Department of Obstetrics and Gynecology, White Memorial Medical Center, 1720 Cesar E. Chavez Avenue, Los Angeles, CA, 90033, USA.
Department of Neonatology, White Memorial Medical Center, Los Angeles, CA, 90033, USA.
BMC Pediatr. 2019 Aug 1;19(1):265. doi: 10.1186/s12887-019-1645-x.
Streptococcus pasteurianus is a rare cause of neonatal infection, with only 3 cases reported in the USA and 18 cases reported in other countries within the past decade. Neonatal S. pasteurianus infection typically presents as meningitis. This case report describes the first neonatal case of S. pasteurianus endocarditis in the literature, in addition to a neonatal case of S. pasteurianus infection presenting as pneumonitis without meningitis. The S. pasteurianus infections in these two cases are unusual not only because of how rare this particular pathogen is, but also because of the atypical clinical manifestations.
The first patient is a full-term male infant admitted to NICU at 20 h of life due to respiratory distress. He was empirically started on ampicillin and gentamicin for presumed sepsis. Laboratory analysis of cerebral spinal fluid obtained after initiation of antibiotics was suggestive of partially treated meningitis. Blood cultures came back positive for S. pasteurianus. The neonate was transitioned from ampicillin to cefepime, while gentamicin was continued. Echocardiograph showed a possible tricuspid valve vegetation concerning for endocarditis. Due to the unusual complication of endocarditis, the patient remained on IV cefepime for 28 days rather than the more conventional duration of 14-21 days reported in the literature. The baby clinically improved with no evidence of thrombi or vegetations on repeat cardiac echo. The second patient is a full-term male infant who required intubation at birth for respiratory distress. Chest X-ray findings were concerning for meconium aspiration with pneumonitis. The baby went into septic shock and was empirically started on ampicillin and gentamicin. Blood cultures came back positive for S. pasteurianus, while cerebral spinal fluid and urine cultures were negative. Ampicillin and gentamicin were discontinued after 3 days and the baby was started on cefepime and clindamycin for a total 14-day course. The baby clinically recovered and was discharged from NICU without any sequelae.
These two cases highlight the importance of recognizing S. pasteurianus as a potential cause of neonatal sepsis and the importance of recognizing endocarditis and pneumonitis as possible clinical manifestations of this infection.
唾液链球菌（Streptococcus pasteurianus）是一种罕见的新生儿感染病原体，仅在美国有 3 例报告，在过去十年中，其他国家报告了 18 例。新生儿唾液链球菌感染通常表现为脑膜炎。本病例报告描述了文献中首例唾液链球菌心内膜炎的新生儿病例，以及首例无脑膜炎表现的新生儿唾液链球菌感染性肺炎病例。这两例病例中的唾液链球菌感染不仅因其罕见的病原体，还因其非典型的临床表现而不同寻常。
第 1 例患者为足月男性，生后 20 小时因呼吸窘迫入住新生儿重症监护病房（NICU）。他被经验性地开始使用氨苄西林和庆大霉素治疗疑似败血症。抗生素治疗开始后获得的脑脊髓液实验室分析提示为部分治疗的脑膜炎。血液培养结果为唾液链球菌阳性。新生儿从氨苄西林转换为头孢吡肟，同时继续使用庆大霉素。超声心动图显示可能存在三尖瓣赘生物，提示心内膜炎。由于出现了不常见的心内膜炎并发症，该患者静脉注射头孢吡肟治疗 28 天，而不是文献中报道的更常见的 14-21 天疗程。婴儿临床状况改善，在重复心脏超声检查时未见血栓或赘生物。第 2 例患者为足月男性，因呼吸窘迫出生时需要插管。胸部 X 线片结果提示为胎粪吸入性肺炎。婴儿出现感染性休克，经验性地开始使用氨苄西林和庆大霉素。血液培养结果为唾液链球菌阳性，而脑脊髓液和尿液培养结果为阴性。氨苄西林和庆大霉素在 3 天后停用，婴儿开始接受头孢吡肟和克林霉素治疗，疗程共 14 天。婴儿临床康复，无任何后遗症从 NICU 出院。
这两例病例强调了认识到唾液链球菌可能是新生儿败血症的潜在病因的重要性，以及认识到心内膜炎和肺炎可能是这种感染的临床表现的重要性。
