Clinical metagenomic sequencing for rapid diagnosis of neonatal meningitis caused by Ureaplasma parvum: A case report.

INTRODUCTION: It is challenging to obtain favorable results through conventional diagnostic testing for Ureaplasma parvum (UP), a conditional pathogen, because of the atypical clinical phenotype of UP meningitis. PATIENT CONCERNS AND DIAGNOSIS: Herein, we report a pediatric case of neonatal meningitis caused by UP in a spontaneously delivered full-term baby. The infant's temperature peak was 38.3°C at the age of 9 days. The patient was diagnosed with neonatal suppurative meningitis. INTERVENTIONS AND OUTCOMES: The pathogen was diagnosed in a timely and accurate manner by metagenome sequencing, and the patient was eventually discharged with azithromycin. CONCLUSIONS: Neonatal Ureaplasma meningitis may be more common than previously suspected. The clinical manifestations were not obvious and were similar to those of neonatal meningitis caused by other bacteria. When conventional treatments and conventional pathogenic tests are negative, mNGS is a better choice for timely and accurate pathogen identification.

Noncongenital central nervous system infections in children: radiology review.

Infections of the central nervous system (CNS) are a very common worldwide health problem in childhood with significant morbidity and mortality. In children, viruses are the most common cause of CNS infections, followed by bacterial etiology, and less frequent due to mycosis and other causes. Noncomplicated meningitis is easier to recognize clinically; however, complications of meningitis such as abscesses, infarcts, venous thrombosis, or extra-axial empyemas are difficult to recognize clinically, and imaging plays a very important role on this setting. In addition, it is important to keep in mind that infectious process adjacent to the CNS such as mastoiditis can develop by contiguity in an infectious process within the CNS. We display the most common causes of meningitis and their complications.

[Epididymo-orchitis in a newborn: rare illness revealing late-onset Streptococcus agalactiae meningitis]. / Orchi-épididymite néonatale : une affection rare révélatrice d'un sepsis secondaire à streptocoque du groupe B.

Acute scrotum is unusual during the neonatal period. Testicular torsion is a surgical emergency aimed at salvaging the affected testis. Epididymo-orchitis is the main differential diagnosis, but few cases have been described in the newborn. Here, we report the case of a late-preterm infant who presented with late-onset group B streptococcal sepsis revealed by unilateral epididymo-orchitis.

Pediatric intracranial infections.

Infection of the central nervous system (CNS) in children is an important entity and early recognition is paramount to avoid long-term brain injury, especially in very young patients. The causal factors are different in children compared with adults and so are the clinical presentations. However, imaging features of CNS infection show similar features to those of adults. This article reviews some of the common types of pediatric infections, starting with the congenital (or in utero) infections followed by bacterial infections of the meninges and brain parenchyma.

Bacillus cereus meningitis in a term neonate.

A case of Bacillus cereus meningitis in a term neonate without identifiable risk factors or source of the organism is presented. Prompt identification of the organism and treatment resulted in a favourable outcome.

Posterior fontanelle sonography: an acoustic window into the neonatal brain.

BACKGROUND AND PURPOSE: Sonographic brain studies are classically performed through the anterior fontanelle, but visualization of posterior supratentorial and infratentorial structures is poor with this approach. Posterior fontanelle sonography is recommended for better assessment of these structures. Our purpose was 1) to determine whether sonography of the brain through the posterior fontanelle (PF) improves visualization of brain lesions when added to the routine anterior fontanelle (AF) approach and 2) to describe standardized PF coronal and sagittal sections. METHODS: In this prospective study (conducted from February 1999 to January 2001), PF sonography was added to AF sonography in 165 consecutive premature neonates with a birth weight of < 2000 g. Sonograms were recorded in digital format for re-evaluation at the end of the study. Lesions were grouped as congenital, infectious, hemorrhagic, or hypoxic-ischemic. The chi2 test for paired data and the kappa coefficient were used to compare diagnoses with AF alone and diagnoses with AF plus PF. RESULTS: PF sonography was performed in 164 of 165 patients. Results were normal in 86 and abnormal in 78. The single posterior fossa malformation detected in this series was best delineated with the PF approach. PF sonography increased the diagnostic rate of grade II hemorrhage by 32%. Cerebellar hemorrhage (two patients) and cerebellar abscesses (one patient) were diagnosed by using the PF approach. PF sonography did not contribute to the diagnosis of periventricular leukomalacia. CONCLUSION: Study of the neonatal brain with the addition of PF sonography afforded greater accuracy in detecting intraventricular hemorrhage compared with AF sonography alone, especially when the ventricle was not dilated. The PF approach better defines posterior fossa malformations.

