FT

Title
Author(s)
Streptococcus bovis infection in infants and young children in a

regional hospital in Hong Kong
Sham, Chak-on, Philip;
Citation
Issued Date
URL
Rights
2010
http://hdl.handle.net/10722/133489
Creative Commons: Attribution 3.0 Hong Kong License
Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010
Project dissertation for the Postgraduate Diploma in

Infectious Diseases 2008-2010
Streptococcus bovis infection in infants and young children
Title:
in a regional hospital in Hong Kong

Name of student:
SHAM Chak On Philip
University Student
2002364876
Number:
Department of Paediatrics and Adolescent Medicine, Tuen
Affiliation:
Mun Hospital, Hong Kong

Name of supervisor:
Dr. HO Pak Leung
Date of submission:
17th April 2010
This work is submitted to

Faculty of Medicine of the University of Hong Kong
In partial fulfillment of the requirements for
The Postgraduate Diploma in Infectious Diseases, PDipID (HK)
Streptococcus bovis infection in infants and young children in a regional hospital in Hong Kong
Declaration
I, Sham Chak On Philip, declare that this manuscript represents my own work and
that it has not been submitted to this or other institutions in application for a degree,
diploma or any other qualifications.
I, Sham Chak On Philip, also declare that I have read and understand the guideline
on What is plagiarism? published by The University of Hong Kong (available at
http://www.hku.hk/plagiarism/) and that all parts of this work complies with the
guideline.
_______________________
SHAM Chak On Philip
Date: 17th April 2010
Streptococcus bovis infection in infants and young children

in a regional hospital in Hong Kong
Abstract:
Objectives:
To identify the features of infants and young children infected by

Streptococcus bovis in a regional hospital in Hong Kong.
Case series
Design and
setting:
Clinical features of all patients infected by Streptococcus bovis
Main
measurements: were retrieved from the database of the Department of Paediatrics
and Adolescent Medicine, Tuen Mun Hospital, from 1999 to 2009.
A literature review was also performed concerning this infection in
infants and young children.
Eight infants were identified from our database. All of the
Results:
patients had Streptococcus bovis bacteraemia. Only 2 of our
patients had the bacteria isolated from cerebrospinal fluid. Four
of the patients presented with fever. Six of the patients were born
at full term while the other 2 were premature babies. Six of the
patients presented within the first 7 days of life, while the other 2
presented on Day 23 and day 46 of life. At least 7 days of
intravenous antibiotics were given. All of the patients recovered
and none of our patients died. To date, all of our patients had
normal growth and development.
Bacteraemia was the most common manifestation in our case
Conclusions:
series. This was the same as what can be found in the literature.
However, in our series, respiratory distress was common but
gastrointestinal disturbance was uncommon, which is different
from previous reports. Further research has to be performed for
better understanding of this bacterial infection in the paediatric
population.
Introduction
While Streptococcus bovis infection is uncommon in infants and young children, it
may be associated with malignancies and other serious consequences in adults. In
the Western World, the association between Streptococcus bovis bacteraemia and
colorectal cancer has been established [1]. It is therefore worthwhile to review
paediatric cases of Streptococcus bovis infection to improve our understanding about
the problem.
Similar to the practice overseas [2], our laboratories also use the term Streptococcus
bovis to designate viridans group Streptococci that now form the Streptococcus
bovis/ Streptococcus equines complex: Streptococcus gallolyticus (including
sub-species gallolyticus, pasteruianus, macedonius), Streptococcus infantarius
(including subspecies infantarius and coli), Streptococcus equines and Streptococcus
alactolyticus.[3]
Methods
Patients were identified from the database of the Department of Paediatrics and
Adolescent Medicine, Tuen Mun Hospital.
Patients were included if they had
Streptococcus bovis isolated from specimens obtained from them, which included
blood, cerebrospinal fluid, surface swab, gastric lavage and urine. Patients were
excluded from this case series if they were asymptomatic and only had
Streptococcus bovis isolated from surface swabs, as this might suggest that the
bacteria was a colonizer rather than a pathogen causing disease in the patient.
Results
Eight patients were found to meet our criteria in our search.
shown in Table 1.
The results were
All of our patients were newborns.
All had some
complications or medical problems in the antenatal period or during labour.(Table 2)

