Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants: A Systematic Review.

Published on Sep 1, 2018in Pediatric Infectious Disease Journal2.126
· DOI :10.1097/INF.0000000000001931
Monika Wojtera2
Estimated H-index: 2
,
Horace Cheng2
Estimated H-index: 2
(UWO: University of Western Ontario)
+ 3 AuthorsJulie E. Strychowsky8
Estimated H-index: 8
Sources
Abstract
BACKGROUND: There is no consensus regarding approaches to infantile group B streptococcal (GBS) head and neck cellulitis and necrotizing fasciitis. We present a case of GBS necrotizing cellulitis and summarize the literature regarding the presentation and management of infantile head and neck GBS cellulitis and necrotizing fasciitis. METHODS: The literature was searched using PubMed, Web of Science, EMBASE and Medline (inception to April 2017) by 2 independent review authors. Inclusion criteria encompassed case reports or case series of infants less than 12 months of age with GBS cellulitis of the head and neck or with GBS necrotizing fasciitis without restriction to the head and neck. Data were extracted using tables developed a priori by 2 independent review authors, and discrepancies were resolved by consensus. RESULTS: An infant presenting at 33 days of age with GBS facial necrotizing fasciitis was successfully treated conservatively with antibiotics. Our literature search identified 40 infants with GBS head and neck cellulitis. Late-onset (98%), male gender (65%) and prematurity (58%) predominated. Penicillin is the main therapy used (97%). The 12 identified cases of necrotizing fasciitis were associated with polymicrobial etiology (36%) and broad-spectrum antibiotic use. Seventy-five percent required debridement, including 4 of 5 (80%) cases involving the head and neck. CONCLUSIONS: Skin and soft tissue involvement is an uncommon manifestation of late-onset GBS infection which requires antibiotic therapy and possibly surgical debridement cases with necrotizing fasciitis.
References37
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#1Rhashedah Ekeoduru (Memorial Hermann Healthcare System)H-Index: 1
#2Matthew R. GreivesH-Index: 3
Last. Eric A. Nesrsta (Memorial Hermann Healthcare System)H-Index: 1
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: A former 25-week-old neonate presented at 34 weeks postconceptual age with necrotizing fasciitis and purpura fulminans because of Group B Streptococcus infection. He was septic and coagulopathic when he was intubated, and the endotracheal tube was secured with adhesives. When he subsequently developed large purpuric, bullous lesions on the face and neck, he presented to the operating room for excision and debridement of his facial lesions. No change was made in how the endotracheal tube was se...
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#1Junpei KurodaH-Index: 1
#2Nobuaki InoueH-Index: 4
Last. Yukihiro HasegawaH-Index: 4
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We herein describe the case of a 27-day-old male infant who was brought to the emergency room for intermittent crying, and swelling of the left scrotum. Based on the clinical findings, necrotizing fasciitis was suspected, and surgical intervention was successfully completed within a few hours of admission. Streptococcus agalactiae type Ia was cultured from the drained abscess, and was considered the causative pathogen. To our knowledge, this is the first report of neonatal necrotizing fasciitis ...
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#1Jelena Martic M.D.H-Index: 2
#2Vera Mijac (University of Belgrade)H-Index: 7
Last. Jelena VuksanovicH-Index: 1
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Abstract: We report a case of late onset neonatal invasive group A streptococcal disease characterized with rapidly progressing cellulitis and development of sepsis. The infection was acquired from benign and mild skin infection of the child’s mother. The causative agent was group A streptococcus, belonging to the emm type 53.2, which usually causes mild skin disease.
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A 3033g male infant was born to a healthy mother at 39 weeks gestation by normal vaginal delivery with Grade 1 meconium stained liquor. There was no prolonged rupture of membranes or any antenatal risk factors for sepsis. The immediate neonatal period was uneventful and the baby was discharged after two days. At 6 weeks of age the baby was admitted with an 8-hour history of inconsolable crying. He was pyrexial. Initially the possibility of intussuception was considered, however, the submandibula...
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Introduction The relation between cellulitis and Group B streptococcus infection in newborns and small infants was first reported during the early 1980s and named cellulitis-adenitis syndrome. We report a case of a neonate with cellulitis-adenitis syndrome in an unusual location (retroauricular).
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#1Alessandro LiberatiH-Index: 50
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Systematic reviews and meta-analyses are essential to summarise evidence relating to efficacy and safety of healthcare interventions accurately and reliably. The clarity and transparency of these reports, however, are not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users. Since the development of the QUOROM (quality of reporting of meta-analysis) statement—a reporting guideline published in 1999—there have been several conceptual, ...
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The case of a premature intra-uterine growth retardation (IUGR) infant, born from caesarean section to a mother with hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome, and admitted to NICU for low birth weight is reported. The baby girl was fed with pasteurized maternal milk, and she had a normal growth. Before discharge, at the age of 23 days of life, she started to be breast-fed from the mother. Suddenly, the infant presented inconsolable crying, and then she appeared pale, hyp...
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#1Ihuoma Eneli (OSU: Ohio State University)H-Index: 20
#2H. Dele Davies (MSU: Michigan State University)H-Index: 18
Last. H. Dele Davies (MSU: Michigan State University)H-Index: 28
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Objective To describe the epidemiology, management, and outcome of pediatric necrotizing fasciitis (NF) in Canada before full implementation of varicella immunization programs. Study design This was a prospective cohort study of all children under age 16 years identified by the Canadian Paediatric Surveillance Program (CPSP). Results Between November 1, 2001 and October 31, 2003, 36 NF cases were identified (mean age, 5.9 ± 5 years). Group A streptococcus (GAS)-related and non–GAS-related NF acc...
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This little girl was born at 32 weeks’ gestation by emergency caesarean section for pregnancy-induced hypertension and fetal distress. Initial course of penicillin and gentamicin were discontinued at 36 h, when her blood culture done at birth was found to be negative. On day …
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#2Andrea Roman (Midland Regional Hospital Portlaoise)
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We report a case of cellulitis of the soft tissue of the neck with group B streptococcus (GBS) sepsis in a 4-week-old baby boy presented with a 1-day history of fever, irritability and feed refusal. While in the hospital, a left-sided submandibular swelling extending to preauricular area started emerging, which progressed dramatically. Ultrasound scan of the neck confirmed inflammation of the underlying soft tissue while revealing multiple enlarged lymph nodes without any abscess formation and o...
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Abstract Group B streptococcus (GBS) is an important pathogen that causes neonatal sepsis and meningitis, which have high mortality and morbidity. Cellulitis is a rare presentation of late-onset neonatal GBS infection. We report the case of an extremely low birthweight infant with facial cellulitis caused by late-onset GBS infection. A 590-g male neonate was delivered by Cesarean section at 23 gestational weeks due to intrauterine GBS infection. Although he was effectively treated with 2 weeks o...
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Necrotizing fasciitis is a rare and life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. These children should be managed promptly with broad-spectrum antibiotics and possible surgical debridement. Here, we present a 5-week-old female infant who presented with fever and ulcer on right lower jaw. She had a sudden onset of darkening of the right lower jaw, which progressed to reddish discolorati...
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A 23+0 week gestation twin girl weighing 465 g was born via spontaneous vaginal delivery. On postnatal day 4, a small area of broken skin was noted on her back. Flucloxacillin and gentamicin were commenced and Cavilon cream was applied. Vancomycin was substituted after blood culture grew Staphylococcus epidermidis . A skin swab isolated skin flora only. By postnatal day 10, the lesion had worsened with a haemorrhagic petechial appearance …
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