[Recurrent infection by Streptococcus agalactiae]. / Infección recidivante por Streptococcus agalactiae.

BACKGROUND: To study the factors implicated in the infectious process (host, microorganism and antibiotic) of a newborn early sepsis by S. agalactiae that suffered a reactivation at day five from discharge. METHODS: Description of two episodes of newborn sepsis by S. agalactiae corresponding to the same patient and microbiologic study of the isolated strain: typing by "genomic macrorestriction" and antibiotic tolerance by "timed killing curves". RESULTS: It was demonstrated that both strains of S. agalactiae type la/c belonged to the same clone as well as the tolerance to ampicillin of the strain. DISCUSSION: This sort of infections processes in the newborn are very serious and there is possibility of relapse. Thus, it is important to study the ethiologic agent and its relationship with antibiotics, in order to stablish the best treatment regimes, avoiding the possibility of relapses as the case we have described.

Meningitis neonatal y bacteremia por streptococcus ß hemolítico grupo C / Streptococcus group C neonatal meningitis and bacteremia

Se presenta el caso clínico de un neonato de término, adecuado a la edad gestacional, nacido tras un embarazo fisiológico y parto eutócico, que a los dos días de vida presentó bacteremia y meningitis bacteriana aguda causadas por streptococcus grupo C, también aislada con posterioridad de la secreción vaginal materna, lo que sugiere fuertemente la transmisión vertical. La evolución clínica y la respuesta a la terapia antibiótica fueron favorables. Se hace referencia a la escasa frecuencia de reportes de este agente etiológico en la literatura, como a lo indistinguible del cuadro clínico de otras etiologías más frecuentes

[Perinatal Streptococcus agalactiae infections. Clinical epidemiological study and evaluation of a prevention program]. / Infecciones perinatales por Streptococcus agalactiae. Estudio clínico epidemiológico y evaluación de un programa de prevención.

BACKGROUND: To prove both the importance of SGB (group B streptococci) as a cause of perinatal infection and the efficacy of a prophylactic treatment in pregnant women with cervicovaginal colonization by SGB. METHODS: Retrospective study of 197 third trimester pregnant women who were carriers of SGB (155 received intrapartum prophylaxis) and of 44 patients with SGB infections during pregnancy, post-partum and neonatal periods. RESULTS: No neonatal sepsis was detected in the group of SGB carrier mothers who received antibiotic prophylaxis. In carrier pregnant women who did not receive prophylaxis, one case of neonatal sepsis by SGB was detected and a greater prevalence of intrapartum fever, and neonatal infection with negative cultures was observed. SGB was frequently isolated as a cause of early sepsis and neonatal meningitis (13 cases), intraamniotic infection (12 cases) and puerperal endometritis (8 cases). In 45% of the patients with perinatal infections by SGB, the cervicovaginal culture performed in the third trimester of pregnancy did not detect the presence of SGB. CONCLUSIONS: The administration of intrapartum ampicillin to pregnant SGB carriers permits the prevention of perinatal infections by this microorganism in a great number of patients, although the possibility of late colonization, which may not be detected during pregnancy, stil remains.