case study on a 48 hour neonate with lethargy in the NICU
| FrontText | Sheree walker, a neonatologist at a local hospital, is checking on Mercy, a 48- hour-old infant girl. mercy was delivered normally at 39 weeks and appeared to be a healthy baby. in the last 2 days, however, she has taken a bad turn and is admitted to neonatal intensive care unit. mercy is limp, has difficulty breathing, body temp. of 35 C; but her lungs are clear, her heart exam is normal. dr. walker speaks w/ Mercys mother, who confirms she received appropriate prenatal care and has no other medical problems. dr. walker orders a lumbar puncture for mercy to check her cerebrospinal fluid for possible infections. the report back from lab shows blood in Mercy's CSF. dr. walker diagnoses mercy w/ meningitis and then orders a venous blood culture to check for bacteria. what bacteria could cause of Mercys meningitis? |
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| BackText | Neisseria meningitidis and Streptococcus pnuemoniae. |
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| FrontText | the gram stain of mercys venous blood shows gram-positive cocci among the red blood cells. needing to identify the species of bacteria that is causing Mercys meningitis, the lab cultures the cocci on blood agar. based on new info, what bacteria was responsible for Mercy's meningitis? |
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| BackText | streptococci |
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| FrontText | the blood agar and Gram stain results show beta-hemolytic streptococci. dr. walker sends a request to the lab for Lancefield typing of the blood culture to find out which Streptococcus species is causing mercy's meningitis. the results confirm the presence of the group B Lancefield antigen, thus verifying a diagnosis of group B Streptococcus (GBS), or S. agalactiae, infection. although mercy's mother tested negative for GBS when she was pregnant, dr. walker suggests mercy's mother be retested. this time results are positive. What is GBS? |
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| BackText | GBS is often part of the normal intestinal or genitourinary microbiota, but it can cause disease in immunocompromised individuals. GBS emerged as a major cause of neonatal bacteria sepsis in the 1970'2 and is a leading infectious cause of neonatal morbidity in the United States. the bacterium, a common colonizer of the maternal genital tract, can infect the fetus during gestation, causing fetal death. GBS can also be acquired by the fetus during passage through the birth canal during delivery. prevention includes screening all pregnant women for GBS at 35 to 37 weeks' gestation and administering antibiotics to carriers during labor. although mercys mother tested negative during her pregnancy, her results were a rare false negative. mercy is put on intravenous antibiotics and remains in the hospital for 10 days until her infection clears. she is sent home after 2 weeks and is now a healthy, happy 2-month-old girl |
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