A fatal case of fulminant group: a streptococcal infection in a neonate
Abstract Background Fulminant hemolytic streptococcal infection is a condition of sudden onset and rapidly progressing septic shock caused by Streptococcus pyogenes. It causes beta (complete) hemolysis. Although type A Streptococcus occurs more frequently, all streptococci that cause beta-hemolysis...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2023-06-01
|
| Series: | Egyptian Journal of Forensic Sciences |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s41935-023-00352-3 |
| _version_ | 1827910653063462912 |
|---|---|
| author | Fumiko Satoh Wataru Irie Chizuko Sasaki Eriko Ochiai Maho Kondo |
| author_facet | Fumiko Satoh Wataru Irie Chizuko Sasaki Eriko Ochiai Maho Kondo |
| author_sort | Fumiko Satoh |
| collection | DOAJ |
| description | Abstract Background Fulminant hemolytic streptococcal infection is a condition of sudden onset and rapidly progressing septic shock caused by Streptococcus pyogenes. It causes beta (complete) hemolysis. Although type A Streptococcus occurs more frequently, all streptococci that cause beta-hemolysis are eligible as causes. This report describes a rare autopsy case of fulminant group A streptococcal infection in a neonate. Case presentation A 16-day-old girl, 3300 g, born by spontaneous delivery at 41 weeks 1 day, experienced a 1-day history of low-grade fever, malaise, and a few hours of cyanosis and anuria, prompting her parents to bring her to the hospital. Her eldest brother, who lived with her, had been infected with Streptococcus approximately one month earlier, and had been treated with ten days of antibiotics. The infant died three hours after presentation. Autopsy findings indicated her to be 52 cm in length, weighing 3585 g, with medium build and normal nutrition. Her lungs were slightly oligemic with decreased volumes. The liver and kidneys were mildly enlarged. The spleen was markedly enlarged. The adrenal glands showed diffuse cortical hemorrhage (Fig. 1). There was some thymic atrophy (thymus weight 7.4 g, < 1 SD below the mean). Histopathological findings included chronic and neutrophilic infiltration of the tonsils and multiple septic emboli containing cocci in the lungs. Perivascular inflammatory cell infiltrates were observed in the lungs, myocardium, kidneys, adrenal glands, brain, meninges, and liver, with micro-necrotic changes in the kidneys and liver. Fibrin thrombi were observed in multiple renal glomeruli. Hemophagocytosis by macrophages was observed in the spleen, liver, lymph nodes, bone marrow, and adrenal glands. Immunostaining showed positive results for group A Streptococcus antibody in the tonsils, with bacterial masses. Blood cultures were positive for group A Streptococcus pyogenes. Conclusions Because of the lower respiratory tract infection and suspected sibling transmission, in addition to the adrenal hemorrhages, a diagnosis of fulminant sepsis with group A Streptococcus pyogenes with associated Waterhouse–Friderichsen syndrome was made. |
| first_indexed | 2024-03-13T01:52:48Z |
| format | Article |
| id | doaj.art-b9f6f09b72cc4f35beb368ae50bd2e2d |
| institution | Directory Open Access Journal |
| issn | 2090-5939 |
| language | English |
| last_indexed | 2024-03-13T01:52:48Z |
| publishDate | 2023-06-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Egyptian Journal of Forensic Sciences |
| spelling | doaj.art-b9f6f09b72cc4f35beb368ae50bd2e2d2023-07-02T11:25:51ZengSpringerOpenEgyptian Journal of Forensic Sciences2090-59392023-06-011311710.1186/s41935-023-00352-3A fatal case of fulminant group: a streptococcal infection in a neonateFumiko Satoh0Wataru Irie1Chizuko Sasaki2Eriko Ochiai3Maho Kondo4Department of Legal Medicine, Kitasato University School of MedicineDepartment of Legal Medicine, Kitasato University School of MedicineDepartment of Legal Medicine, Kitasato University School of MedicineDepartment of Legal Medicine, Kitasato University School of MedicineDepartment of Legal Medicine, Kitasato University School of MedicineAbstract