Early-Onset Neonatal Pneumococcal Infection: A Problem Deserving More RecognitionA Case Report and Review of the Literature

Streptococcus pneumoniae (SP) is a major cause of morbidity in childhood but has accounted for only a few reported cases of early-onset neonatal sepsis. Over the past decade, there have been increasing reports of early-onset neonatal sepsis due to SP associated with fulminant systemic disease and high mortality rates. Simultaneous maternal and neonatal sepsis with SP is relatively unusual. The literature reports rare cases of vaginal carriage and/or endometritis with this organism resulting in neonatal sepsis. We present a case of neonatal pneumococcal serotype 1 sepsis and cellulitis occurring concurrently with puerperal pneumococcal bacteremia. A male neonate was born at 38 weeks' gestation after a normal pregnancy. Although he was administered the appropriate antibiotics, the baby developed nape cellulitis and sepsis on the second day of life with SP that progressed to abscess formation requiring surgical drainage. The mother simultaneously developed pneumococcal bacteremia and endometritis 2 hours after delivery. Blood culture isolates from the mother and child were both serogroup 1. Transmission to the neonate may have been ascending or hematogenous. In addition, we summarize the neonate and maternal characteristics, clinical courses, and outcomes of published case reports of early-onset neonatal pneumococcal sepsis in the peer-reviewed literature. Our case highlights the need to consider SP as a cause of neonatal sepsis that can mimic early-onset group B streptococcal infection. Recognition of resistant strains in cases of bacteremia and meningitis is critical, and should be considered in choice of antibiotic therapy. Enhanced surveillance for the maternal carriage of SP and invasive pneumococcal disease during the neonatal period would help to define the epidemiology. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Correspondence to: Sarah S. Alsubaie, MD, Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, PO Box 2925, Riyadh 11461, Saudi Arabia. E-mail: salsubaie@ksu.edu.sa. The author has no funding or conflicts of interest to disclose. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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