Group B streptococcal infections in children: the changing spectrum of infections in infants.

During a 9-year period from January 1988 to December 1996, 36 patients less than 18 years of age with Lancefield group B streptococcal infections were seen in the National Cheng Kung University Hospital. Among 33 infants with invasive group B streptococcal infections, 3 (9%) were early onset disease (EOD), 27 (82%) late onset disease (LOD) and 3 (9%) onset beyond the third month of life. All cases of EOD were detected during the first day of life and 2 of them were premature births. In the infants with LOD, a high incidence of meningitis occurred (78%). The most common clinical presentation in group B streptococcal infections was fever (81%), followed by irritable crying (42%) and poor feeding (39%). Seizure was noted in 57% of meningitis cases. Obstetric and neonatal risk factors were compared between EOD and LOD, with prematurity and low birth weight significantly (P=0.01) more common among infants with EOD compared with LOD. Of the strains tested, the sensitivity to penicillin, ampicillin and erythromycin were 83%, 74%, and 75%, respectively. All strains were resistant to tetracycline and gentamicin. There were 2 case fatalities (6%) and 6 (17%) had major neurologic sequelae. These data provide that the vast majority of EOD are recognized on the first day of life and prematurity is an important risk factor. In comparison to the previous report in Taiwan, a changing spectrum of GBS infections in infants occurs during the study period. The observed incidence of EOD is decreased and meningitis is still predominantly in LOD. It is suggested early recognition and aggressive therapy have resulted in a much lower mortality rate than previously reported.