Cytokine Profiles Before and After Exchange Transfusions in Severe Late-Onset Neonatal Group B Streptococcus Meningitis: A Case Report

Abstract

Streptococcus agalactiae or group B streptococcus (GBS) is a pathogen that causes severe neonatal infections, resulting in sepsis, pneumonia, and meningitis. Neonatal GBS meningitis has a poor neurological prognosis and a high mortality rate. GBS disease is classified as early-and late-onset if the onset age is 0-6 and 7-89 days after birth, respectively. There is currently no effective preventive strategy against late-onset GBS (LOGBS) disease. Here, we report a case of female infant with LOGBS meningitis who recovered from the septic shock by two exchange transfusions (ExTs) but still experienced severe neurological sequela. She was born at a gestational age of 39 weeks via caesarian section due to oligohydramnios and had fever 11 days after birth. GBS was detected in her cerebrospinal fluid (CSF) and blood but not in the vaginal or breast-milk cultures of the mother. The patient was treated with intravenous antibiotic administration; however, she suddenly developed pulseless ventricular tachycardia and asystole the next day. Her heart rate was normalized via cardiopulmonary resuscitation. We also performed two ExTs, and she recovered from the septic shock. Cytokine-profile analysis revealed that the serum and CSF levels of various pro-inflammatory and anti-inflammatory cytokines were elevated before the ExTs, after which the serum levels of several of these cytokines decreased. Two ExTs were effective in saving the life of the patient but did not improve the neurological prognosis. Given that neonatal GBS meningitis has high fatality and sequela rates; thus, it is necessary to establish a preventive strategy.

Dysregulated monocyte-derived macrophage response to Group B Streptococcus in newborns

“…Indeed, a dysregulated host response, characterized by excessive activation of the immune system, concomitantly with features of immune suppression, plays a central role in the pathogenesis of sepsis, and sepsis-related adverse outcomes in adults ( 23 ). In accordance with this concept, GBS infection is associated with strong systemic pro- and anti-inflammatory responses in newborns ( 21 , 22 , 70 ).…”

Investigation of biomarkers in a rare case of fulminant necrotizing enterocolitis in a preterm infant

“…The cytokine profile of the infant was characterized by increases in TNFα and IL-1β that were about an order of magnitude lower than those seen during common neonatal sepsis 19 - 21) . However, IL-6, IL-8, G-CSF, and the anti-inflammatory cytokine IL-10 showed quite significant elevations.…”

Exchange Transfusion in Neonatal Sepsis: A Narrative Literature Review of Pros and Cons

“…Sugiura et al reported that in an extremely low-birthweight infant with septic shock due to necrotizing enterocolitis, the elevated serum IL-8 and calprotectin levels decreased after ET and the blood pressure increased and stabilized [ 24 ]. Moreover, Chishiki et al reported that ET saved the life of a neonate with septic shock due to severe Group B streptococcus meningitis, and that the procedure reduced the levels of both proinflammatory and anti-inflammatory cytokines [ 25 ]. Improvement of pulmonary perfusion, ventilation, and tissue oxygenation; Gottuso et al reported significantly improved pulmonary perfusion and ventilation after ET in low-birth-weight infants with severe respiratory distress [ 26 ].…”

“…Therefore, cytokine elimination therapy may improve the condition of neonates with sepsis. Although ET has been reported to have a cytokine elimination effect [ 24 , 25 ], the direct removal of inflammatory cytokines from whole blood using therapeutic PE is a potential alternative [ 63 ]. PE is a well-established therapeutic procedure commonly used in adults; it is based on the removal of plasma from whole blood followed by replacement of that volume with fresh frozen plasma.…”