is discussed.     

Characteristics of Streptococcus pyogenes strains isolated from Chinese children with scarlet fever

Aim: To analyse the characteristics of Streptococcus pyogenes isolates from Chinese children with scarlet fever. Methods: Minimal inhibitory concentration with nine antibiotics was performed on 145 Streptococcus pyogenes isolates acquired from Beijing and Shanghai in 2007. Their macrolide‐resistant genes (mefA, ermB and ermA– a subclass of ermTR), superantigens (speA and speC), and en‐coding mature M protein gene (emm gene) were amplified by PCR. Results: A total of 97.9% of the isolates exhibited resistance to the macrolides, while 96.6% manifested resistance to tetracycline. All isolates were sensitive to chloramphenicol, penicillin, cefradine, and ofloxacin. Moreover, 94.5% exhibited a cMLSB phenotype, while 90.3% had the ermB gene. Five emm types (emm1.0, emm4.0, emm12.0, emm22.0 and st5240) were discovered, of which 9.7% carried the superantigen speA, 35.9% carried the speC, 42.8% carried both speA and speC and 11.7% carried neither speA nor speC. Finally, 85.5% of emm1.0 and 15.5% of emm12.0 isolates carried speA, while 79.0% of emm1.0 and 75.9% of emm12.0 isolates carried speC. Conclusion: The Streptococcus pyogenes isolates had high resistance rates against macrolides and tetracycline. They mainly expressed the ermB gene type and cMLSB phenotype. Their common emm types are emm1.0 and emm12.0, which have different frequencies of speA and speC.     

Haemophilus influenzae type D infection and JgG2 deficiency in a patient with chronic mucocutaneous candidiasis

A 14 year old boy with chronic mucocutaneous candidiasis and persistent pulmonary infection caused by Haemophylus influenzae and Streptococcus pneumoniae is reported. Initial bacterial culture studies showed H. influenzae type B and S. pneumoniae as causative agents. H. influenzae type D was constantly isolated from the patient's sputum. Abnormally low levels of serum immunoglobulin G2 (IgG2) found in the patient may have contributed to the pulmonary infection and H. influenzae type D may be an important causative agent in immunodeficient patients.     

The aetiology of paediatric inflammatory vulvovaginitis

Vulvovaginitis is the most common gynaecological problem in prepubertal girls and clear-cut data on the microbial aetiology of moderate to severe infections are lacking. Many microorganisms have been reported in several studies, but frequently the paediatrician does not know the pathogenic significance of an isolate reported in vaginal specimens of girls with vulvovaginitis. A multicentre study was performed, selecting 74 girls aged 2 to 12 years old with a clinical picture of vulvovaginitis and inflammatory cells on Gram stain. All the specimens were cultured following standard microbiological techniques and the paediatricians completed a questionnaire to highlight risk factors after interviewing the parents or tutors. The data were compared with those obtained in a control group of 11 girls without vulvovaginitis attending a clinic. Streptococcus pyogenes and Haemophilus spp.were isolated in 47 and 12 cases, respectively. Upper respiratory infection in the previous month ( P <0.001) and vulvovaginitis in the previous year ( P <0.05) were identified as significant risk factors. Foreign bodies, sexual abuse, poor hygiene and bad socioeconomic situation were not identified as risk factors for the infection. Conclusion: Paediatric inflammatory vulvovaginitis is mainly caused by pathogens of the upper respiratory tract and the most common risk factor for this infection is to have suffered an upper respiratory tract infection in the previous month.Abbreviations HI Haemophilus influenzae - PIV paediatric inflammatory vulvovaginitis - SP Streptococcus pyogenes On behalf of the Spanish Study Group for Primary Care Infection     

Streptococcus pyogenes meningitis: report of a case and review of the literature

Streptococcus pyogenes is a very uncommon cause of bacterial meningitis beyond the neonatal period. A case report and a review of the recent literature is presented. We report on a previously healthy 7-year-old boy who developed S. pyogenes meningitis following a 2-day history of otitis media. A CT scan revealed right-sided mastoiditis as a possible focus of infection. The patient was treated with penicillin G for 14 days. The clinical course was uneventful, and he recovered without sequelae. By means of the polymerase chain reaction, the presence of streptococcal pyrogenic exotoxin (SPE) B and SPE C, but not SPE A genes was discovered from the bacterial DNA. Conclusion Streptococcus pyogenes is a rare cause of bacterial meningitis but has to be considered as the causative pathogen beyond the neonatal period. Received: 17 May 1999 / Accepted: 4 January 2000     

