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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…

Sexually Transmitted Infections

Introduction Sexually transmitted infections (STIs) contribute to the majority of reportable communicable diseases worldwide. More than a million STIs are acquired every day worldwide, with an estimated 357 million new infections annually with gonorrhea, chlamydia, syphilis, or trichomoniasis. Furthermore, there are emerging STIs such as Mycoplasma genitalium and viral STIs such as genital herpes that are highly prevalent on a global scale. The growing threat of…

Sepsis

Introduction Sepsis is among the oldest medical conditions described, yet remains a leading cause of death. The Centers for Disease Control and Prevention estimate that 1.5 million people in the United States are affected each year, with a resulting 250,000 American deaths annually. For many, if not most, hospitals, sepsis is the main cause of mortality, and in a 2016 report contributed to $24 billion in…

Vector-Borne Infections

Introduction Vector-borne infections include diseases caused by diverse pathogens (bacteria, viruses, parasites) that are transmitted to humans by a variety of vectors such as ticks, mosquitoes, lice, tsetse flies, sandflies, triatome bugs, blackflies, mites, and snails. Vectors are typically blood-sucking insects that ingest the pathogen from an infected host reservoir (human, animal, bird) and then transmit them to a susceptible human during their next bloody meal.…

Diagnostic Approach to a Patient with Suspected Central Nervous System Infection

A diagnostic hypothesis for a suspected central nervous system (CNS) infection has two components: an anatomic and a microbiologic or etiologic diagnosis. The anatomic diagnosis localizes the inflammation to a specific part of the CNS. The microbiologic or etiologic diagnosis identifies the pathogen or etiology that is causing the CNS inflammation. An accurate anatomic and microbiologic hypothesis requires a detailed history (including symptoms, duration, exposure, and…

Bone and Joint Infections

Infectious Arthritis Infectious arthritis is defined as infection of one or more joints. It can be caused by bacteria, fungi, viruses, and parasites. Acute Bacterial Arthritis Introduction Native joint septic arthritis is an uncommon illness, with a reported incidence in the United States of 2 to 10 cases per 100,000 persons per year. However, the incidence appears to be rising, in part due to an increasing…

Skin and Soft Tissue Infections

Introduction Skin and soft tissue infections (SSTIs) are among the most commonly occurring bacterial infections, and their frequency approaches 10% of hospital admissions for infections in the United States. Many factors contribute to the increase in awareness of SSTIs: the aging of the general population, the growing number of critically ill or immunocompromised patients, and the emergence of multidrug-resistant (MDR) pathogens are commonly considered the main…