Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Tuberculosis

Mycobacterium tuberculosis (Mtb) may spread by aerosol when an adult with pulmonary tuberculosis (TB) coughs. Ninety percent of newly infected adults never develop disease; in the other 10%, TB most commonly manifests as lung disease. Infants and young children appear to have a 5- to 10-fold increased risk of progressing to TB disease after infection, compared with adults The young could be viewed as epidemiologic sentinels…

Borrelia Infections: Lyme Disease and Relapsing Fever

Lyme Disease Lyme disease, caused by the spirochete Borrelia burgdorferi, is the most common vector-borne illness in the United States. Although, in retrospect, a form of the illness had been recognized in Scandinavia in the early 1900s, modern awareness of Lyme disease began in the mid-1970s after a group of parents living on one small street reported a cluster of cases of “juvenile rheumatoid arthritis” in…

Syphilis

Syphilis is a sexually transmitted disease caused by infection with the bacterium Treponema pallidum . Congenital syphilis results when the infection is transmitted from a pregnant mother to her fetus. Syphilis has been known for a long time to cause serious infections in the newborn of an infected mother. The horror syphilis causes is best encapsulated in its other old name “lues,” which means “plague” in…

Gonococcal Infections

Infections of the fetus and newborn infant caused by Neisseria gonorrhoeae are restricted primarily to mucosal surfaces of the newborn infant, although scalp abscess and systemic infections, including bacteremia, meningitis, and septic arthritis, can occasionally occur. The most common condition related to infection by this organism during the neonatal period is ophthalmia neonatorum, or neonatal conjunctivitis. N. gonorrhoeae produces purulent conjunctivitis in the newborn, which may…

Staphylococcal Infections

Acknowledgment The authors are indebted to Rachel C. Orscheln, Henry R. Shinefield, and Joseph W. St. Geme III, whose previous contributions to this chapter and clinical images provided the strong baseline framework and inspiration for the current version. Staphylococcal disease has been recognized in neonates for centuries and reported at least as early as 1773, when pemphigus neonatorum was described. Outbreaks of staphylococcal disease in nurseries…

Listeriosis

Listeria monocytogenes is a serious and sometimes lethal pathogen, especially for pregnant women and their fetuses, the newborn, and for older adults and immunocompromised individuals. The pathogen was first described in 1926 by Murray and colleagues during an investigation of an epizootic outbreak of infection in laboratory rabbit and guinea pigs. Human disease caused by L. monocytogenes was identified in 1929 by Nyfeldt. The present name…

Group B Streptococcal Infections

Lancefield group B β-hemolytic streptococci were first recorded as a cause of human infection in 1938, when Fry described three patients with fatal puerperal sepsis. Sporadic cases were reported until the 1970s, when a dramatic increase in the incidence of septicemia and meningitis in neonates caused by group B streptococci (GBS) was documented from geographically diverse regions. Emergence of GBS infections in neonates was accompanied by…

Microorganisms Responsible for Neonatal Diarrhea

Diarrheal disease continues to be a significant cause of morbidity and mortality in children worldwide in the 21st century. The World Health Organization (WHO) estimates about 2 billion cases and 1.9 million deaths yearly by acute diarrhea in children younger than 5 years. Most of these cases occur in infants from developing countries, mainly in Africa and Southeast Asia. These estimates are a decrease from the…

Focal Bacterial Infections

Infections of the Liver Bacterial infection of the hepatic parenchyma frequently is recognized as multiple, small inflammatory foci (hepatic microabscesses) observed as an incidental finding in infants dying with sepsis. Diffuse hepatocellular damage, often in conjunction with infection of several organ systems, may be present after transplacental passage of microorganisms to the fetal circulation. Liver involvement rarely may take the form of a solitary purulent abscess.…

Bacterial Infections of the Urinary Tract

In 1918, Helmholz recognized the cryptogenic nature and underdiagnosis of urinary tract infection (UTI) in the newborn. His observations still hold true today. There are no specific signs of UTI in a newborn; the clinical presentation can vary, ranging from fever with or without other signs of septicemia to minimal changes such as alteration in feeding habits or poor weight gain. The diagnosis of UTI in…

