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LETTER TO EDITOR  
Year : 2016  |  Volume : 59  |  Issue : 4  |  Page : 573-574
Streptococcus pneumoniae: An unusual and forgotten pathogen in neonatal sepsis


Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India

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Date of Web Publication10-Oct-2016
 

How to cite this article:
Arora S, Kaur N, Galhotra S, Jindal N. Streptococcus pneumoniae: An unusual and forgotten pathogen in neonatal sepsis. Indian J Pathol Microbiol 2016;59:573-4

How to cite this URL:
Arora S, Kaur N, Galhotra S, Jindal N. Streptococcus pneumoniae: An unusual and forgotten pathogen in neonatal sepsis. Indian J Pathol Microbiol [serial online] 2016 [cited 2019 Nov 15];59:573-4. Available from: http://www.ijpmonline.org/text.asp?2016/59/4/573/191791


Editor,

Neonatal sepsis is a clinical syndrome characterized by systemic signs of infection, accompanied by bacteremia in the 1 st month of life. [1] We present a case of early onset neonatal sepsis due to Streptococcus pneumoniae.

An 1800 g male child, of 4 h age, born by lower segment cesarian section in a private hospital at 32 weeks of gestation was admitted to the Neonatal Intensive Care Unit with respiratory distress. There was a history of leaking per vaginum for the last 3 days along with meconium stained liquor. Antenatal scans and blood tests of the mother were normal. The child was irritable and was continuously crying. His general condition was poor and chest indrawing was present. Hemogram showed hemoglobin 15.4 g% and leukocytes 10,000/cumm with 90% neutrophils. Platelet count was 180,000/cumm. C-reactive protein was 13.9 mg/l. Chest X-ray revealed consolidation of the left lower lobe. The child was put on oxygen therapy by hood and empirically intravenous cefotaxime and amikacin were started. Urine was found to be sterile after 24 h of incubation while blood culture in automated blood culture system (BACTEC 9120) gave positive signal after 16.5 h of incubation. A pure growth of Gram-positive, catalase-negative cocci was obtained on subculture, and the isolate was found to be sensitive to erythromycin, vancomycin, and chloramphenicol but resistant to penicillin and gentamicin. The patient was started vancomycin 27 mg intravenous 8 hourly on receiving culture report. The isolate was identified as S. pneumoniae by matrix-assisted laser desorption ionization-time of flight at PGIMER, Chandigarh, India. The patient recovered and was discharged from the hospital after completion of 14 days of antibiotic treatment.

S. pneumoniae accounts for 1-11% of neonatal sepsis. [2] S. pneumoniae is not a part of the usual resident vaginal flora but can exist at the more alkaline pH of the vagina during pregnancy. It may have an early or late onset, and the possible forms of transmission can be vertical by vaginal colonization and horizontal due to local source of infection. Authors from different parts of the world have reported the infrequent isolation of S. pneumoniae from cases of neonatal sepsis. [3],[4] From India, we could find one study that mentioned two cases of S. pneumoniae sepsis and both of these were early onset sepsis similar to this report. [5] Early onset S. pneumoniae neonatal sepsis has a worse prognosis and higher mortality than late onset sepsis. Another concern in the present case is reduced susceptibility of S. pneumoniae isolate to penicillin which was reported in neonatal infections in earlier studies also. [2],[3]

Physicians should be aware of this uncommon but well-recognized cause of neonatal sepsis. It should be specifically sought in swabs taken from the pregnant mother and newborn, and if isolated, antibiotic therapy should be strongly considered for both mother and child even in the absence of symptoms. The limitations of this report are (a) as it was outborn delivery, the maternal vaginal and blood specimens were not available for culture. Hence, the source of infection remained unclear; (b) serotyping could not be performed as the strain was lost on subculture.

Acknowledgment

We are thankful to the Bacteriology Section, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Jain NK, Seth D, Mangal V. A clinicomicrobial association in neonatal septicaemia. Pediatr Oncall J 2010;7:97-9.  Back to cited text no. 1
    
2.
Hoffman JA, Mason EO, Schutze GE, Tan TQ, Barson WJ, Givner LB, et al. Streptococcus pneumoniae infections in the neonate. Pediatrics 2003;112:1095-102.  Back to cited text no. 2
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3.
Malhotra A, Hunt RW, Doherty RR. Streptococcus pneumoniae sepsis in the newborn. J Paediatr Child Health 2012;48:E79-83.  Back to cited text no. 3
[PUBMED]    
4.
Rodriguez BF, Mascaraque LR, Fraile LR, Perez IC, Kuder K. Streptococcus pneumoniae: The forgotten microorganism in neonatal sepsis. Fetal Pediatr Pathol 2015;34:202-5.  Back to cited text no. 4
[PUBMED]    
5.
Zakariya BP, Bhat V, Harish BN, Arun Babu T, Joseph NM. Neonatal sepsis in a tertiary care hospital in South India: Bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr 2011;78:413-7.  Back to cited text no. 5
[PUBMED]    

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Correspondence Address:
Shilpa Arora
Department of Microbiology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.191791

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