Case Report: Prolonged CSF PCR Positivity in a Neonate With GBS Meningitis

Late-Onset Meningitis in a Preterm Infant Caused by Streptococcus gallolyticus Subsp. Pasteurianus in Saudi Arabia: A Case Report and Literature Review

This report describes the progression of meningitis in a 24-day-old preterm male infant infected with Streptococcus gallolyticus subsp. pasteurianus (SGSP) and its medical care, pathogen detection, antibiotic treatment, and monitoring, ultimately leading to a positive outcome of successful recovery. Neonatal meningitis (NM) is a serious and potentially life-threatening condition, particularly in immunocompromised preterm infants. This report from Saudi Arabia presents a rare case of late-onset neonatal meningitis caused by SGSP in a preterm male infant. The 24-day-old preterm neonate presented with fever, lethargy, poor feeding, and respiratory distress. SGSP was confirmed by cerebral spinal fluid analysis showing the presence of pleocytosis and a low glucose ratio. Prompt antibiotic therapy with intravenous Ampicillin and Cefotaxime led to decreased pleocytosis, and the infant was discharged after 21 days. This report highlights the importance of vigilance, diagnosis, and management of neonatal infections caused by uncommon pathogens such as SGSP. The rarity of SGSP-caused meningitis emphasizes the need to monitor pregnant women for potential transmission and to implement early diagnostic and management strategies. This case report also encompasses a review of recent globally reported cases of neonatal S. gallolyticus infection, highlighting the distinctiveness of this report as the first of its type in Saudi Arabia.

Mania: An atypical presentation of probable Streptococcus agalactiae meningoencephalitis

Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a common pathogen in the neonatal period, causing meningitis and sepsis. In non-pregnant adults it is an unusual cause of meningitis. We report about an elderly female with several risk factors for invasive GBS infection who developed GBS meningoencephalitis one month after treatment for COVID-19 upper respiratory tract infection. The patient presented with mania, and the classic triad of headache, neck stiffness, and fever was absent which contributed to the delay in diagnosis. Following initiation of treatment with intravenous ceftriaxone she attained full recovery, and her behavior returned to baseline. This case illustrates an unusual presentation of an emerging infection and should alert clinicians about this presentation. By reporting this case we want to raise awareness about mania as a presenting feature of meningoencephalitis. This should lead to more timely diagnosis and better outcomes for future patients.