Elsevier

Legal Medicine

Volume 15, Issue 5, September 2013, Pages 260-263
Legal Medicine

Case Report
Sudden unexpected neonatal death due to late onset group B streptococcal sepsis—A case report

https://doi.org/10.1016/j.legalmed.2013.02.002Get rights and content

Abstract

We report a case of sudden unexpected death due to late onset neonatal group B streptococcal sepsis. A male neonate weighing 2731 g was born at 35 week gestational age, and discharged at the age of 4 days after the birth. At 6 days after the discharge (10 days after the birth), because of consciousness loss and hypothermia, the neonate was conveyed to an emergency hospital, eventually followed by his death. Forensic autopsy revealed neither severe trauma nor cardiac anomaly. Both lungs were edematous. Histopathologically, a lot of bacterial clusters were found in the lungs and intracerebral vessels. Cerebrospinal fluid contained a lot of leukocytes. Streptococcus agalactiae was detected in the specimens from the feces and the blood. Collectively, we diagnosed that the cause of the neonate’s death was late onset group B streptococcal sepsis. In autopsy cases of neonates, careful macroscopic and microscopic observations and bacteriological/virological examination should be performed.

Introduction

Sudden unexpected infant/neonate death is one of the most important matters in both forensic medicine and pediatrics [1]. It is needless to say that forensic autopsy is essential in order to make differentiation between internal death and external death and to clarify the cause of death in neonates and infants. Especially, infectious diseases should be taken into consideration in autopsy cases of neonates and infants [1]. Group B Streptococcus (GBS) is the leading cause of infectious illness among newborns. Invasive infections in neonates can result in pneumonia, sepsis, or meningitis [2], [3], [4]. To the best of knowledge, there are no reports about GBS-related infectious diseases in the field of forensic pathology. Herewith, we report a case of sudden unexpected neonatal death due to late onset group B streptococcal sepsis.

Section snippets

Case history

A male neonate was born to a healthy 30’s-year-old mother at 35 weeks of the gestation. There were no serious problems such as lots of hemorrhage during the delivery. The neonate weighed 2731 g, and newborn Apgar scores were 10 at both 1 and 5 min after the birth. The neonate was discharged from the hospital at 4 days after the birth. At 6 days after the discharge (10 days after the birth), the neonate was found on his bed in a dorsal position by his family at 06:00 AM, and the family noticed that

Discussion

This case was categorized as sudden unexpected neonatal death. Upon hospitalized, DIC was clinically suspected with the reduction of WBC number and normal CRP level. Forensic autopsy and histopathological findings indicated the presence of severe infectious disease such as meningitis and pneumonia in the neonate. Moreover, based on the bacteriological and CSF examination, the cause of his death was diagnosed as group B streptococcal sepsis complicated with meningitis. In neonatal sepsis,

Declaration

There is no conflict of interests.

Acknowledgments

We sincerely thank Drs. Hironao Yasuoka and Yasushi Nakamura (Department of Clinical Laboratory Medicine, Wakayama Medical University) for their technical assistance of Gram staining.

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