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Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases
BACKGROUND: Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic mater...
Autores principales: | , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180162/ https://www.ncbi.nlm.nih.gov/pubmed/34090359 http://dx.doi.org/10.1186/s12879-021-06231-3 |
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author | Horiba, Kazuhiro Suzuki, Michio Tetsuka, Nobuyuki Kawano, Yoshihiko Yamaguchi, Makoto Okumura, Toshihiko Suzuki, Takako Torii, Yuka Kawada, Jun-ichi Morita, Makoto Hara, Shinya Ogi, Tomoo Ito, Yoshinori |
author_facet | Horiba, Kazuhiro Suzuki, Michio Tetsuka, Nobuyuki Kawano, Yoshihiko Yamaguchi, Makoto Okumura, Toshihiko Suzuki, Takako Torii, Yuka Kawada, Jun-ichi Morita, Makoto Hara, Shinya Ogi, Tomoo Ito, Yoshinori |
author_sort | Horiba, Kazuhiro |
collection | PubMed |
description | BACKGROUND: Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic material in patients with infectious diseases. We report two cases of infantile sepsis of GBS meningitis with negative results for CSF culture tests, but positive results for NGS analysis. CASE PRESENTATION: Patient 1 was a 22-day-old male infant diagnosed with sepsis and meningitis. His CSF findings showed pleocytosis, decreased glucose, and increased protein levels. However, CSF and blood culture results at admission were negative. He received a total of 3 weeks of treatment with ampicillin and cefotaxime, and showed clinical improvement. GBS was detected through NGS analysis of CSF collected at admission. Patient 2 was a 51-day-old male infant with sepsis. CSF findings on admission were normal, and blood and CSF cultures were also negative. Intravenous ampicillin and cefotaxime treatment were initiated. Treatment was de-escalated to ampicillin alone because Enterococcus faecalis was cultured from urine. He was discharged after a total of 1 week of antibiotic treatment. Six days after discharge, he was re-hospitalized for sepsis. Blood and CSF cultures were negative, and E. faecalis was again cultured from urine. He received a total of 3 weeks of ampicillin treatment for enterococcal-induced nephritis and did not relapse thereafter. NGS pathogen searches were retrospectively performed on both blood and CSF collected at the first and second admission. GBS was detected in the CSF collected at the first admission, but no significant pathogen was detected in the other samples. Inadequate treatment for GBS meningitis at the first admission may have caused the recurrence of the disease. CONCLUSION: Infantile sepsis may present bacterial meningitis that is not diagnosed by either culture testing or CSF findings. NGS analysis for CSF may be useful for confirming the diagnosis of bacterial meningitis. |
format | Online Article Text |
id | pubmed-8180162 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-81801622021-06-07 Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases Horiba, Kazuhiro Suzuki, Michio Tetsuka, Nobuyuki Kawano, Yoshihiko Yamaguchi, Makoto Okumura, Toshihiko Suzuki, Takako Torii, Yuka Kawada, Jun-ichi Morita, Makoto Hara, Shinya Ogi, Tomoo Ito, Yoshinori BMC Infect Dis Case Report BACKGROUND: Group B Streptococcus (GBS) is an important cause of invasive infection in neonates and infants. Cerebrospinal fluid (CSF) findings and culture may not show evidence of infection early in GBS meningitis. Next-generation sequencing (NGS) has the potential to detect microbial genetic material in patients with infectious diseases. We report two cases of infantile sepsis of GBS meningitis with negative results for CSF culture tests, but positive results for NGS analysis. CASE PRESENTATION: Patient 1 was a 22-day-old male infant diagnosed with sepsis and meningitis. His CSF findings showed pleocytosis, decreased glucose, and increased protein levels. However, CSF and blood culture results at admission were negative. He received a total of 3 weeks of treatment with ampicillin and cefotaxime, and showed clinical improvement. GBS was detected through NGS analysis of CSF collected at admission. Patient 2 was a 51-day-old male infant with sepsis. CSF findings on admission were normal, and blood and CSF cultures were also negative. Intravenous ampicillin and cefotaxime treatment were initiated. Treatment was de-escalated to ampicillin alone because Enterococcus faecalis was cultured from urine. He was discharged after a total of 1 week of antibiotic treatment. Six days after discharge, he was re-hospitalized for sepsis. Blood and CSF cultures were negative, and E. faecalis was again cultured from urine. He received a total of 3 weeks of ampicillin treatment for enterococcal-induced nephritis and did not relapse thereafter. NGS pathogen searches were retrospectively performed on both blood and CSF collected at the first and second admission. GBS was detected in the CSF collected at the first admission, but no significant pathogen was detected in the other samples. Inadequate treatment for GBS meningitis at the first admission may have caused the recurrence of the disease. CONCLUSION: Infantile sepsis may present bacterial meningitis that is not diagnosed by either culture testing or CSF findings. NGS analysis for CSF may be useful for confirming the diagnosis of bacterial meningitis. BioMed Central 2021-06-05 /pmc/articles/PMC8180162/ /pubmed/34090359 http://dx.doi.org/10.1186/s12879-021-06231-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Case Report Horiba, Kazuhiro Suzuki, Michio Tetsuka, Nobuyuki Kawano, Yoshihiko Yamaguchi, Makoto Okumura, Toshihiko Suzuki, Takako Torii, Yuka Kawada, Jun-ichi Morita, Makoto Hara, Shinya Ogi, Tomoo Ito, Yoshinori Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title | Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title_full | Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title_fullStr | Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title_full_unstemmed | Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title_short | Pediatric sepsis cases diagnosed with group B streptococcal meningitis using next-generation sequencing: a report of two cases |
title_sort | pediatric sepsis cases diagnosed with group b streptococcal meningitis using next-generation sequencing: a report of two cases |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180162/ https://www.ncbi.nlm.nih.gov/pubmed/34090359 http://dx.doi.org/10.1186/s12879-021-06231-3 |
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