Six of them were full born infants and the other two were premature babies.
age of onset of symptoms ranges from day of birth to 46-day-old.
males and 2 females.
The
There were 6
The birth weight ranges from 1175 gram to 3870 gram.
These babies were delivered in various ways, including vaginal delivery, vacuum
extraction and Caesarean Section.
Concerning disease presentation, fever was the most common manifestation of the
disease.
Some babies presented with signs of respiratory illness, which included
cyanosis, tachypnoea and apnoea attack.
Only one of the babies presented with
signs of gastrointestinal illness i.e. regurgitated once after feed.
Intra-partum
antibiotics had been given to the mother in 2 of these cases, while only the 2 babies
with later onset of disease (on Day 23 and Day 46 of life) had received antibiotics
before disease presentation.

In our cases series, Streptococcus bovis was isolated from blood culture in all of our
patients.
In two patients the bacteria were grown from the cerebrospinal fluid
obtained. All of these babies were treated with intravenous antibiotics for at least 7
days.
The most common choice in this case series was Penicillin G. All of the
babies recovered from the disease. Six of the babies had been followed up in our
out-patient clinic.
development.
To date, all of them enjoyed good health with normal
In our unit, liver enzyme levels and ultrasonography of the
hepatobiliary system were not routinely done in babies with Streptococcus bovis
bacteraemia.
Serum bilirubin levels in neonates were usually affected by neonatal
jaundice and did not reflect liver function. Our laboratory did not proceed to check
the biotype of the bacteria.
Discussion
This case series, to our knowledge, was the first case series concerning Chinese
babies being infected by Streptococcus bovis. Although there were only 8 patients
involved and strong scientific conclusions could not be made, we can use our data to
compare with those cases previously reported from other parts of the world. In the
year 2006, Gerber et al. had performed a case series in 2 hospitals in the United
States concerning Streptococcus bovis infection in infants. [3] The group had
identified 7 of such patients managed at their institutions and 23 from the

literature.(Table 3)
Streptococcus bovis infection is more commonly found in
young infants, particularly in the neonatal period, as in our case series, Gerbers case
series and the study groups literature review [3] -- all of the babies presented before
the age of 2 months.
In our case series, most of the babies presented early within
first 7 days of life, and the most common presentation was fever.
these babies acquire the infection in perinatal period.
It is possible that
As in the case of Group B
Streptococcus, the large bowel is the reservoir of Streptococcus bovis and sporadic
vaginal colonization of the bacteria may occur.
when they pass through the female genital tract.
Babies may acquire the infection

Therefore, use of intra-partum
Penicillin or ampicillin may decrease the risk of perinatal Streptococcus bovis

infection.
Our findings contrast with cases described by Gerber et al [3] that, in their case
series, most infants with Streptococcus bovis infection developed the disease after
day 14 of life, and presented with signs of gastrointestinal illness. In that case
series 5 out of 7 babies presented with abdominal distension and diarrhoea. It
remained uncertain how these babies acquired the infection. Fortunately in both of
the case series, including the babies who suffered from bacteraemia and meningitis,
none of the babies died.
Streptococcus bovis, a normal inhabitant of the human gut, is a Gram positive

