Neonatal infection with Streptococcus milleri

Epidural abscess caused by Streptococcus milleri in a pregnant woman

BACKGROUND

Bacteria in the Streptococcus milleri group (S. anginosus, S. constellatus, and S. intermedius) are associated with bacteremia and abscess formation. While most reports of Streptococcus milleri group (SMG) infection occur in patients with underlying medical conditions, SMG infections during pregnancy have been documented. However, SMG infections in pregnant women are associated with either neonatal or maternal puerperal sepsis. Albeit rare, S. milleri spinal-epidural abscess in pregnancy has been reported, always as a complication of spinal-epidural anesthesia. We report a case of spinal-epidural abscess caused by SMG in a young, pregnant woman without an antecedent history of spinal epidural anesthesia and without any underlying risk factors for invasive streptococcal disease.

CASE PRESENTATION

A 25 year old pregnant woman developed neurological symptoms consistent with spinal cord compression at 20 weeks gestation. She underwent emergency laminectomy for decompression and was treated with ceftriaxone 2 gm IV daily for 28 days. She was ambulatory at the time of discharge from the inpatient rehabilitation unit with residual lower extremity weakness.

CONCLUSION

To our knowledge, this is the first reported case of a Streptococcus milleri epidural abscess in a healthy, pregnant woman with no history of epidural anesthesia or invasive procedures. This report adds to the body of literature on SMG invasive infections. Treatment of SMG spinal-epidural abscess with neurologic manifestations should include prompt and aggressive surgical decompression coupled with targeted anti-infective therapy.

Bacteraemic Streptococcus pyogenes infection in the peri-partum period: now a rare disease and prior carriage by the patient may be important

OBJECTIVES

To describe the features of invasive peri-partum Streptococcus pyogenes infection as it occurs in current day practice in North Yorkshire.

METHODS

The case and laboratory records of all mothers and/or babies with detected S. pyogenes bacteraemia in the Harrogate and Northallerton districts of North Yorkshire (combined catchment population 260 000) were reviewed for the 20 years 1980-99. An additional bacteraemic case occurring recently in the York district was included.

RESULTS

In six recorded episodes, both mother and baby were affected in three, mother only in two and baby only in one. The incidence of detected infection was one such episode per million population per year, one episode per 11 000 live births and one infected baby per 18 000 live births. Maternal features included endometritis, septicaemia, peritonitis, necrotising fasciitis and toxic shock syndrome while, in babies, infection was manifest by stillbirth or septicaemia, cyanosis, jaundice, lethargy and cellulitis.

CONCLUSION

Peri-partum S. pyogenes infection is rare in North Yorkshire, with a local incidence revealed in this study of 1/million population/year, or 1:11 000 live births. Invasive neonatal infection with S. pyogenes appears to be six times less frequent in this locality than with group B streptococci. Mothers and/or their babies can be affected. Data suggests that some infection is autogenous from streptococci carried in the mother's genital tract. Although data in this setting are currently few, when a mother has suspected invasive group A streptococcal infection we recommend that the newborn child should also receive antibiotics without delay.

[Role of group B streptococcus serotype V in materno-fetal infections]

BACKGROUND

The classification of serogroup B streptococci in serotype is based on the structural differences of capsular polysaccharides and on presence or absence of a protein c antigen. They are classified as Ia, Ia/c, Ib/c, II, II/c, III, IV and V. The serotype V, unknown in 1970, seems emerging, and is placed in third position of frequency in some American studies. We have therefore decided to evaluate its frequency in Paris.

POPULATION AND METHODS

In a population of 137 pregnant women and 60 neonates carrying streptococcus of serogroup B, the serotype was systematically determined using the test "Group B streptococcus serotyping test" (Dako, Danemark).

RESULTS

In the pregnant women population, 12% of the isolated strains were of serotype V, 26% of serotype III, 15% of serotype II, 14% of serotype Ia, and 21% could not be typed. In neonates, it represented 15% of the isolates and took place after the serotype Ia (20%), the serotype III (18%) and the serotype II (15%). None of the neonates had early- or late-onset disease. They were only colonized. Only one mother exhibited, during the per-partum, a positive blood culture with a streptococcus group B of serotype V.

CONCLUSION

These results confirm, in Paris, the importance of this serotype previously observed in foreign studies. It represents 11 to 15% of the isolated streptococcus group B in the neonates and can cause early or late-onset disease. However, larger studies are needed to evaluate the exact risk of pathology for the serotype V and its significance in neonatal infectious disease.

Species belonging to the "Streptococcus milleri" group: antimicrobial susceptibility and comparative prevalence in significant clinical specimens

The association between the three species belonging to the "Streptococcus milleri" group and different sites of isolation was examined for 73 successive strains recovered from clinically significant, purulent infections. Susceptibility testing was performed on 64 of these strains. The present study supports the association of particular species with different clinical sources. Susceptibility data suggest that emerging penicillin resistance among Streptococcus anginosus and Streptococcus intermedius isolates may represent a potential clinical problem in the therapeutic management of infections caused by these species.