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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus pneumoniae &#40;S&#46; pneumoniae&#41;</span> has a high morbidity rate in the pediatric population and causes a wide range of diseases such as otitis media&#44; pneumonia&#44; sepsis&#44; or meningitis&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> However&#44; infections caused by this microorganism in the neonatal period only account for 1&#37;&#8211;11&#46;5&#37; of neonatal sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> Nevertheless&#44; a recent study using molecular techniques &#40;PCR&#41; as well as blood cultures to study pathogens causing neonatal sepsis seems to indicate that the incidence may be higher &#40;up to 18&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Mortality from <span class="elsevierStyleItalic">S&#46; pneumoniae</span> among neonates is high &#40;35&#37;&#8211;50&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;5</span></a> and long-term neurological sequelae are common&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We report the clinical case of a neonate with early-onset <span class="elsevierStyleItalic">S&#46; pneumoniae</span> sepsis caused by vertical transmission&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a full-term newborn boy &#40;39 weeks of gestational age&#41; with high birth weight &#40;3820&#8239;g&#41;&#46; The mother had a monitored&#44; incident-free pregnancy&#44; except for <span class="elsevierStyleItalic">Candida albicans</span> infection in the third trimester that was properly treated&#44; and an episode of sinusitis at week 37&#44; for which she received a 1-week course of amoxicillin-clavulanate&#46; Serologies performed during pregnancy and culture of vaginorectal exudate were negative&#46; Gestational ultrasound showed mild bilateral pyelectasis&#46; Delivery was normal and no resuscitation maneuvers were required&#46; Apgar score was 10&#47;10 and umbilical arterial pH 7&#46;25&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the first day of life&#44; the patient developed poor oral tolerance and intermittent expiratory grunt &#40;Silverman score 2&#41;&#44; with no other signs of respiratory distress&#46; Laboratory tests requested at 8&#8239;h of life were normal&#44; and after performing blood culture the patient remained under observation&#46; At 24&#8239;h of life when the infant was already asymptomatic&#44; the microbiology department reported isolation of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> in blood culture&#46; Therefore&#44; laboratory tests were repeated&#44; showing leukocytosis &#40;32&#44;500&#47;mm<span class="elsevierStyleSup">3</span>&#41; with no left shift&#44; and raised CRP &#40;5&#8239;mg&#47;dl&#41;&#46; The patient was admitted and the early neonatal sepsis protocol was initiated&#44; with a lumbar puncture which did not present any alterations&#44; and empirical intravenous treatment with ampicillin and gentamicin was started&#44; the latter being discontinued when the result of the susceptibility testing was received&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the results of the culture&#44; sputum samples and urinary antigen samples were taken from both parents&#44; and a sample of vaginal exudate from the mother&#46; Pneumococcal antigen in urine was also studied in the patient&#8217;s 4-year-old brother&#46; In the family study&#44; a positive result was obtained in the vaginal exudate of the mother&#44; supporting the hypothesis of vertical transmission of the patient&#8217;s sepsis&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pneumococcal typing was performed in the patient and mother&#44; revealing a 19A serotype in both cases&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical progress was good and the patient remained stable and without requiring respiratory support&#44; so after completing 7 days of antibiotic therapy&#44; he was discharged home&#46; The mother remained asymptomatic throughout the patient&#8217;s admission&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Since the first case of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> neonatal sepsis was published in 1889&#44;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> this disease has scarcely appeared in the literature&#44; given its low prevalence&#46; There are more than 90 serotypes&#44; the most common in neonatal sepsis being 3 and 19&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In other studies&#44; more serotypes have been defined as common etiological agents in addition to those mentioned above &#40;serotypes 1&#8211;12&#44; 14&#44; 17&#44; 23&#44; 27&#44; 28&#44; 31 and 39&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Neonatal sepsis caused by <span class="elsevierStyleItalic">S&#46; pneumoniae</span> has two routes of transmission&#46; On the one hand&#44; it may be due to vertical transmission&#44; either at the end of pregnancy or intrapartum&#44; caused by vaginal colonization&#46; We should not forget that <span class="elsevierStyleItalic">S&#46; pneumoniae</span> is a common microorganism in the respiratory tract&#44; but very rare in the vaginal flora &#40;&#60;0&#46;75&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> due to its difficulty surviving the low pH of the vagina&#59; this explains the reduced prevalence of neonatal sepsis due to this etiology&#46; On the other hand&#44; transmission may be horizontal&#44; caused by infection of the neonate by close contacts with acute <span class="elsevierStyleItalic">S&#46; pneumoniae</span> infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several studies have found that factors such as prematurity&#44; low weight&#44; and prolonged rupture of membranes do not increase the risk of developing <span class="elsevierStyleItalic">S&#46; pneumoniae</span> sepsis&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> An increased risk of infection has been observed in normal deliveries compared to cesarean deliveries and in women who have undergone invasive gynecological procedures&#46; The use of intrauterine devices for contraception also increases the incidence of vaginal colonization&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There are no differences in clinical symptoms with respect to sepsis due to other etiologies&#46; In the case of <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; up to 40&#37; of neonatal sepsis are early-onset&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;5</span></a> which is suggestive of vertical disease transmission&#46; Mortality is higher in cases occurring in the first 48&#8239;h or when the mother has an invasive pneumococcal disease&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Neonatal pneumococcal sepsis usually presents with an aggressive course&#44; so early appropriate treatment is important&#46; Most strains of <span class="elsevierStyleItalic">S&#46; pneumoniae</span> are sensitive to penicillin or ampicillin&#44; so one of these antibiotics should be used&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;4</span></a> In areas with a high prevalence of penicillin resistance&#44; vancomycin should be added to the regimen&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">Pneumococcal vaccination has led to a decrease in diseases caused by this microorganism in the population&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Vaccination during pregnancy increases the production of IgG antibodies&#44; which are transmitted to the fetus through the placenta&#44; with elevated levels observed in children up to 2 months of life&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> It also produces an increase in IgA antibodies in breast milk and reduces vaginal colonization&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The use of the pneumococcal vaccine in the third trimester may be a useful measure in the future to reduce cases of neonatal sepsis&#44; but further studies are needed to confirm the usefulness of this approach&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; D&#237;az Mart&#237;n C&#44; Marrero P&#233;rez CL&#44; Mart&#237;n Fumero L&#44; Torres Moreno A&#44; de Quir&#243;s I&#46; Sepsis neonatal precoz por <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>&#46; Arch Bronconeumol&#46; 2020&#59;56&#58;671&#8211;672&#46;</p>"
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