Department of Pediatrics, Division of Infectious Diseases, Boston Children's Hospital, Boston, MA, USA.
Harvard Medical School, Boston, MA, USA.
Clin Pediatr (Phila). 2023 Feb;62(2):96-99. doi: 10.1177/00099228221113630. Epub 2022 Jul 26.
To our knowledge, late, late-onset group B streptococcal (GBS) meningitis in identical twins has yet to be reported. We describe a case of 14-week-old twins who developed fever hours apart and presented simultaneously to the emergency department 2 days later with seizures. Blood and cerebrospinal fluid (CSF) cultures from both infants were positive for GBS. Their clinical courses were highly similar, with magnetic resonance imaging (MRI) demonstrating ventriculitis and subdural empyema, complicated by clinical and subclinical seizures requiring quadruple antiepileptic treatment. The CSF was sterile for both on follow-up lumbar puncture 48 hours after the initial positive CSF culture. Both showed marked improvement on antimicrobial and antiepileptic therapy, with fever resolving after 5 days of therapy, control of seizures, and slowly improving MRI findings. Twin A received a 6-week course of penicillin, whereas twin B received 6 weeks plus an additional 10 days due to persistent left cochlear enhancement consistent with labyrinthitis. Evaluation for an underlying primary immunodeficiency was negative. Genomic analysis revealed that the patients' CSF GBS isolates were essentially identical and of capsular polysaccharide serotype Ia.
据我们所知，尚未有关于同卵双胞胎晚发型、迟发型 B 群链球菌（GBS）脑膜炎的报道。我们描述了一对 14 周大的双胞胎的病例，他们在相隔数小时出现发热，并在 2 天后同时因癫痫发作而到急诊科就诊。两名婴儿的血液和脑脊液（CSF）培养均为 GBS 阳性。他们的临床病程非常相似，磁共振成像（MRI）显示有脑室炎和硬膜下积脓，并发有临床和亚临床癫痫发作，需要进行四重抗癫痫治疗。在初次 CSF 培养阳性后 48 小时进行的后续腰椎穿刺中，CSF 对两者均无菌。在接受抗菌和抗癫痫治疗后，他们均有明显改善，发热在治疗 5 天后消退，癫痫得到控制，MRI 发现也在缓慢改善。双胞胎 A 接受了 6 周的青霉素治疗，而双胞胎 B 则接受了 6 周加 10 天的治疗，因为左侧耳蜗增强持续存在，符合迷路炎。未发现潜在原发性免疫缺陷的证据。基因组分析显示，患者 CSF GBS 分离株基本相同，均为荚膜多糖血清型 Ia。