bacterium that has been reported to cause infective endocarditis, meningitis, bones
and joints infections and biliary tract disease in humans. [1][2][3][4] In one local
study done concerning Streptococcus bovis in both adults and children, it was found
out that in Streptococcus bovis bacteraemia, 38% of the patients had underlying acute
cholangitis or cholecystitis and 11% had infective endocarditis.
patients with underlying carcinoma of colon.
There were 11% of
In 40% of these patients, no infective
foci could be identified. Therefore in this study the authors recommended that in our
locality, biliary tract disease should be actively looked for in any future case of
unexplained Streptococcus bovis bacteraemia. [1]
Overseas, there have been reports that at least one-third of adult patients with
Streptococcus bovis bacteraemia had underlying colonic pathology.[5][6]
Although
the mechanism is unclear, malignant disruption of gastrointestinal mucosa may

facilitate bacteraemia in patients with Streptococcus bovis colonization.[3] Some
authors suggested that even when Streptococcus bovis was found to be the culprit of
hepatic or splenic abscess, the observation mandated a subsequent search for
underlying colonic neoplasm.[7] It was suggested that such geographical difference
in disease association in Streptococcus bovis bacteraemia was related to the biotype of
Streptococcus bovis.
Streptococcus bovis biotype II/2 accounts for 87% of
Streptococcus bovis isolates in our locality, while biotype I is more common is the
Western World.[1]
It was reported that there was a 94% association of Streptococcus
bovis biotype I bacteraemia with infective endocarditis and a 71% association of

Streptococcus bovis biotype I bacteraemia with colonic carcinoma.
On the other
hand, for Streptococcus bovis isolates of biotype II, association between bacteraemia
and infective endocarditis was only 18% and that between bacteraemia and carcinoma
of the colon was only 17%.[1]
In our case series, although all of our patients suffered from Streptococcus bovis
bacteraemia, primary foci could not be identified.
In addition, there was no
associated biliary tract disease or infective endocarditis, though such conclusion was
based mainly on clinical grounds.
There were no tenderness on abdominal
examination, no heart murmur nor signs of heart failure.
Because of these negative
physical signs, we performed ultrasonography of the liver in none of our patients.

Trans-thoracic echocardiogram was performed in five of our patients and none of
them had features suggestive of infective endocarditis.
Streptococcus bovis
bacteraemia had been found associated with diseases of the gastrointestinal and
hepatobiliary systems and Gerber et al. demonstrated that gastrointestinal disturbance
was common in young infants with Streptococcus bovis infection.
presentation was not common in our case series.
However such
Only one baby in our case series
presented with gastrointestinal disturbance (regurgitated once after feeding).

In this study we have reviewed the records of our patients concerning the use of
intrapartum antibiotics to the mothers of these babies.
In our hospital, we follow
the guideline issued by the Royal College of Obstetricians and Gynaecologists

concerning use of intrapartum Penicillins in mothers whose babies are at risk of
Group B Streptococcal (GBS) disease. [8] The clinical risk factors are:
1. Mothers who have a previous infant with invasive GBS disease
2. Mothers who are carriers of GBS, especially those who have GBS bacteriuria
during pregnancy
3. Delivery before 37 weeks of gestation
4. Duration of ruptured membrane longer than 18 hours [prolonged rupture of
membranes (PROM)]
5. Mothers who have intrapartum body temperature higher than 38C
Intrapartum antibiotics will be given to mothers who have one or more of the above
risk factors.
Although intravenous Penicillin G is the preferred choice in the
guideline, ampicillin is commonly used by our Obstetric unit because of wider

coverage of other potential pathogens.[9]
All babies delivered in our hospital will
be observed for at least 48 hours in ward, and will be discharged if no signs of

infection were noted. In all our 8 cases, none of the mothers of the babies had
10
received more than 1 dose of intrapartum ampicillin.
Because of the small number
of cases, it is difficult to conclude whether intrapartum antibiotics can prevent or

