Streptococcus bovis - unusual etiology of meningitis in a neonate with Down syndrome: a case report

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.

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.

Comparative Analysis of Gut Microbiota Among the Male, Female and Pregnant Giant Pandas (Ailuropoda Melanoleuca)

The giant panda (GP) was the most endangered species in China, and gut microbiota plays a vital role in host health. To determine the differences of the gut microbiota among the male, female and pregnant GPs, a comparative analysis of gut microbiota in GPs was carried out by 16S rRNA and ITS high-throughput sequencing. In 16S rRNA sequencing, 435 OTUs, 17 phyla and 182 genera were totally detected. Firmicutes (53.6%) was the predominant phylum followed by Proteobacteria (37.8%) and Fusobacteria (7.1%). Escherichia/Shigella (35.9%) was the most prevalent genus followed by Streptococcus (25.9%) and Clostridium (11.1%). In ITS sequencing, 920 OTUs, 6 phyla and 322 genera were also detected. Ascomycota (71.3%) was the predominant phylum followed by Basidiomycota (28.4%) and Zygomycota (0.15%). Purpureocillium (4.4%) was the most prevalent genus followed by Cladosporium (2.5%) and Pezicula (2.4%). Comparative analysis indicated that the male GPs harbor a higher abundance of phylum Firmicutes than female GPs with the contribution from genus Streptococcus. Meanwhile, the female GPs harbor a higher abundance of phylum Proteobacteria than male GPs with the contribution from genus Escherichia/ Shigella. In addition, the shift in bacteria from female to pregnant GPs indicated that phylum Firmicutes increased significantly with the contribution from Clostridium in the gut, which may provide an opportunity to study possible associations with low reproduction of the GPs.