Group B streptococcal meningitis in a 10 month old infant – is it different from GBS meningitis during early infancy?

Abstract

We report a case of Group B Streptococcus (GBS) meningitis in a 10 month old infant. He presented with a history of pyrexia for two days and vomiting for one day. He was admitted and became irritable within a few hours. Full septic screen was performed. CRP was 112 and FBC showed neutrophilia. Cloudy CSF showed a predominantly polymorph leucocytosis and gram positive cocci were seen. The provisional diagnosis was pneumococcal meningitis. He was started on IV dexamethasone and ceftriaxone. Both parents are French - the baby was born in the UK at term. His mother did not have a vaginal swab perinatally. There were no neonatal problems or previous significant illnesses. He had received vaccines per UK schedule. Clinical improvement was noted within 24 hours of starting treatment. Both CSF and blood cultures grew Group B streptococci. As per advice from the infectious diseases team, his dexamethasone course was completed, and his antibiotic treatment rationalised. GBS is a common pathogen in the neonatal period and early infancy, and the characteristics of early onset (first week of life) and late onset (7-89 days) infection have been well documented. GBS infection has also occasionally been reported in older infants and children,1 though relatively little is known about GBS infection beyond 3 months of age. It has been described as ‘Ultra late GBS infection’2 or ‘late late GBS infection’. The epidemiological data from a french study suggests that ultra late GBS meningitis is a same clinical and bacteriological entity as late onset GBS meninigitis.2 Ultra late GBS meningitis seems to be less severe than pneumococcal meningitis in late infancy.3 Using our case as an example, we present and discuss the relevant published literature about ultra late group B streptococcal meningitis.