Background Streptococcus bovis is a commensal colonic pathogen that is found in both human and animals. Streptococcus bovis biotype II/2, which is currently known as streptococcus gallolyticus subspecies (ssp) pasteurianus (SGP), is associated with sepsis and meningitis in neonates and infants. While this is uncommon, it has been associated with long term morbidity and mortality.
Objectives The aim of this study is to describe the clinical course and outcomes of infants with SGP infection.
Methods This is a systematic review and meta-analysis of studies identified from PubMed/Medline, Embase, Scopus, Web of Science, Google Scholar, and Cochrane Library. The following MeSH keywords were used: ‘streptococcus gallolyticus’, ‘streptococcus bovis’, ‘newborn’, ‘infant’. Studies were included if they described infants with culture-proven streptococcus gallolyticus (in blood or cerebrospinal fluid) up to 1 year of life. Data extracted included perinatal factors, clinical presentation, investigations, treatment received, and outcomes. Subgroup analyses were performed according to early and late onset of infection, and preterm compared to term infants.
Results A total of 42 articles were identified, which included a total of 97 cases, of which 59 had streptococcus bovis, and 38 with SGP infection (i.e. streptococcus bovis biotype II/2). Of the 97 cases, they were predominantly term infants (65.7%) male (54.5%), and were born via vaginal delivery (67.4%). The most common clinical symptom at presentation was lethargy (63.3%, 95% CI 45.1%-78.4), fever (60.3%, 48.3–71.2%)), irritability (57.6%, 35.1–77.4%), tachypnea (58.1%, 40.4–73.9%)and respiratory distress (48.3%, 21.9–68.0%). There were 28 early-onset infections (£3 days of life), which commonly presented as bacteremia (64.3%). Compared to late-onset infection, neonates with early-onset infection presented with more respiratory symptoms [pooled-risk difference for tachypnea 41.7% (11.2–72.2%), respiratory distress 32.4% (0.5–64.2%)]. The median inflammatory markers at onset of symptoms were not raised - median leukocyte 7000/microL (3490–16100/microL), neutrophils 45% (34–60%), C-reactive protein 9.6mg/dL (5.2–13.48 mg/dL)). CSF studies in neonates with meningitis showed predominant pleocytosis (median leukocyte 824/mm3(13–3016/mm3)). Most cases were susceptible to penicillin (66.1%, 53.6–76.8%) and were treated with a penicillin derivative with good recovery. The reported cases of meningitis had cranial imaging findings of intraventricular hemorrhage, ventriculitis, hydrocephalus, as well as frontal and subdural effusion. There were 4 mortalities - two presented and died on the first day of life, and two had a late-onset presentation and deteriorated before antibiotics could be given.
Conclusions SGP is an important cause of sepsis and meningitis in neonates. Penicillin derivative is an effective medication for SGP with limited reports of resistance and outcomes appear to be favourable.
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