decrease the number of babies suffering from Streptococcus bovis infection.
However, this postulation can be valid. A 16-year prospective study performed in
Spain had shown that the rate of penicillin resistance was 0% among Streptococcus
bovis isolates.[10]
Therefore intravenous ampicillin given to mothers may act
against both Group B Streptoccoccus and also Streptococcus bovis, thus lowering
the chance of babies being infected by both bacteria. This may also explain the
low incidence of Streptococcus bovis infection in neonates in our locality.
However, it has been documented that intrapartum antibiotics could not lower the
incidence of late onset Group B Streptococcal disease in neonates. Whether the
same can be applied to Streptococcus bovis infection cannot be proven yet.
In the
case series by Gerber et al, late onset Streptococcus bovis infection was in fact more
common than early onset diseases.
Concerning treatment of Streptococcus bovis infection, all except one of our cases
was treated with -lactam group of antibiotics. The most common choice was
intravenous Penicillin G.
All of our Streptococcus bovis isolates were sensitive to
penicillin. Although our laboratory did not report the actual figures concerning
antibiotic sensitivities of Streptococcus bovis because of the small number of isolates,
11
[11] the findings in our case series and the reports from Gerber [2] and Corredoira
[10] suggested that -lactam group of antibiotics are reasonable first line treatment
of Streptococcus bovis infection.
In a local study by Lee, all of the Streptococcus
bovis isolates were sensitive to penicillin, cephalothin and vancomycin. [1] The only
one baby that we treated with vancomycin was a 46-day-old premature infant with
central venous catheter in-situ.
Vancomycin was used in this case because the case
doctor would like to include coverage of Methicillin resistant Staphylococcus aureus

(MRSA) and coagulase negative Staphylococcus (CONS), which were common
culprits of central venous line infection in our neonatal intensive care unit.[11]
It is difficult to determine the optimal duration of antibiotic treatment in patients
with Streptococcus bovis infection. This should be based on clinical presentation,
the site of infection and the patients response to treatment.
In the 2 of our 8 cases
with confirmed Streptococcus bovis central nervous system infection, the two babies
were treated with intravenous antibiotics for 14 days and 21 days.
For the other 6
cases with only Streptococcus bovis bacteraemia, the treatment duration ranges from
7 to 14 days.
It was previously reported that the mortality rate of neonatal Streptococcus bovis
bacteraemia was over 20%, and all of the patients who died presented within the first
24 hours of life.[2] However, none of the patients in our cases series and Gerbers
12
case series,[2] died.
In addition, for the 6 out of 8 babies who were followed up in
our out-patient clinic, all of them enjoyed good health with normal development.
It
seems that the mortality of neonatal Streptococcus bovis infection was lower than
previously reported, and with suitable treatment, these patients may enjoy good health
and normal development as other children.
Conclusion
Streptococcus bovis infection, particularly bacteraemia, has been research interest of
different parties because of its association with colon cancer.[1] Today with better
understanding of the disease and the bacteria, it was found out that the picture was
much more complicated.
Streptococcus bovis is now a term used to designate
viridans group Streptococci that now form the Streptococcus bovis/ Streptococcus
equines complex, instead of a particular species of bacteria.[3]
In addition, it was
found out that in Hong Kong, Streptococcus bovis bacteraemia was associated with
biliary tract disease instead of colon cancer or infective endocarditis,[1] as
Streptococcus bovis biotype II/2 accounts for 87% of Streptococcus bovis isolates in
our locality. It is now recommended that biliary tract disease should be actively
looked for in any future case of unexplained Streptococcus bovis bacteraemia.[1]
However, in the paediatric age group, our understanding of the disease is still limited.
13
There seems to be a big variation in presentation of the disease.
This may be
explained by the difference in timing of presentation of the disease in our case series
and Gerbers one.[2]
In our case series, babies usually presented with fever and
respiratory distress, while in the other case series, babies usually presented with
gastrointestinal disturbance.
Fortunately, all of the babies survived after intravenous
antibiotics were given, and in our case series, the babies enjoyed good health and
normal development.
Mortality from the disease was lower than previously
reported.[2]
Antibiotics remain as the mainstay of treatment for Streptococcus bovis bacteraemia.
Our local data revealed that most of the isolates of the bacteria remained sensitive to
penicillin, making it a good and reasonable choice of antibiotic.[1][2] However,
penicillin resistance has been reported in the literature and this has to be considered
when empirically treating severely ill infants.[2]
Our knowledge of paediatric Streptococcus bovis infection and bacteraemia is
limited.
There seems to be a lot of variation in the presentation of the disease, and
the disease association differs from that of adult infection. As the bacteria can
cause potentially serious infection such as bacteraemia and meningitis, further
research is warranted for better understanding of the disease.
14
Reference
1. Lee RA, Woo CY, To APC, Lau KPC, Wong SSY, Yuen KY.
Geographical
difference of disease association in Streptococcus bovis bacteraemia. Journal

