Nada Faiez K Alabdulkarim: Poster 12
King Saud university, Saudi Arabia
Nada Alabdulkarim has graduated (2013) from King Saud University in Saudi Arabia with a bachelor degree of Medicine and surgery plus honor class. Nada completed two years of general pediatric training in Saudi Arabia. She has been interested in public health education and organized many events for that. Currently, she is working on research subjects including neonates of diabetic mothers and neonatal infections. In addition Nada is a member of the Saudi Pediatric society.
Introduction: Infection remains one of the leading causes of neonatal morbidity and mortality worldwide. Yearly 3·257 million child below 5 years old dies because of infections, 44% of them die in the neonatal period. Group B Streptococcus (GBS) is the most common pathogen particularly in infants under three months of age and it is unusual to present after that age. Neonatal GBS disease is divided into 3 categories according to the age of hospital admission; early-onset disease (EOD) (day 0–6), late-onset disease (LOD) (day 7–89), and ultra-late onset disease (ULOD) if more than 3 months (range 91–226 days). Significance of the study: To the best of our knowledge, only few cases were reported of invasive ULOD GBS outside of Saudi Arabia. In this report, we present and discuss a neonate who developed a rare invasive ULOD GBS. Patient description: Full term Afghani female was brought to the ER at 15 weeks (450 days) of age with 2 days history of fever, vomiting, poor appetite and lethargy. Blood and cerebrospinal fluid (CSF) cultures confirmed a heavy growth of streptococcus agalactiae. She developed multiple episodes of tonic-clonic convulsions of the right arm and left leg with lip smacking that lasted for few seconds. A right side facial palsy with generalized spasticity also noted, she was started on anticonvulsants. Electroencephalogram (EEG) demonstrated tendency for seizure and encephalopathy. Imaging showed bilateral extensive meningo-encephalitis and bilateral subdural fluid collection. Initial dexamethasone and empirical antibiotics were started. Her total antibiotics duration and hospital stay was ten weeks. Ptosis and spasticity improved to full recovery by her third week of admission.
Discussion: we present a rare GBS ULOD case with complicated course, including slow response to treatment, seizure and transient facial palsy. Although necessitating long hospital stay and despite of presence of persistent MRI changes, fortunately no functional deficit is noted till four months after hospital discharge at one year of age. More reports are needed for GBS ULOD patients for better understanding of pathophysiology and risk factors associated with it. Vaccination against specific strains of GBS is a promising preventive measure in the near future which possibly going to protects against both EOD and LOD.