A 21-day-old black male infant presented with a fever up to 38.5°C, chest rejection and respiratory catarrhal manifestations.
History of pregnancy and delivery -occurring at 39 weeks of gestation- were normal; Apgar score was 9-9 and weighed 2,880 g at birth.
She was discharged from the hospital with exclusive breastfeeding.
Physical examination at admission showed good vitality and color, weighed 3,580 g, had low serous rhinorrhea and no other significant findings.
The evaluation for sepsis research established: leukocytes of 8,500/mm3 (PMN 68%), ESR 26 mm/h, normal urine test, cytochemical examination of the cerebrospinal fluid with 6 leukocytes/mm3, pleuro-dl chest protein 26 mg.
Due to her good clinical conditions and laboratory tests within normal ranges, she was admitted without antimicrobial treatment.
On the second day, the fever reappeared up to 38.0 °C and a positive result was reported in the urocultive, late vomiting (7 mg/kg) and a Serratia sp/day was identified.
CSF culture was negative.
Between the third and the third day, her clinical condition, complained of rejection of breastfeeding, adynamia and hyporeflexia, drowsiness with irritability, tachycardia with distal hypofection, vomiting, tissue seizures,
Reassessed with laboratory tests, the following were found: leukocytes 12,300/mm3 (PMN 34% with presence of metabolic granulomas), HSV 16 mm/h, platelets 110,000/mm3, normal chest X-ray findings of acidosis.
The patient was supported with intensive care: volume replacement, inotropic, mechanical ventilation, immunomodulators (immunoglobulin IV and corticosteroids) and received fenobarbital.
Penicillin G sodium (200,000 U/kg/day) ev was indicated as a result of the positive admission blood culture to S. pyogenes.
Forty-eight hours after starting antimicrobial treatment, the lumbar puncture was repeated and the cytochemical examination of the CSF was reported 47 leukocytes/mm3, second culture of cerebrospinal fluid CSF/mm3, protein 87 mg/dl.
In the following days, the patient presented progressive clinical deterioration with the appearance of seizures, thus increasing the dose of anticonvulsants, fell into deep coma, with mydriasis and b pupillary response.
Cerebral ultrasound showed periventricular and intraventricular hemorrhage.
Treatment for intracranial hypertension was initiated and initial antimicrobials were changed by ceftriaxone (130 mg/kg/day) ev.
However, the newborn died.
The necropsy showed signs of meningitis with hemorrhages and severe brain damage, signs of septic shock and lungs compatible with adult respiratory distress syndrome.
