One Case Of Sepsis,Purulent Meningitis And Subdural Effusion Caused By Late-Onset Group B Streptococcus Infection

Objective: To investigate the clinical features and treatment of group B streptococcus(GBS)infection caused sepsis,purulent meningitis and subdural effusion,and to improve the management of purulent meningitis caused by Streptococcus agalactiae infection.Methods: The general information,clinical characteristics,laboratory examinations,imaging results,treatment strategies,and outcomes of a child with sepsis,purulent meningitis and subdural effusion caused by GBS admitted to The People's Hospital of Hebei Province in March 2018 were detailed analyzed.Results: The subject was late-onset GBS infection with high fever as the first clinical manifestation.Both the result of cerebrospinal fluid culture and the result of blood bacteria culture were streptococcus agalactiae.Two definitive clinical diagnosis of “1.Purulent meningitis caused by Streptococcus agalactiae 2.Septicemia” were made.At the beginning of meropenem combined with ceftriaxone anti-infection treatment,the white blood cell count of cerebrospinal fluid decreased significantly.But the clinical recovery was slow after adjusted antibiotics according to the results of culture and drug sensitive test.Vancomycin combined with Ceftriaxone,Linezolid combined with Ceftriaxone or Linezolid combined with penicillin were the main combined therapy.During the treatment,the subject had relapse.After replacing meropenem treatment again,the level of white blood cells in this case' cerebrospinal fluid was <45×10^6/L.The baby was improved and discharged after 83 days of antibiotic treatment.Thankfully,eye exams,hearing screening and brainstem auditory evoked potential were not abnormal after discharge.Gesell's neurodevelopment was normal.This neonatedeveloped late-onset severe GBS infection and achieved better outcome without neurological sequelae.Conclusions:1.The clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific.It is associated with insidious onset,rapid progress,longer hospitalization and higher hospital costs.The incidence of neurological complications was high.Infants with meningitis have poor prognosis.2.The virulence factors of Streptococcus agalactiae can assist bacteria to adhesion to the host cell,penetrate the host cell barrier,evade immune clearance,and cause invasive infections.3.Neonates with GBS-associated septicemia and purulent meningitis are tending to be in critical conditions.It is imperative to apply strong antibacterial efficacy against positive cocci and high permeability of the blood-brain barrier antibiotics,such as Ceftriaxone,Meropenem,Vancomycin,Linezolid,in time or drug combination therapy when necessary.4.Group B Streptococcus is an important pathogen which may result in GBS infection during perinatal period.The main risk factor for neonatal infection was GBS vaginal colonization in late pregnant woman.Therefore,special attention should be paid to the screening of GBS in the third trimester of pregnancy,and early anti-infection therapy should be given to improve pregnancy outcome.