苏州地区14994例儿童呼吸道感染细菌病原学特点

目的 了解儿童呼吸道感染的细菌病原学特点。方法 收集2005 年11 月至2014 年10 月连续9 年因呼吸道感染入住苏州大学附属儿童医院的14 994 例儿童的病例资料进行回顾性分析。结果 14 994 份呼吸道感染患儿的痰标本中,细菌培养阳性3 947 份,总阳性检出率为26.32%。第1 位细菌病原为肺炎链球菌(12.79%),其次为流感嗜血杆菌(5.02%)、卡他莫拉菌(2.91%)。在不同年份、不同季节、不同年龄段儿童细菌检出率差异有统计学意义(P<0.01)。入院前未使用过抗菌药物的患儿痰细菌培养阳性率高于使用过抗菌药物的患儿(P<0.01)。院外病程<1 个月组、1~3 个月组及>3 个月组患儿痰培养细菌检出率差异有统计学意义(P<0.05)。肺炎链球菌、卡他莫拉菌、鲍曼不动杆菌的阳性检出率随病程的延长呈上升趋势(P<0.05)。结论 肺炎链球菌是引起儿童呼吸道感染的最常见细菌病原,其次为流感嗜血杆菌和卡他莫拉菌。各种细菌在不同的年份、不同的季节、不同的年龄阳性检出率有差异。疾病病程与院外抗菌药物使用对细菌的阳性检出率有影响。     

Defective phagocytosis confined to Staphylococcus aureus in a female infant with recurrent infections

Defective chemotaxis and phagocytosis of Staphylococcus aureus was identified in a female infant with marked hepatosplenomegaly and recurrent infections. Neutrophil mobilization from the marrow and marginal pool; random mobility; phagocytosis of yeast particles, latex beads and carbon particles; phagocytosis and intracellular killing capacity of Streptococcus pyogenes and E. coli; and NBT dye reduction were normal. Infiltration of neutrophils was depressed in the skin window test. The complement system and cellular immunity were intact. The patient also had a persistent EB virus infection.Defective phagocytosis limited to Staphylococcus aureus seems to be caused by an intrinsic cellular defect, such as congenital defect in neutrophil receptors for Staphylococcus aureus.     

Méningite à pneumocoque résistant à la pénicilline et transmission nosocomiale en milieu hospitalier pédiatrique confirmée par analyse génomique

Background.

Careful epidemiological studies and sophisticated diagnostic procedures are necessary to prove that bacterial infection is nosocomial in origin. DNA finger printing method can be useful with this aim in view.

Case reports.

A 11 month-old girl suffered from a febrile pneumonia. She developed acute meningitis 15 days later; culture of CSF grew Streptococcus pneumoniae, serotype 23 F, resistant to β-lactamines, erythromycin and cotrimoxazole. She died 24 hours later. Five days after this death, a 5 month-old infant hospitalized in the next bed developed an acute pulmonary infection due to the same strain with the same bacterial characteristics; this patient was cured with cefotaxime plus vancomycin and gentamicin. Randomly amplified polymorphic DNA analysis showed an identical profile of both strains.

Conclusion.

This is the first case of meningitis due to penicillin-resistant Streptococcus pneumoniae (PRSP) associated with nosocomial spread between two children in adjacent beds. This case suggests that it is necessary to isolate patients with PRSP infection during hospitalization.     

Possible Role of Streptococcus pyogenes in Mucocutaneous Lymph Node Syndrome. Ill Electron Microscopic Observations on Group A Hemolytic Streptococci Inoculated into Mice

Because of various circumstantial evidence, we have been asserting the streptococcal etiology of mucocutaneous lymph node syndrome (MCLS), although there has been no recovery of Streptococcus pyogenes from the patients at any site. The present study was designed to provide a satisfactory explanation for the failure to isolate these bacteria from patients with MCLS, by electron microscopic observation of group A ftera-hemolytic streptococci which had been inoculated intramuscularly into mice. “Spherical bodies” were detected in biopsy specimens obtained from the infection sites from 10 – 14 days onward after infection; these were spherical, 0.5–1.5 yua in diameter, devoid of cell walls, perhaps uncultivable on any culture medium, and undistinguishable from those discovered in the buffy coat from peripheral blood of MCLS patients and described as ruined etiological microorganisms by Ueno et al. The implications of these findings, particularly in terms of the etiology of MCLS, were discussed.     

Magnetic resonance imaging of lung infections in children

The advantages and limitations of MRI in lung infections in children have not been well established. This article illustrates the MRI findings in children with pneumonia caused by Mycoplasma pneumoniae, Streptococcus pneumoniae, and other pathogens. Lung parenchymal, pleural, and lymph node abnormalities are well characterized by MRI. Loculation of pleural fluid is detected in children with empyema. Contrast enhancement may be useful in the differentiation of active inflammation from noninflammatory changes. MRI can be particularly useful in the follow-up of children with chronic pulmonary diseases.     

