Invasive Streptococcus Gallolyticus Infections in Infants At Texas Children's Hospital: A 9-Year Retrospective Review

Infantile bacterial meningitis combined with sepsis caused by Streptococcus gallolyticus subspecies pasteurianus: A case report

BACKGROUND

Streptococcus gallolyticus subspecies pasteurianus (SGSP) is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings. Hence, we present a case of SGSP-induced infant meningitis and sepsis, accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus (MRSA), providing insights into the identification, management, and prognosis of this bacterial infection.

CASE SUMMARY

A 45-day-old female infant presented with two episodes of high fever (maximum temperature: 39.5 °C) and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms. Postadmission, the patient's C-reactive protein level was 40.73 mg/L, white blood cell count was 13.42 × 109/L, neutrophil ratio was 78.4%, procalcitonin level was 7.89 μg/L, cerebrospinal fluid (CSF) white cell count was 36 × 106/L, multinucleated cell ratio was 95.2%, and protein concentration was 0.41 g/L. Blood and CSF culture revealed that the pathogen was SGSP. The bacterium was sensitive to ampicillin, furazolidone, penicillin, lincomycin, moxifloxacin, rifampicin, vancomycin, and levofloxacin but resistant to clindamycin and tetracycline. Sputum culture revealed the presence of MRSA, which was sensitive to vancomycin. The patient was diagnosed with meningitis and sepsis caused by SGSP, accompanied by bronchopneumonia induced by MRSA. Ceftriaxone (100 mg/kg/d) combined with vancomycin (10 mg/kg/dose, q6h) was given as an anti-infective treatment postadmission. After 12 days of treatment, the infant was discharged from the hospital with normal CSF, blood culture, and routine blood test results, and no complications, such as subdural effusion, were observed on cranial computed tomography. No growth retardation or neurological sequelae occurred during follow-up.

CONCLUSION

SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures, and a sensitive antibiotic therapy to ensure a favorable prognosis.

Clinical Course and Outcomes of Infants with Streptococcus bovis/Streptococcus Gallolyticus subspecies pasteurianus Infection: A Systematic Review and Meta-analysis

BACKGROUND

Streptococcus gallolyticus subspecies pasteurianus (SGP), a subtype of Streptococcus bovis , is an uncommon but important cause of neonatal sepsis. Although uncommon, SGP infections during infancy have been associated with an increased risk of morbidity and mortality.

METHODS

This is a systematic review and meta-analysis of available literature on the clinical course and outcomes of infants with SGP infection. Studies were identified using the following MeSH keywords: " Streptococcus gallolyticus ," " Streptococcus bovis ," "newborn" and "infant." Data including perinatal factors, clinical presentation, investigations, treatment and outcomes were extracted and analyzed.

RESULTS

A total of 46 articles were identified (116 cases: 60 S. bovis , 56 SGP). The cases were predominantly term (52%), male (57%) and born via vaginal delivery (67%). The most common symptom was fever [67% (95% confidence interval (CI): 43%-84%)], lethargy [66% (95% CI: 32%-89%)], tachypnea [59% (95% CI: 27%-85%)] and irritability [59% (95% CI: 34%-79%)]. Infants with early-onset infections (<3 days of life) were more likely to have respiratory symptoms and bacteremia (73%), whereas late-onset infections presented predominantly with gastrointestinal symptoms. Four mortalities were reported which occurred before antibiotic administration. Isolated bacteria were mostly penicillin-susceptible [95% (95% CI: 78-99%)] and cases treated with penicillin derivative had good recovery.

CONCLUSIONS

SGP is an important cause of neonatal sepsis and meningitis. Penicillin derivative is an effective treatment for SGP, and outcomes appear to be favorable.

A Rare Case of Meningitis Caused by Streptococcus gallolyticus subsp. pasteurianus in an Immunocompetent Young Adult

Bacterial meningitis is a life-threatening condition that is mainly caused by Streptococcus pneumoniae and Neisseria meningitis. Although Streptococcus gallolyticus subsp. pasteurianus (Sgp) is also known to cause meningitis, its frequency is quite low, especially in adults. We herein report the first immunocompetent Japanese adult patient (20-year-old woman) with bacterial meningitis caused by Sgp. The patient showed dramatic improvement after antibiotic treatment. Although previous reports have described an association between Sgp infection and an immunosuppressive status, bowel and hepatobiliary diseases, or strongyloidiasis, our case did not demonstrate any of these conditions, suggesting that Sgp can cause meningitis even in young immunocompetent adults.