of Medical Microbiology (2003), 52, 903908
2. Gerber JS, Glas M, Frank G and Shah SS.
Streptococcus bovis infection in
young infants. Paediatr Infect Dis J 2006;25:1069-1073

3. Schlegel L, Grimont F, Ageron E, Grimont PA, Bouvet A.
Reappraisal of the
taxonomy of the Streptococcus bovis/ Streptococcus equines complex and

related species: description of Streptococcus gallolyticus subsp. Gallolyticus
subsp. nov., S.gallolyticus subsp. macedonius subsp. nov. and S.gallolyticus
subsp. macedonius subsp. nov. and S.gallolyticus subsp. pasteurianus subsp. nov.
Int J Syst Evol Microbiol. 2003;53:631-645.
4. Okumura A, Takahashi H, Ogawa A, Kuno K and Watanabe K.
bovis meningitis in an otherwise healthy infant.
Streptococcus
Clinical Paediatrics
2002;41:523-524.
5. Steinberg D and Naggar CZ. Streptococcus bovis endocarditis with carcinoma
of the colon. New England Journal of Medicine 297, 13541355.
6. Gold JS, Bayar S, Salem RR. Association of Streptococcus bacteraemia with
colonic neoplasia and extracolonic malignancy. Arch Surg. 2004;139:760-765.
15
7. Jolobe OMP. Special considerations apply when Streptococcus bovis is the

culprit pathogen. Am J Emerg Med February, 2010; 28(2); 253
8. Royal College of Obstetricians and Gynaecologists.
neonatal
Group
Streptococcal
disease.
Prevention of early onset

Guideline
number
36.
http://www.rcog.org.uk/files/rcog-corp/uploaded-files/GT36GroupBStrep2003.p
df Accessed 11th March 2010.
9. Kwong NS.
Prevention of Group B Early onset Perinatal Group B
Streptococcus in neonates.
Department
of
Updated guideline 2003.
Paediatrics
http://tmh.home/frm_dept.htm.
and
Adolescent
Tuen Mun Hospital

Medicine
intranet.
Accessed 11th March 2010.
10. Corredoira JC, Alonso MP, Garcia JF, Casariego E, Coira A, Rodriguez A, Pita J,
Louzao C, Pombo B, Lopez MJ and Varela J.
Clinical characteristics and
significance of Streptococcus salivarius bacteremia and Streptococcus bovis

