Title of Case:

Early-Onset Neonatal Pneumococcal Sepsis: an old but sometimes forgotten pathogen

Background:

Streptococcus pneumoniae (SP) is an uncommon but potentially serious neonatal pathogen. SP is recognized as an important cause of morbidity and mortality in childhood, but there are rather few reported cases of neonatal sepsis, with incidences described between 1% and 11%.

We aim to report the spectrum of morbidity associated with SP infections in the neonatal period.

Case Presentation Summary:

Two cases of neonatal SP infection are reported.

The first neonate presented with very early onset of severe clinical disease with bacteremia and pneumonia. She developed severe pulmonary hypertension and needed intensive ventilatory and vasoactive support including nitric oxide. A SP serotype 23B was isolated from blood cultures and bronchial secretions as well as from the mother’s vaginal secretions

In the second case, the baby presented with bacteremia and meningitis. He remained hemodynamically stable and had no need for respiratory support. The blood and cerebrospinal fluid cultures revealed a SP serotype 8.

In both cases, the neonates started antibiotic therapy with vancomycin and cefotaxime. Since both strains showed susceptibility to ampicillin and cefotaxime, vancomycin was withdrawn during hospitalization.

Both mothers remained well and asymptomatic during the perinatal period.

Learning Points/Discussion:

These reported cases emphasize the importance of considering a wide range of microorganisms in the differential diagnosis of early-onset neonatal sepsis. Although uncommon, SP can have different clinical manifestations and cause significant disease in newborns. In the absence of sufficient scientific evidence to implement specific preventive measures against early-onset sepsis for this agent, early and aggressive treatment remains the best therapeutic option.