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precoz por <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Streptococcus pneumoniae (S. pneumoniae)</span> has a high morbidity rate in the pediatric population and causes a wide range of diseases such as otitis media, pneumonia, sepsis, or meningitis.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> However, infections caused by this microorganism in the neonatal period only account for 1%–11.5% of neonatal sepsis.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3–5</span></a> Nevertheless, a recent study using molecular techniques (PCR) as well as blood cultures to study pathogens causing neonatal sepsis seems to indicate that the incidence may be higher (up to 18%).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Mortality from <span class="elsevierStyleItalic">S. pneumoniae</span> among neonates is high (35%–50%)<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2–5</span></a> and long-term neurological sequelae are common.<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. pneumoniae</span> sepsis caused by vertical transmission.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a full-term newborn boy (39 weeks of gestational age) with high birth weight (3820 g). The mother had a monitored, incident-free pregnancy, except for <span class="elsevierStyleItalic">Candida albicans</span> infection in the third trimester that was properly treated, and an episode of sinusitis at week 37, for which she received a 1-week course of amoxicillin-clavulanate. Serologies performed during pregnancy and culture of vaginorectal exudate were negative. Gestational ultrasound showed mild bilateral pyelectasis. Delivery was normal and no resuscitation maneuvers were required. Apgar score was 10/10 and umbilical arterial pH 7.25.</p><p id="par0020" class="elsevierStylePara elsevierViewall">During the first day of life, the patient developed poor oral tolerance and intermittent expiratory grunt (Silverman score 2), with no other signs of respiratory distress. Laboratory tests requested at 8 h of life were normal, and after performing blood culture the patient remained under observation. At 24 h of life when the infant was already asymptomatic, the microbiology department reported isolation of <span class="elsevierStyleItalic">S. pneumoniae</span> in blood culture. Therefore, laboratory tests were repeated, showing leukocytosis (32,500/mm<span class="elsevierStyleSup">3</span>) with no left shift, and raised CRP (5 mg/dl). The patient was admitted and the early neonatal sepsis protocol was initiated, with a lumbar puncture which did not present any alterations, and empirical intravenous treatment with ampicillin and gentamicin was started, the latter being discontinued when the result of the susceptibility testing was received.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the results of the culture, sputum samples and urinary antigen samples were taken from both parents, and a sample of vaginal exudate from the mother. Pneumococcal antigen in urine was also studied in the patient’s 4-year-old brother. In the family study, a positive result was obtained in the vaginal exudate of the mother, supporting the hypothesis of vertical transmission of the patient’s sepsis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Pneumococcal typing was performed in the patient and mother, revealing a 19A serotype in both cases.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical progress was good and the patient remained stable and without requiring respiratory support, so after completing 7 days of antibiotic therapy, he was discharged home. The mother remained asymptomatic throughout the patient’s admission.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Since the first case of <span class="elsevierStyleItalic">S. pneumoniae</span> neonatal sepsis was published in 1889,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> this disease has scarcely appeared in the literature, given its low prevalence. There are more than 90 serotypes, the most common in neonatal sepsis being 3 and 19.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In other studies, more serotypes have been defined as common etiological agents in addition to those mentioned above (serotypes 1–12, 14, 17, 23, 27, 28, 31 and 39).<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. pneumoniae</span> has two routes of transmission. On the one hand, it may be due to vertical transmission, either at the end of pregnancy or intrapartum, caused by vaginal colonization. We should not forget that <span class="elsevierStyleItalic">S. pneumoniae</span> is a common microorganism in the respiratory tract, but very rare in the vaginal flora (<0.75%)<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> due to its difficulty surviving the low pH of the vagina; this explains the reduced prevalence of neonatal sepsis due to this etiology. On the other hand, transmission may be horizontal, caused by infection of the neonate by close contacts with acute <span class="elsevierStyleItalic">S. pneumoniae</span> infection.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Several studies have found that factors such as prematurity, low weight, and prolonged rupture of membranes do not increase the risk of developing <span class="elsevierStyleItalic">S. pneumoniae</span> sepsis.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</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. The use of intrauterine devices for contraception also increases the incidence of vaginal colonization.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">There are no differences in clinical symptoms with respect to sepsis due to other etiologies. In the case of <span class="elsevierStyleItalic">S. pneumoniae</span>, up to 40% of neonatal sepsis are early-onset,<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,5</span></a> which is suggestive of vertical disease transmission. Mortality is higher in cases occurring in the first 48 h or when the mother has an invasive pneumococcal disease.<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, so early appropriate treatment is important. Most strains of <span class="elsevierStyleItalic">S. pneumoniae</span> are sensitive to penicillin or ampicillin, so one of these antibiotics should be used.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,4</span></a> In areas with a high prevalence of penicillin resistance, vancomycin should be added to the regimen.<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.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Vaccination during pregnancy increases the production of IgG antibodies, which are transmitted to the fetus through the placenta, with elevated levels observed in children up to 2 months of life.<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.<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, but further studies are needed to confirm the usefulness of this approach.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Díaz Martín C, Marrero Pérez CL, Martín Fumero L, Torres Moreno A, de Quirós I. Sepsis neonatal precoz por <span class="elsevierStyleItalic">Streptococcus pneumoniae</span>. Arch Bronconeumol. 2020;56:671–672.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "<span class="elsevierStyleItalic">Streptococcus pneumoniae</span>: un patógeno poco habitual en la sepsis neonatal de trasmisión vertical" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Hermoso Torregosa" 1 => "Carrasco Zalvide" 2 => "M.T. 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Year/Month | Html | Total | |
---|---|---|---|
2024 October | 52 | 18 | 70 |
2024 September | 58 | 17 | 75 |
2024 August | 77 | 35 | 112 |
2024 July | 55 | 24 | 79 |
2024 June | 61 | 36 | 97 |
2024 May | 76 | 40 | 116 |
2024 April | 39 | 29 | 68 |
2024 March | 48 | 19 | 67 |
2024 February | 36 | 20 | 56 |
2023 March | 8 | 5 | 13 |
2023 February | 23 | 24 | 47 |
2023 January | 44 | 28 | 72 |
2022 December | 50 | 22 | 72 |
2022 November | 58 | 27 | 85 |
2022 October | 51 | 38 | 89 |
2022 September | 42 | 25 | 67 |
2022 August | 30 | 41 | 71 |
2022 July | 32 | 45 | 77 |
2022 June | 39 | 36 | 75 |
2022 May | 38 | 41 | 79 |
2022 April | 56 | 39 | 95 |
2022 March | 42 | 44 | 86 |
2022 February | 14 | 21 | 35 |
2021 June | 1 | 0 | 1 |
2021 April | 5 | 1 | 6 |
2021 March | 3 | 2 | 5 |
2020 November | 1 | 0 | 1 |
2020 October | 1 | 0 | 1 |