Background Fulminant hemolytic streptococcal infection is a condition of sudden onset and rapidly progressing septic shock caused by Streptococcus pyogenes. It causes beta (complete) hemolysis. Although type A Streptococcus occurs more frequently, all streptococci that cause beta-hemolysis are eligible as causes. This report describes a rare autopsy case of fulminant group A streptococcal infection in a neonate. Case presentation A 16-day-old girl, 3300 g, born by spontaneous delivery at 41 weeks 1 day, experienced a 1-day history of low-grade fever, malaise, and a few hours of cyanosis and anuria, prompting her parents to bring her to the hospital. Her eldest brother, who lived with her, had been infected with Streptococcus approximately one month earlier, and had been treated with ten days of antibiotics. The infant died three hours after presentation. Autopsy findings indicated her to be 52 cm in length, weighing 3585 g, with medium build and normal nutrition. Her lungs were slightly oligemic with decreased volumes. The liver and kidneys were mildly enlarged. The spleen was markedly enlarged. The adrenal glands showed diffuse cortical hemorrhage (Fig. 1). There was some thymic atrophy (thymus weight 7.4 g, < 1 SD below the mean). Histopathological findings included chronic and neutrophilic infiltration of the tonsils and multiple septic emboli containing cocci in the lungs. Perivascular inflammatory cell infiltrates were observed in the lungs, myocardium, kidneys, adrenal glands, brain, meninges, and liver, with micro-necrotic changes in the kidneys and liver. Fibrin thrombi were observed in multiple renal glomeruli. Hemophagocytosis by macrophages was observed in the spleen, liver, lymph nodes, bone marrow, and adrenal glands. Immunostaining showed positive results for group A Streptococcus antibody in the tonsils, with bacterial masses. Blood cultures were positive for group A Streptococcus pyogenes. Conclusions Because of the lower respiratory tract infection and suspected sibling transmission, in addition to the adrenal hemorrhages, a diagnosis of fulminant sepsis with group A Streptococcus pyogenes with associated Waterhouse–Friderichsen syndrome was made.https://doi.org/10.1186/s41935-023-00352-3AutopsyFulminant group A streptococcal infectionHemophagocytosisImmunohistochemistryNeonateSepsis |
| spellingShingle | Fumiko Satoh Wataru Irie Chizuko Sasaki Eriko Ochiai Maho Kondo A fatal case of fulminant group: a streptococcal infection in a neonate Egyptian Journal of Forensic Sciences Autopsy Fulminant group A streptococcal infection Hemophagocytosis Immunohistochemistry Neonate Sepsis |
| title | A fatal case of fulminant group: a streptococcal infection in a neonate |
| title_full | A fatal case of fulminant group: a streptococcal infection in a neonate |
| title_fullStr | A fatal case of fulminant group: a streptococcal infection in a neonate |
| title_full_unstemmed | A fatal case of fulminant group: a streptococcal infection in a neonate |
| title_short | A fatal case of fulminant group: a streptococcal infection in a neonate |
| title_sort | fatal case of fulminant group a streptococcal infection in a neonate |
| topic | Autopsy Fulminant group A streptococcal infection Hemophagocytosis Immunohistochemistry Neonate Sepsis |
| url | https://doi.org/10.1186/s41935-023-00352-3 |
| work_keys_str_mv | AT fumikosatoh afatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT wataruirie afatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT chizukosasaki afatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT erikoochiai afatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT mahokondo afatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT fumikosatoh fatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT wataruirie fatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT chizukosasaki fatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT erikoochiai fatalcaseoffulminantgroupastreptococcalinfectioninaneonate AT mahokondo fatalcaseoffulminantgroupastreptococcalinfectioninaneonate |