Sudden and Unexplained Neonatal Death with Group a Streptococcus Infection

Introduction: Group A streptococcus (GAS) is a rare infection in neonates. A 2004 review of GAS invasive infection in the neonates has described 39 patients since 1966 in the world literature. The mode of transmission in the majority of invasive late onset cases is unknown. Vertical transmission or postnatal acquisition of focal GAS infection such as pharyngitis and episiotomy abscess are probable sources of transmission.

Case Report: A 5 days old baby boy, born term to a healthy mother by vaccum delivery, was vigorous at birth and no resuscitation was required. He was brought to the emergency department with poor feeding, reduced activity and difficulty in breathing. On examination, initially he was pink, afebrile, vitals were normal, he had intermittent grunting and marked hypotonia with poor response to stimulation. Septic work up was done, bloods showed WCC=1.6, Neutrophils=1.02, Platelets were out of range, Prolonged PT of 22.8, CRP 186. He received IV Cefotaxime, Amoxicillin and Gentamicin. He had a chest xray which showed consolidation in both lung bases. He deteriorated clinically after 1 hour of presentation, he started having apnoeic episodes, capillary refill was >4 secs, mean blood pressure <30, he had a full anterior fonanelle and weak pulses. He was fully resuscitated with Endotracheal intubation and ventilation. He received a total of 3 IV Normal saline 20ml/kg boluses. He also received dopamine, noradrenaline, and mannitol. He was then transferred to a tertiary ICU. His blood culture was positive for Streptococcus pyogenes Group A at 9 hours. His clinical condition continued to deteriorate; ventilatory support was withdrawn after parental consent and was pronounced RIP after 12 hours of presentation.

Conclusion: Even though Group B strep is more common in neonatal sepsis, group A strep also needs to be considered in the differentials as it can be fatal.