Presenter Status
Fellow
Abstract Type
Case Report
Primary Mentor or Principal Investigator
Susana Chavez- Bueno
Presentation Type
Poster
Start Date
21-5-2026 11:00 AM
End Date
21-5-2026 12:00 PM
Abstract Text
Background:
Neonatal early‑onset sepsis (EOS) remains a significant cause of morbidity and mortality in the immediate postnatal period. While Group B Streptococcus and Escherichia coli account for most EOS cases, Streptococcus pneumoniae is a rare but highly aggressive pathogen associated with mortality rates as high as 20–60%. In this case, a term newborn experienced fulminant multi‑organ failure within hours of birth despite minimal perinatal risk factors and negative maternal GBS screening.
Objectives
This report aims to (1) identify the unusual etiologic agent responsible for severe EOS in a term neonate, (2) outline the diagnostic and clinical course marked by respiratory and multi‑organ failure, and (3) highlight key teaching points regarding pneumococcal EOS, including transmission risk, antimicrobial susceptibility, and serotype‑specific considerations.
Methods/Design
Clinical data was obtained through chart review for patient history, laboratory evaluation and radiographic imaging and performing serial physical examinations.
Case:
A male infant born at 37 1/7 weeks initially required CPAP but rapidly progressed to respiratory failure and shock within the first 24 hours of life. Blood cultures demonstrated gram‑positive cocci, later identified as Streptococcus pneumoniae serotype 3 via PCR and Quellung reaction. Laboratory findings included leukocytosis, thrombocytopenia, metabolic acidosis, and a normal CRP. Chest imaging showed rapid progression from coarse infiltrates to multifocal airspace opacities. The infant required VA‑ECMO by hour 20, CRRT by hour 48, and three sessions of plasmapheresis for persistent coagulopathy. Antimicrobials were narrowed to ampicillin after susceptibilities confirmed penicillin and ceftriaxone sensitivity. The patient recovered gradually, with ECMO discontinued on day 13 and CRRT on day 23. He completed 14 days of antibiotics and was discharged home on day 68 on room air, with normal newborn screening results and normal splenic imaging.
Conclusions :
This case illustrates a rare but severe presentation of pneumococcal EOS in a term infant without classical risk factors. Vertical transmission of S. pneumoniae, while uncommon, remains clinically significant. Serotype 3 is associated with invasive disease and incomplete protection despite inclusion in current pneumococcal conjugate vaccines. Early recognition is challenging due to its low incidence, yet essential given rapid progression and potential resistance to standard empiric EOS therapy. Aggressive supportive management, including ECMO and CRRT, may improve outcomes in fulminant cases. Increased awareness of pneumococcal EOS is critical for guiding early diagnostic consideration and tailored therapy.
Neonatal Early‑Onset Sepsis: It’s Not Always What You Think
Background:
Neonatal early‑onset sepsis (EOS) remains a significant cause of morbidity and mortality in the immediate postnatal period. While Group B Streptococcus and Escherichia coli account for most EOS cases, Streptococcus pneumoniae is a rare but highly aggressive pathogen associated with mortality rates as high as 20–60%. In this case, a term newborn experienced fulminant multi‑organ failure within hours of birth despite minimal perinatal risk factors and negative maternal GBS screening.
Objectives
This report aims to (1) identify the unusual etiologic agent responsible for severe EOS in a term neonate, (2) outline the diagnostic and clinical course marked by respiratory and multi‑organ failure, and (3) highlight key teaching points regarding pneumococcal EOS, including transmission risk, antimicrobial susceptibility, and serotype‑specific considerations.
Methods/Design
Clinical data was obtained through chart review for patient history, laboratory evaluation and radiographic imaging and performing serial physical examinations.
Case:
A male infant born at 37 1/7 weeks initially required CPAP but rapidly progressed to respiratory failure and shock within the first 24 hours of life. Blood cultures demonstrated gram‑positive cocci, later identified as Streptococcus pneumoniae serotype 3 via PCR and Quellung reaction. Laboratory findings included leukocytosis, thrombocytopenia, metabolic acidosis, and a normal CRP. Chest imaging showed rapid progression from coarse infiltrates to multifocal airspace opacities. The infant required VA‑ECMO by hour 20, CRRT by hour 48, and three sessions of plasmapheresis for persistent coagulopathy. Antimicrobials were narrowed to ampicillin after susceptibilities confirmed penicillin and ceftriaxone sensitivity. The patient recovered gradually, with ECMO discontinued on day 13 and CRRT on day 23. He completed 14 days of antibiotics and was discharged home on day 68 on room air, with normal newborn screening results and normal splenic imaging.
Conclusions :
This case illustrates a rare but severe presentation of pneumococcal EOS in a term infant without classical risk factors. Vertical transmission of S. pneumoniae, while uncommon, remains clinically significant. Serotype 3 is associated with invasive disease and incomplete protection despite inclusion in current pneumococcal conjugate vaccines. Early recognition is challenging due to its low incidence, yet essential given rapid progression and potential resistance to standard empiric EOS therapy. Aggressive supportive management, including ECMO and CRRT, may improve outcomes in fulminant cases. Increased awareness of pneumococcal EOS is critical for guiding early diagnostic consideration and tailored therapy.
Comments
Poster Board Number: 9