Department of Pediatrics, Ohta Nishinouchi Hospital.
Department of Pediatrics, Fukushima Medical University School of Medicine.
Tohoku J Exp Med. 2021 Apr;253(4):269-273. doi: 10.1620/tjem.253.269.
Streptococcus agalactiae or group B streptococcus (GBS) is a pathogen that causes severe neonatal infections, resulting in sepsis, pneumonia, and meningitis. Neonatal GBS meningitis has a poor neurological prognosis and a high mortality rate. GBS disease is classified as early- and late-onset if the onset age is 0-6 and 7-89 days after birth, respectively. There is currently no effective preventive strategy against late-onset GBS (LOGBS) disease. Here, we report a case of female infant with LOGBS meningitis who recovered from the septic shock by two exchange transfusions (ExTs) but still experienced severe neurological sequela. She was born at a gestational age of 39 weeks via caesarian section due to oligohydramnios and had fever 11 days after birth. GBS was detected in her cerebrospinal fluid (CSF) and blood but not in the vaginal or breast-milk cultures of the mother. The patient was treated with intravenous antibiotic administration; however, she suddenly developed pulseless ventricular tachycardia and asystole the next day. Her heart rate was normalized via cardiopulmonary resuscitation. We also performed two ExTs, and she recovered from the septic shock. Cytokine-profile analysis revealed that the serum and CSF levels of various pro-inflammatory and anti-inflammatory cytokines were elevated before the ExTs, after which the serum levels of several of these cytokines decreased. Two ExTs were effective in saving the life of the patient but did not improve the neurological prognosis. Given that neonatal GBS meningitis has high fatality and sequela rates; thus, it is necessary to establish a preventive strategy.
无乳链球菌或 B 组链球菌（GBS）是一种病原体，可导致严重的新生儿感染，引起败血症、肺炎和脑膜炎。新生儿 GBS 脑膜炎的神经预后较差，死亡率较高。如果发病年龄分别为出生后 0-6 天和 7-89 天，则 GBS 疾病分为早发型和晚发型。目前尚无针对晚发型 GBS（LOGBS）疾病的有效预防策略。在这里，我们报告了一例女性婴儿 LOGBS 脑膜炎病例，该患者通过两次换血（ExT）从感染性休克中恢复，但仍出现严重的神经后遗症。她因羊水过少而在 39 周时通过剖腹产出生，出生后 11 天出现发热。在她的脑脊液（CSF）和血液中检测到 GBS，但母亲的阴道或母乳培养物中未检测到 GBS。患者接受了静脉抗生素治疗；然而，第二天她突然出现无脉性室性心动过速和心搏停止。她的心率通过心肺复苏术恢复正常。我们还进行了两次 ExT，她从感染性休克中恢复。细胞因子谱分析显示，在 ExT 之前，血清和 CSF 中各种促炎和抗炎细胞因子的水平升高，之后这些细胞因子的血清水平降低。两次 ExT 有效挽救了患者的生命，但并未改善神经预后。鉴于新生儿 GBS 脑膜炎的死亡率和后遗症率较高；因此，有必要建立预防策略。
