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Group B streptococcal cellulitis-adenitis in infants
Insights
Group B Streptococcus (GBS) infections in infants often present as cellulitis-adenitis, with a potential link to otitis media. This suggests lymphatic spread, not just bacteremia, may cause these unusual GBS infections.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neonatology
Background:
- Group B Streptococcus (GBS) is a common cause of neonatal infections.
- Cellulitis-adenitis is a recognized manifestation of GBS infection in infants.
Observation:
- Seven infants with GBS cellulitis-adenitis were studied, with a mean age of onset at five weeks.
- Common symptoms included poor feeding or irritability (94%), with a male predominance (75%).
- Bacteremia was present in 94% of cases, with Type III GBS implicated in 75%.
Findings:
- Unusual sites of GBS involvement included inguinal lymph nodes and a thyroglossal duct cyst.
- A significant association was found between GBS cellulitis and ipsilateral otitis media (80%).
- No antibody response to Type III GBS capsular antigen was detected in convalescent sera.
Implications:
- Otitis media may play a role in the pathogenesis of GBS cellulitis-adenitis via lymphatic spread.
- This challenges the assumption of primary bacteremia as the sole cause of these infections.
- Understanding alternative pathways can inform diagnostic and treatment strategies for GBS infections.
Abstract:
Seven infants with group B streptococcal (GBS) cellulitis-adenitis were compared with nine previously described patients. The clinical features of infection included a mean age at onset of five weeks, a male predominance (75%), a history of poor feeding or irritability (94%), and a rapid resolution with appropriate antimicrobial therapy. Bacteremia occurred in 94% of the patients. Type III GBS were associated with 75% of these infections; no antibody response to the capsular antigen of these organisms was detected in convalescent sera. Two of our cases had previously unreported sites of involvement, inguinal lymph nodes and a thyroglossal duct cyst. Four infants (80%) with typical facial or submandibular GBS cellulitis had ipsilateral otitis media at the time of admission. Otitis media with subsequent lymphatic spread to facial or submandibular areas, rather than primary bacteremia, may explain the pathogenesis of these unusual infections.