Clinical Spectrum of Group B Streptococcol Cellulitis-Adenitis Syndrome
Methods: Retrospective review of GBS cultures in infants aged < 1 year, from January 2000 through December 2013 hospitalized at Texas Children’s Hospital, Houston. Infants with invasive infection, defined as positive blood or cerebrospinal fluid (CSF) cultures, had medical records reviewed to determine if cellulitis-adenitis was present.
Results: Among 237 infants with blood and/or CSF cultures that grew GBS, 15 (6.3%) presented with GBS cellulitis-adenitis (5 cellulitis, 3 adenitis, 7 cellulitis-adenitis). Eight infants (53%) were male; 7 (47%) were Hispanic, 5 (33.3%) were white and 3 (20%) were black. The median infant birth weight was 1415 grams (range 940-4252) and gestation was 32 weeks (27-41). Five infants were born at term (>37-weeks), 6 were preterm (28-36 weeks) and 4 were extremely preterm (<28-weeks). Only 2 mothers (13%) were known to be GBS colonized. Median infant age at presentation was 58 days (16-109). Most infants had symptoms for < 24 hours (93%). Common features noted at admission were irritability (80%), poor feeding (60%), fever (47%), swelling (47%), erythema (40%) and respiratory distress (33%). Seven (47%) infants had shock at admission and 5 (33%) were admitted to intensive care units. Sites of cellulitis/adenitis included submandibular or preauricular regions (11), inguinal, (2), chest (1), and periorbital (1). One infant with submandibular adenitis had a prevertebral phlegmon by imaging. All infants had bacteremia; 2 of 13 (15.4%) who had lumbar puncture performed also had meningitis. GBS types III, Ib, and Ia accounted for 69%, 23%, and 8%, respectively, of 13 typed isolates. All infants recovered. Two infants with submandibular cellulitis developed overlying eschars that improved with medical therapy and wound care.
Conclusion: Cellulitis-adenitis was a presenting feature of 1 in 16 cases of GBS bacteremia, and most often occurred in submandibular and preauricular areas, although other sites were also involved. GBS type III accounted for approximately 70% of cases. Except for the rate of preterm infants, cellulitis-adenitis syndrome is similar to cases in the 20th century.
C. C. Pretorius,
C. M. Healy, Sanofi Pasteur: Grant Investigator, Research grant
Novartis: Grant Investigator and Scientific Advisor, Consulting fee and Research grant