bacteremia: a prospective 16-year study. Eur J Clin Microbiol Infect Dis (2005)
24: 250255
11. Tuen Mun Hospital Antimicrobial Sensitivity Statistics 2008 and comment.
Tuen Mun Hospital intranet.
http://tmh.home/frm_guide.htm Assessed 11th
March 2010.
16
Case
Age at
Sex Maturity
number diagnosis
Day 23
Birth
weight
32 week
and 5
days
2.25kg
38 week
and 4
days
2.6kg
Mode of
delivery
Child
received
Presentation antibiotics
before
presentation
C/S (twin,
Fever and
pre-eclampsia apnoea
in mother)
attack
Yes
Day 7
C/S (breech
presentation)
Cyanosis,
No
respiratory
distress,
septic shock
Positive
site of
culture
Treatment
Blood
and CSF;
Klebsiella
from
CSU
Ampicillin,
cefotaxime,
meropenem
for 14 days
Blood
Amikacin
and
cefotaxime
for 14 days
Echocardiogram
Outcome
No
echocardiogram
Normal
development,
defaulted
BAEP, last
seen in
September
2008
Coarctation of
aorta, decrease
left ventricle
contractility, no
signs of
infective
endocarditis
Normal
development;
last seen in
March 2010
17
Case
number
Age at
Sex Maturity Birth
diagnosis
weight
Mode of
delivery
Presentation Child
Positive
received
site of
antibiotics
culture
before
presentation
Treatment
Echocardiogram Outcome
Day 7
38 week
and 3
days
3.1kg
Spontaneous
vaginal
delivery
Fever and
irritable
No
Blood
and CSF
Penicillin,
ampicillin,
cefotaxime,
vancomycin
for 21 days
Normal
echocardiogram
Normal
growth and
development
since last
seen in 2004
Day 0
40 week
3.81kg
C/S (failed
VE)
Meconium
aspiration
No
Blood
Penicillin
and
netilmicin
for 14 days
Normal
echocardiogram
Normal
growth and
development,
last seen in
2006
Day 46
28 week
and 2
days
1.175kg C/S (severe

Tachycardia Yes
pre-eclampsia and
and breech
desaturation
presentation)
Blood
Vancomycin PDA on
for 14 days echocardiogram,
no signs of
infective
enoocarditis
Normal
growth and
development
since last
seen in 2006
18
Case
number
Age at
Sex Maturity Birth
diagnosis
weight
Mode of
delivery
Presentation Child
Positive
received
site of
antibiotics
culture
before
presentation
Treatment
Echocardiogram Outcome
Day 0
39 week
and 4
days
3.3kg
VE
(prolonged
2nd stage)
Fever
No
Blood
Penicillin
for 7 days,
netilmicin
for 5 days
No
echocardiogram
No follow up
Day 1
37 week
and 5
days
3.12kg
Spontaneous
vaginal
deliver
Fever
No
Blood
Penicllin
and
netilmicin
for 10 days
Normal
echocardiogram
Normal
development,
last seen in
2009
Day 2
40 week
2.9kg
Vacuum
extraction
Regurgitate
once after
feed
No
Blood
Penicillin
for 10 days,
netilmicin
for 5 days
No
echocardiogram
No follow up
Key to abbreviations:
M: male; F: female; C/S: Caesarean Section; VE: vacuum extraction; CSF: cerebrospinal fluid; CSU: catheterized urine;
BAEP: brainstem auditory evoked potential
Table 1: Patients infected by Streptococcus bovis
19
Case
number
Age at
diagnosis
Sex
Maternal
age
Gestational complications/ condition after delivery
Local/ Mainland
mother
Intra-partum
antibiotics given
Mainland
1 dose
Day 23
28
Severe pre-eclampsia
Perinatal pneumonia treated with continuous positive airway
pressure and antibiotics, no positive growth
Day 7
28
Fetal distress, thin meconium stained liquor
Local
No
Day 7
36
Fetal distress, delayed crying at birth
Local
No
Day 0
32
Fetal distress, thick meconium stained liquor
Local
No
Day 46
31
Severe pre-eclampsia
Local
No
Day 0
31
Vacuum extraction for prolonged second stage
Local
No
Day 1
36
Gestational impaired glucose tolerance
Local
No
Day 2
25
Fetal distress, thick meconium stained liquor