Neonatal necrotizing fasciitis of the scrotum caused by Streptococcus agalactiae

We herein describe the case of a 27‐day‐old male infant who was brought to the emergency room for intermittent crying, and swelling of the left scrotum. Based on the clinical findings, necrotizing fasciitis was suspected, and surgical intervention was successfully completed within a few hours of admission. Streptococcus agalactiae type Ia was cultured from the drained abscess, and was considered the causative pathogen. To our knowledge, this is the first report of neonatal necrotizing fasciitis caused by S. agalactiae. Prompt diagnosis and immediate surgical debridement are crucial in the initial management of this disease.     

Bacterial meningitis in Saudi children

During the four years period from 1988 to 1991, 50 pediatric patients were diagnosed to have bacterial meningitis, out of a total number of 9057 pediatric admissions at Qatif Central Hospital, Qatif, Saudi Arabia, and 82% were less than two years of age. The causative organisms were isolated in 27 (54%) patients. The bacteria grown includedhaemophilus influenzae type B in 8 patients (29.6%),Neisseria meningitidis in 8 patients (29.6%),Streptococcus pneumonia in 6 (22%) patients, and other bacteria in 5 patients (18.5%). Cerebro spinal fluid cultures from twenty three patients (46%) showed no organisms, however their clinical and C.S.F. findings were compatible with bacterial meningitis. One case ofH. influenzae type B was resistant to ampicillin. Six patients died with an over all mortality of 12%, and 10 patients (20%) developed some kind of C.N.S. sequelae. Partially treated meningitis formed a large percentage of our sample.     

Group B Streptococcal Meningitis in a 5-year-old boy

Group B Streptococcus (Streptococcus agalactiae) is a well-known cause of early and late onset infections in neonates and very young infants. Recently attention has focused on the changing spectrum of invasive Group B Streptococcus (GBS) disease, including children beyond early infancy and non-pregnant adults. There is very little information available on invasive GBS infection especially meningitis in pediatric population older than three months of age. We report a case of uncomplicated meningitis due to GBS in a previously healthy 5-year-old boy. The literature on infection especially meningitis caused by Group B Streptococcus beyond infancy is reviewed.     

Social-economic factors and irrational antibiotic use as reasons for antibiotic resistance of bacteria causing common childhood infections in primary healthcare

The most prevalent childhood bacterial infections in primary healthcare are respiratory, gastrointestinal and urogenital infections. The main aim of this paper was to consider factors (socio-economic factors and irrational antibiotic use) that contribute to the development of bacterial resistance, as well as measures that resulted in a reduction of this problem. Computerized search through the Medline of published articles on antibiotic resistance from 1996 to 2011 in English or Serbian was completed in August 2011. Combinations of used terms were antimicrobial/antibacterial/antibiotic and resistance/susceptibility in pediatric/children, and Streptococcus pneumoniae/Streptococci/Haemophilus influenzae/Salmonellae/Escherichia coli/Shigella/Staphylococcus aureus as well as antibiotics/antimicrobials/antibacterials and consumption/utilization/use. In many developing countries, antibiotic dispensing and its use in medicine, cattle breeding and agriculture are inadequately regulated, or existing laws are not being appropriately implemented. In addition, human travel contributes to antimicrobial drug resistance around the world. All of these factors have led to a very high level of bacterial resistance. On the contrary, in countries with a clearly defined and implemented legal framework concerning antibiotic prescribing, dispensing and utilization, the use of antibiotics is under constant surveillance. That resulted in a significantly lower antibacterial resistance. In conclusion, bacterial resistance could be reduced by the implementation of systemic and long-term measures at a country level as well as at all levels of healthcare. In order to reduce bacterial resistance, antibiotic use needs to be precisely regulated, and regulations should be coherent with practice. The international community must have a more active role in solving this global problem.     

Three distinct episodes of GBS septicemia in a healthy newborn during the first month of life

In neonates, recurrent group B streptococcal infection is uncommon, and two relapses are extremely rare. We report a case of three distinct episodes of Streptococcus agalactiae bacteremia in a healthy full-term infant over a 4-week period. The newborn had no apparent predisposing condition or infectious focus, and the recurrences occurred after adequate antimicrobial treatment, the second occurring after withdrawal of colonized breast milk. Finally, oral rifampin was combined to his antibiotic regimen, his colonization cultures turned negative, and no further relapses have occurred during the 11-month follow-up. Conclusion In this report, we describe a newborn with two exceptionally rapid recurrences of group B streptococcal septicemias, and who was successfully treated with combining rifampin to the antibiotic regimen.     

Autoinfarcted Wandering Spleen and Fatal Pneumococcal Sepsis in an Infant

A wandering or ectopic spleen, a rare congenital condition caused by improper fixation of the ligamentous attachments, was identified during a postmortem examination of a 10-month-old female who had died of Streptococcus pneumoniae sepsis. The wandering spleen was autoinfarcted and adherent to the left hepatic lobe, with resultant functional hyposplenism.