Abstract:
Background: Group B Streptococcus (GBS) is the most common cause of severe infection and meningitis in babies under 3 months of age. Recurrent GBS sepsis is rare but serious. We present two neonates who re-presented with GBS sepsis after initial treatment.
Case 1: A pre-term male neonate developed late-onset GBS meningitis on day 24 of life. He was treated with IV Benzylpenicillin and Gentamicin for 17 days. Repeat CSF culture was negative and he was discharged home. However, he was readmitted three days later with GBS sepsis (but not meningitis). He was again started on Benzylpenicillin and Gentamicin for 21 days and fully recovered.
Case 2: A term female neonate screened for sepsis due to grunting at 12 hours of life. She completed a 10 day treatment course of IV Benzylpenicillin and Gentamicin. Blood culture was positive for GBS, but CSF culture was negative. As she clinically improved, she was discharged home but re-presented to hospital on day 27 of life with GBS sepsis. She received IV Ceftriaxone for 6 weeks and fully recovered with negative repeat CSF cultures. Both infants had unremarkable immunological workups. Both received a 6 month course of prophylactic antibiotics after treatment.
Discussion: Although described, recurrent GBS is uncommon. These cases add to those already described. Predisposing factors include poor CSF antibiotic penetration, anatomical anomalies, persistent colonisation, or subtle immune deficiencies. This case series highlights that despite guideline-concordant treatment and microbiological clearance, recurrence is possible; and the need for studies to determine the risk factors for recurrence and the optimum treatment for this condition.
Conclusion: For the time being, strict and extended follow-up should be considered in these patients, especially in the early post-discharge phase. Treatment protocols should be reevaluated and tailored for individual patients.
