Sudden Infant Death due to Early-Onset Group B Streptococcal Sepsis Diagnosed by Post-mortem Microbiology Analysis - A Case Report

                           http://austinpublishinggroup.com/clinical-microbiology/online-first.php

Suddeninfants’ death is one of the most important matters in forensic medicine. The ability to pose a differential diagnosis between internal/infection and external/violent death is of paramount importance. Here, we report a case of a sudden death of an infant due to early-onset Group B Streptococcal (GBS) sepsis diagnosed by post-mortem microbiology analysis, since the mother was negative at vaginorectal GBS screening by culture. This case report highlights the importance of rapid and accurate nucleic acid amplification tests to detect GBS carriage status, especially in the delivery room.

Streptococcus agalactiae or Group B Streptococcus (GBS) is a beta-hemolytic, catalase negative aerobe/anaerobe-facultative organism a common commensal of the gastrointestinal and/or genitourinary tract in 10-30% of pregnant women. GBS is also capable of causing severe infections, such as neonatal bacteremia, pneumonia, and meningitis and severe invasive infections both in pregnant women and in non-pregnant adults associated with significant mortality. Neonatal GBS infections may present as either fulminating septicemia or with subtle and non-specific early signs that overlap with those of non-infectious diseases. If not promptly treated with targeted antibiotic therapy, GBS infection may lead to rapid clinical deterioration represented by septic shock, multi-organ failure and disseminated intravascular coagulopathy.

Thetransmission of Group B Streptococcus between mother and her newborn is considered an important risk factor that could significantly increase the probability of the development of GBS disease. Invasive neonatal GBS infections have been categorized in two different diseases, following the definition by CDC (http://www.cdc.gov/groupbstrep/about/newborns-pregnant.html), namely Early Onset Disease (EOD) and Late Onset Disease (LOD). EOD is usually related to vaginal colonization of the mother and consequent vertical transmission during the delivery; it generally appears within 24 hours and occurs within the first week of life.