Bacterial Infections of the Bones and Joints

Osteomyelitis Osteomyelitis occurring in the first 2 months of life is uncommon. During the worldwide pandemic of staphylococcal disease from the early 1950s to the early 1960s, pediatric centers in Europe, Australia, and North America reported the infrequent occurrence of neonatal osteomyelitis, accounting for only one or two admissions per year at each institution. An overall incidence of neonatal osteomyelitis has been reported as 1 in…

Bacterial Infections of the Respiratory Tract

Infections of the Oral Cavity and Nasopharynx Pharyngitis, Retropharyngeal Cellulitis, and Retropharyngeal Abscess Neonates with bacterial infection of the oropharynx may present with pharyngeal inflammation with or without exudate or with retropharyngeal cellulitis or abscess. Clinical signs and symptoms include respiratory distress, poor feeding, and irritability. Infants can have submandibular swelling, and some may have a weak or hoarse cry. Infection may extend to the surrounding structures,…

Bacterial Sepsis and Meningitis

Acknowledgment Drs. S. Michael Marcy, Carol Baker and Debra L. Palazzi contributed to this chapter in earlier editions. The authors are indebted to these scholars for their roles in the preparation of this chapter. Bacterial sepsis in the neonate is a clinical syndrome characterized by systemic signs of infection and accompanied by bacteremia in the first month of life. Meningitis in the neonate usually is a…

Human Milk

Mother’s milk delivered naturally through breastfeeding has been the sole source of infant nutrition in mammalian species for millions of years. Since human beings learned to domesticate cattle about 10,000 years ago, nonhuman mammalian milk also has been used to supplement or replace maternal milk in the human infant. The development and widespread use of commercially prepared infant formula products have been phenomena of the 20th…

Developmental Immunology and Role of Host Defenses in Fetal and Neonatal Susceptibility to Infection

The human fetus and neonate are unduly susceptible to infection with a wide variety of microbes, many of which are not pathogenic in more mature individuals. This susceptibility results from limitations of both innate and adaptive (antigen-specific) immunity and their interactions. This chapter focuses on the ontogeny of the immune system in the fetus, neonate, and young infant and the relationship between limitations in immune function…

Obstetric Factors Associated with Infections of the Fetus and Newborn Infant

Overview Obstetric infections remain an important and potentially preventable contributor to maternal and neonatal morbidity and mortality. Intraamniotic infection (IAI) is associated with 20% of all preterm births (PTBs) and 50% of extreme PTBs at 28 weeks of gestation or less. PTB, defined as birth at less than 37 completed weeks of gestation, is one of the leading causes of adverse outcomes of pregnancy. In the…

Neonatal Infections: A Global Perspective

Acknowledgment The authors are grateful to Dr. Danyal Thaver for excellent assistance with article references and editing of this chapter. Among the greatest challenges in global public health are to eliminate the gaps between high- and low-income countries in health care resources, provide access to preventive and curative services, and improve health outcomes. Although child and infant mortality burden has declined substantially in recent decades, neonatal…

Current Concepts of Infections of the Fetus and Newborn Infant

Overview Current concepts of pathogenesis, microbiology, diagnosis, and management of infections of the fetus and newborn are reviewed in this chapter with the goal of providing a brief synthesis and overview. Information within this chapter regarding specific infections or syndromes is illustrative only. Detailed discussions are provided in the subsequent sections, to which the reader should refer to gain the more comprehensive knowledge needed to properly…

Bacteremia

What Is Bacteremia? Human blood is supposed to be a sterile environment. Bacteremia is defined as the presence and detection of bacteria in blood. The body has several defense mechanisms against this, mainly barrier and immunologic defenses. There are several ways in which bacteria can enter the bloodstream. Bacteria can compromise the internal mucosal barrier of the body when the integrity of the gastrointestinal tract is…

HIV Infection

Introduction Human immunodeficiency virus (HIV) infection in the United States has evolved over the past three decades from an untreatable illness that predictably led to death to a chronic disease that can be medically managed, with life expectancy for many patients similar to that for the general population. Most patients who take combination antiretroviral therapy (ART) experience immune reconstitution and resume normal lives. Natural History of…