Mother had chronic hepatitis B
Local
1 dose
Table 2: Patients infected by Streptococcus bovis (gestational complications and condition at birth)
20
Case number
Age at diagnosis (in days unless otherwise specified)
Sex
Positive site of culture
Outcome
Blood, peritoneal fluid
Survived
Blood, CSF
Survived
CSF
Survived
14
Blood
Survived
31
Blood, CSF
Survived
38
Blood
Survived
43
Blood, CSF
Survived
< 24 hour
Blood
Died
< 24 hour
Blood
Survived
10
< 24 hour
Not reported
Blood, CSF, ear
Survived
11
< 24 hour
Not reported
Blood, CSF
Died
12
< 24 hour
Not reported
Blood, gastric, urine
Died
13
< 24 hour
Not reported
Blood, nasopharynx
Survived
14
Not reported
CSF
Survived
15
19
Not reported
CSF
Survived
16
Not reported
Blood
Survived
17
21
Not reported
Blood
Survived
18
Blood, CSF
Survived
19
40
Blood
Survived
20
24 hour
Blood
Died
21
Case number
Age at diagnosis (in days unless otherwise specified)
Sex
Positive site of culture
Outcome
21
7 week
CSF
Survived
22
24 hour
Blood, CSF
Survived
23
Stillborn
Lung, ear
Died
24
5 week
CSF
Survived
25
4 week
Blood, CSF
Survived
26
2 months
Blood, CSF
Survived
27
Stillborn
Blood, lung, umbilicus
Died
28
19
Blood, CSF
Survived
29
50
Blood, CSF, stool
Survived
30
Blood, CSF
Survived
Table 3: Cases of young infants infected by Streptococcus bovis and reported in the literature previously [2]
22

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Streptococcus bovis infection in infants and young children in a

Sham, Chak-on, Philip;

Creative Commons: Attribution 3.0 Hong Kong License

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

Project dissertation for the Postgraduate Diploma in

Streptococcus bovis infection in infants and young children

in a regional hospital in Hong Kong

SHAM Chak On Philip

Mun Hospital, Hong Kong

Dr. HO Pak Leung

17th April 2010

This work is submitted to

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

Streptococcus bovis infection in infants and young children

To identify the features of infants and young children infected by

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

Patients were included if they had

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

The results were

All of our patients were newborns.

All had some

complications or medical problems in the antenatal period or during labour.(Table 2)

The birth weight ranges from 1175 gram to 3870 gram.

Some babies presented with signs of respiratory illness, which included

cyanosis, tachypnoea and apnoea attack.

Only one of the babies presented with

signs of gastrointestinal illness i.e. regurgitated once after feed.

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

before disease presentation.

To date, all of them enjoyed good health with normal

In our unit, liver enzyme levels and ultrasonography of the

Serum bilirubin levels in neonates were usually affected by neonatal

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

identified 7 of such patients managed at their institutions and 23 from the

Streptococcus bovis infection is more commonly found in

In our case series, most of the babies presented early within

As in the case of Group B

Babies may acquire the infection

Penicillin or ampicillin may decrease the risk of perinatal Streptococcus bovis

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

Streptococcus bovis, a normal inhabitant of the human gut, is a Gram positive

There were 11% of

In 40% of these patients, no infective

the mechanism is unclear, malignant disruption of gastrointestinal mucosa may

Streptococcus bovis biotype II/2 accounts for 87% of

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

It was reported that there was a 94% association of Streptococcus

bovis biotype I bacteraemia with infective endocarditis and a 71% association of

In addition, there was no

There were no tenderness on abdominal

examination, no heart murmur nor signs of heart failure.

Because of these negative

physical signs, we performed ultrasonography of the liver in none of our patients.

Only one baby in our case series

Project dissertation for the Postgraduate Diploma in Infectious Diseases 2008-2010

presented with gastrointestinal disturbance (regurgitated once after feeding).

In our hospital, we follow

the guideline issued by the Royal College of Obstetricians and Gynaecologists

Although intravenous Penicillin G is the preferred choice in the

guideline, ampicillin is commonly used by our Obstetric unit because of wider

All babies delivered in our hospital will