Group A Streptococcus (GAS) was the most common cause of neonatal sepsis in the preantibiotic era. Recently, there have been few reported cases of invasive GAS sepsis in neonates. We present a case of a 3-day-old term female infant born via spontaneous vaginal delivery to a 38-year-old mother with GAS from vaginal culture and a history of postpartum fever. The infant was discharged home from the well-baby nursery on day of life 2 and within 24 hours of discharge presented to the emergency room with a history of poor feeding, listlessness, and difficulty breathing. She was found to be hypotensive and in respiratory failure. On examination, she had absent breath sounds over the right lung with coarse left lung sounds. In the emergency department, the infant required immediate intubation. Blood and urine cultures were drawn, lumbar puncture (LP) was performed, and she was empirically placed on ampicillin and gentamicin. Chest radiography revealed an opacified right hemithorax and laboratory investigation revealed profound leukopenia (white blood cell [WBC] count 1,850/mL). Cerebrospinal fluid (CSF) studies were within normal limits. She was then transferred to our tertiary care hospital and admitted to the newborn intensive care unit (NICU). Seventy-eight milliliters of thick purulent material were removed from the right chest by needle thoracentesis. Blood, urine, tracheal aspirate, and pleural fluid cultures all grew pansensitive GAS. CSF culture and latex agglutination panel were negative. Surface cultures for herpes simplex virus were negative. She developed anemia and thrombocytopenia requiring red blood cell and platelet transfusions. The infant clinically improved and was extubated on day of life 4. On day of life 6, she developed fever and respiratory distress. Repeat cultures were drawn and a repeat LP was performed. The CSF had developed a mild pleocytosis (WBC count 18/mL) with normal protein and glucose. Blood, urine, CSF, and tracheal aspirate cultures did not grow any organisms. She remained on ampicillin monotherapy for a total of 3 weeks for presumed meningitis. She clinically improved with no further radiographic evidence of accumulation of the empyema and only mild residual tachypnea. Her hemoglobin, WBCs, and platelets normalized. She was discharged on completion of her antibiotic course with no evident sequelae of the infection.
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