1.Group B streptococcus infection in a sudden unexpected death of infancy – the importance of microbiological investigation at post-mortem
Khalid, N ; Zainun, K.A ; Hisham, S ; Mazan, N.I ; Amin Nordin, S
Tropical Biomedicine 2018;35(3):604-609
Group B streptococcus (GBS) is a common cause of infection in newborns and in
early infants. However, GBS infection in an infant older than three months is infrequently
reported in the literature. We reported a case of an apparently well six-month-old infant who
died of sudden death due to GBS pneumonia, diagnosed at autopsy. The six-month-old,
apparently well male infant was brought in dead to the Emergency Department. He underwent
medicolegal autopsy four hours after death, as part of an overall sudden unexpected death in
infancy investigation (SUDI). Apart from whitish froth oozing out of both nostrils, he appeared
to be well-nourished infant without any deformity, syndromic features or obvious suspicious
marks of injury externally. Internal examination showed generalized hyperinflated with patchy
consolidation of upper and middle lobes of bilateral lung. Multiple matted mesenteric
lymphadenopathy were also detected. Blood and lung tissue specimens collected under
aseptic technique yielded growth of GBS. Post-mortem histology from consolidated lungs
confirmed pneumonic features while mesenteric lymph nodes showed reactive changes inkeeping with underlying infective process. Death was attributed to GBS pneumonia. This
case highlights the importance of a detailed autopsy in sudden unexpected death in infancy
(SUDI) and the crucial role of post-mortem microbiological study in such cases. Relevant
autopsy protocols that need to be employed during microbiological sampling are briefly
discussed.