Infective Endocarditis Due to Group B Streptococcus in a Neonate: A Case Report and Review of the Literature

Bacterial endocarditis is a highly uncommon but life-threatening complication of group B streptococcus in neonates.

We describe a case of endocarditis due to group B streptococcus in a premature infant. In addition, we performed a literature review and identified 8 case reports of infants with group B streptococcus endocarditis over 49 years. These cases were analyzed together with our patients.

Eighty-nine percent (8/9) of the infants were born at term, and 67% (6/9) were male. The median age at presentation was 27 days. Eighty-nine percent (8/9) presented with late-onset disease. Twenty-two percent (2/9) of infants had recurrent group B streptococcus disease, 44% (4/9) had meningitis, 1 infant had septic arthritis and 22% (2/9) had congestive heart failure. All patients were treated with parenteral antibiotics, and these were administered for a mean of 40.8 days (median, 42 days; range 35-42 days). Congenital heart defects were noted in 33% (3/9) of the neonates. The mitral valve was affected in 67% (6/9). Forty-four percent (4/9) of cases who had valvular involvement underwent cardiac surgery. All 4 infants who underwent cardiac surgery survived. Mortality was 22% (2/9).

Group B streptococcus endocarditis often runs a fulminant course and can be associated with devastating consequences such as valvular destruction, systemic embolization and mycotic aneurysms. Physicians should have a high index of suspicion for endocarditis when evaluating neonates with invasive Group B streptococcus disease, particularly meningitis. Early recognition can allow prompt treatment, including a thorough evaluation to determine whether surgical interventions are warranted, given that combined medical and surgical approaches are associated with better outcomes.