GBS Meningitis

GBS MENINGITIS 1

CLASSIFICATION BY AGE AT ONSET 1

1. EARLY-ONSET GBS 1
2. LATE-ONSET GBS 1
3. LATE-LATE ONSET GBS OR GBS BEYOND EARLY INFANCY 2
INVESTIGATIONS 2
O LUMBAR PUNCTURE 2
DIAGNOSIS 2
MANAGEMENT 2
O SUPPORTIVE CARE 2
O ANTIBIOTICS 2

Classification by age at onset

1. Early-onset GBS
▪ Onset: 24hrs to 6 days
▪ 90% of clinical signs present in the first 24hrs
▪ Presentation:
Sepsis o Non-specific signs: Irritable, Lethargic ± Febrile
80 - 85% o Associated w/ Persistent Pulmonary HTN of the newborn

Pneumonia o Signs: Tachypnea, grunting, hypoxia & increased work of

10% breathing
o Radiographic Findings: diffuse alveolar pattern
o ± Pleural effusion

Meningitis o Nonspecific signs

7% o Rarely presents w/ signs of CNS inflammation

2. Late-onset GBS
▪ Onset: 7 days until 3 months
▪ Presentation

Bacteremia o Nonspecific focus of infection

65% o Fever ≥38degC
o Non-specific signs: Irritable, Lethargic ± URTI symptoms

Meningitis o Spectrum of severity

o Signs of meningitis: bulging fontanelle & neurological findings

Done by: Norah AlRohaimi (Pediatric Resident - NGH)

Source: UptoDate + Pediatrics in Review
 Others Septic Arthritis o Acute presentation
o Lower extremities
Osteomyelitis o Insidious onset
o MC Site: Humerus
o Mean onset: 31 days
Cellulitis- o Facial cellulitis, submandibular cellulitis, or
Adenitis cellulitis-adenitis

3. Late-Late Onset GBS or GBS beyond early infancy

o Onset: over 3 months of age
o Most Common in:
▪ Infants born before 28 weeks
▪ Infants with immunodeficiency
o Manifestation: bacteremia without a focus

Investigations
o Complete blood count (CBC) with differential
o Blood Culture + Urine Culture
o Lumbar Puncture
o Should be performed before the institution of antibiotic therapy, unless the infant is
clinically unstable, then priority is to save the patient rather than the LP
o Elevated WBC count and protein
o Decrease in glucose

Diagnosis Isolation of Group B Streptococcus (GBS) from a culture

Management
o Supportive Care
o Ventilatory support
o Adequate hydration
o Management of any electrolyte imbalance
o Treatment of anemia
o Effective seizure control if the patient develops seizures
o Antibiotics: Ampicillin + Vancomycin

Done by: Norah AlRohaimi (Pediatric Resident - NGH)

Source: UptoDate + Pediatrics in Review
Done by: Norah AlRohaimi (Pediatric Resident - NGH)
Source: UptoDate + Pediatrics in Review