Streptococcus gallolyticus subspecies pasteurianus causing early onset neonatal sepsis complicated by solitary liver abscess in a preterm infant

Abstract

Streptococcus gallolyticus ssp pasteurianus (SGp) is an uncommon but increasingly recognized cause of neonatal sepsis and meningitis. Liver abscess in neonates is extremely rare. But liver abscess due to SG has never been reported in the literature. We present the first case of liver abscess due to SGp in a late preterm infant. A female infant was born at 36 weeks via normal vaginal delivery to a mother with unremarkable antenatal history. She had progressively worsening respiratory distress since birth and was intubated at 13 h of life. One dose of surfactant was delivered and ventilation continued. Parenteral crystalline Penicillin and Gentamicin were initiated and her blood culture at birth grew SGp. She had a spike of fever on day 5 of life. An ultrasound (US) scan of the abdomen was included in the septic work up. A multi-septated cystic liver abscess was noted in the right lobe of the liver. As there was inadequate response to appropriate intravenous antibiotics, needle aspiration and biopsy were performed on day 35 of life. Aspirate was sterile and histopathology confirmed a liver abscess. The patient continued to be treated with antibiotics for 8 weeks with serial US scans of the liver showing resolution of the abscess. Increasing awareness among paediatric and neonatal fraternity about these new emerging bacterial infections can facilitate early diagnosis and treatment.

Early-Onset Fulminant Sepsis in a Preterm Neonate due to Streptococcus gallolyticus: A Case Report and Literature Review

“…Streptococcus gallolyticus has been often used interchangeably with S. bovis in literature. 2 Over the years, SBSEC has undergone numerous taxonomical changes. Based on their ability to ferment mannitol, S. bovis has been classified in the older literature into two biotypes, mannitol-fermenting biotype I and mannitol nonfermenting biotype II.…”

“…gallolyticus is commonly associated with infective endocarditis, bacteremia, gastrointestinal infections including hepatobiliary infections, and colon cancer. 1 2 3 Streptococcus pasteurianus has been commonly associated with meningitis. 1 Although uncommon, S. gallolyticus subsp.…”

“…We analyzed the remaining 30 cases of neonatal S. gallolyticus infections reported in literature before November 30, 2021, and the present case ( n = 31) ( Table 1 ). 2 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Of the 30 cases reported in literature, only 10 cases were reported from the United States. 10 13 14 21 …”

“…equinus complex (SBSEC) 1 . S. gallolyticus has been reported as a cause of adult gastrointestinal tract infections and infective endocarditis for decades but is an uncommon cause of neonatal infections 1,2 . However, over the past decade, there have been increasing reports of neonatal sepsis, meningitis, and intrauterine infections due to S. gallolyticus.…”

“… 1 Streptococcus gallolyticus has been reported as a cause of adult gastrointestinal tract infections and infective endocarditis for decades but is an uncommon cause of neonatal infections. 1 2 However, over the past decade, there have been increasing reports of neonatal sepsis, meningitis, and intrauterine infections due to S. gallolyticus. Here, we report an unusual case of a preterm, extremely low birth weight (ELBW) male neonate who developed fulminant early-onset sepsis due to S. gallolyticus .…”