Late-Onset Meningitis in a Preterm Infant Caused by Streptococcus gallolyticus Subsp. Pasteurianus in Saudi Arabia: A Case Report and Literature Review

This report describes the progression of meningitis in a 24-day-old preterm male infant infected with Streptococcus gallolyticus subsp. pasteurianus (SGSP) and its medical care, pathogen detection, antibiotic treatment, and monitoring, ultimately leading to a positive outcome of successful recovery. Neonatal meningitis (NM) is a serious and potentially life-threatening condition, particularly in immunocompromised preterm infants. This report from Saudi Arabia presents a rare case of late-onset neonatal meningitis caused by SGSP in a preterm male infant. The 24-day-old preterm neonate presented with fever, lethargy, poor feeding, and respiratory distress. SGSP was confirmed by cerebral spinal fluid analysis showing the presence of pleocytosis and a low glucose ratio. Prompt antibiotic therapy with intravenous Ampicillin and Cefotaxime led to decreased pleocytosis, and the infant was discharged after 21 days. This report highlights the importance of vigilance, diagnosis, and management of neonatal infections caused by uncommon pathogens such as SGSP. The rarity of SGSP-caused meningitis emphasizes the need to monitor pregnant women for potential transmission and to implement early diagnostic and management strategies. This case report also encompasses a review of recent globally reported cases of neonatal S. gallolyticus infection, highlighting the distinctiveness of this report as the first of its type in Saudi Arabia.

Streptococcus gallolyticus Subspecies pasteurianus Meningitis in an Infant with Hypothyroidism and Diarrhea

Streptococcus gallolyticus subspecies pasteurianus, formerly classified as S. bovis biotype II/2 until 2003, is a rare cause of infant meningitis. Over the past 2 decades, only a few individual case reports and limited case series exist in the English-language literature. Moreover, the pathogenesis of S. gallolyticus subsp. pasteurianus meningitis in infants is unclear. Here we report a case of meningitis in a 6-week-old infant with hypothyroidism and preceding diarrhea. In this case, S. gallolyticus was cultured from cerebrospinal fluid, and then S. gallolyticus subspecies pasteurianus was identified by metagenomic next-generation Sequencing. The infant recovered uneventfully after a 4-week antibiotic course with ceftriaxone and vancomycin. Then combined with the literature of S. gallolyticus subsp. pasteurianus meningitis in infants, we discuss the possible etiology.

The Identification of Streptococcus pasteurianus Obtained from Six Regions in China by Multiplex PCR Assay and the Characteristics of Pathogenicity and Antimicrobial Resistance of This Zoonotic Pathogen

Streptococcus pasteurianus is a zoonotic pathogen causing meningitis and bacteremia in animals and humans. A lack of accurate and convenient detection methods hinders preventing and controlling diseases caused by S. pasteurianus. Additionally, there is limited knowledge about its pathogenicity and antimicrobial resistance characteristics, as there are only three complete genome sequences available. In this study, we established a multiplex PCR assay for the detection of S. pasteurianus, which was applied to six fecal samples from cattle with diarrhea and 285 samples from healthy pigs. Out of the samples tested, 24 were positive, including 5 from pig tonsils, 18 from pig hilar lymph nodes, and 1 from cattle feces. Two strains were isolated from positive samples, and their complete genomes were sequenced. The two strains were non-virulent in mice and multidrug-resistant by the antimicrobial susceptibility test. We first found the presence of genes tet(O/W/32/O) and lsa(E) in S. pasteurianus, leading to resistance to lincosamides and tetracyclines. The convenient and specific multiplex PCR assay provides essential technical support for epidemiological research, and the complete genome sequence of two non-virulent strains contributes to understanding this zoonotic bacterium's genomic characteristics and pathogenesis.

Neonatal Sepsis Caused by Streptococcus gallolyticus Complicated with Pulmonary Hypertension: A Case-Report and a Systematic Literature Review

Streptococcus gallolyticus (S. gallolyticus) has been linked to the development of infections in adults; however, in neonates S. gallolyticus sepsis is very rare and resembles Group B Streptococcal infections. In this case report, we present the case of a full-term neonate who developed early-onset sepsis due to S. gallolyticus. A systematic review of the literature was also conducted. The neonate had good APGAR scores at 1' and 5'. At 5 h postnatally, the neonate developed poor feeding and respiratory distress. She received oxygen in a head box, and a complete blood count and biochemistry, blood, CSF and body surface cultures were obtained. Empiric intravenous antibiotics (ampicillin and tobramycin) were initiated, and she was transferred to a tertiary NICU for further treatment. The neonate was mechanically ventilated and received dopamine and colloid fluids for circulatory support. A cardiology consultation revealed pulmonary hypertension on day one. S. gallolyticus was isolated in the blood culture. Central nervous system ultrasonography, brainstem auditory evoked potentials, and a second cardiology evaluation were normal on day three. Clinical and laboratory improvement was noted on day three, and the baby was discharged after a 12-day hospitalization. Follow-up visits were scheduled for reevaluation.