Browse > Article
http://dx.doi.org/10.3345/kjp.2018.61.8.245

Patterns of ischemic injury on brain images in neonatal group B Streptococcal meningitis  

Choi, Seo Yeol (Department of Pediatrics, Dankook University College of Medicine)
Kim, Jong-Wan (Institute of Tissue Regeneration Engineering (ITREN), Dankook University)
Ko, Ji Won (Department of Pediatrics, Dankook University College of Medicine)
Lee, Young Seok (Department of Radiology, Dankook University College of Medicine)
Chang, Young Pyo (Department of Pediatrics, Dankook University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.61, no.8, 2018 , pp. 245-252 More about this Journal
Abstract
Purpose: This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis. Methods: Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed. Results: GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy. Conclusion: Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.
Keywords
Neonate; Streptococcus agalactiae; Meningitis; Brain ischemia; Magnetic resonance imaging;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Chu SM, Hsu JF, Lee CW, Lien R, Huang HR, Chiang MC, et al. Neurological complications after neonatal bacteremia: the clinical characteristics, risk factors, and outcomes. PLoS One 2014;9:e105294.   DOI
2 Heath PT, Nik Yusoff NK, Baker CJ. Neonatal meningitis. Arch Dis Child Fetal Neonatal Ed 2003;88:F173-8.   DOI
3 Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol 2015;42:29-45   DOI
4 Mahajan R, Lodha A, Anand R, Patwari AK, Anand VK, Garg DP. Cranial sonography in bacterial meningitis. Indian Pediatr 1995;32:989-93.
5 Raju VS, Rao MN, Rao VS. Cranial sonography in pyogenic meningi- tis in neonates and infants. J Trop Pediatr 1995;41:68-73.   DOI
6 Soni JP, Gupta BD, Soni M, Gupta M, Dabi DR, Nemal KR. Cranial ultrasonic assessment of infants with acute bacterial meningitis. Indian Pediatr 1994;31:1337-43.
7 Kim HJ, Kim SY, Seo WH, Choi BM, Yoo Y, Lee KH, et al. Outbreak of late-onset group B streptococcal infections in healthy newborn infants after discharge from a maternity hospital: a case report. J Korean Med Sci 2006;21:347-50.   DOI
8 Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, et al. Group B streptococcus late-onset disease: 2003-2010. Pediatrics 2013;131:e361-8.   DOI
9 Cheong J, Byun SY, Kim MJ. Group B streptococcal meningitis in neonate: 2001-2011. Korean J Perinatol 2013;24:142-7.   DOI
10 Lee SY, You SJ, Kim DS, Ko TS. Clinical study of group B beta- Hemolytic streptococcal meningitis. J Korean Pediatr Soc 2003;46:1224-9.
11 Yikilmaz A, Taylor GA. Sonographic findings in bacterial meningitis in neonates and young infants. Pediatr Radiol 2008;38:129-37.   DOI
12 Briand C, Levy C, Baumie F, Joao L, Béchet S, Carbonnelle E, et al. Outcomes of bacterial meningitis in children. Med Mal Infect 2016; 46:177-87.   DOI
13 Bodilsen J, Dalager-Pedersen M, Schonheyder HC, Nielsen H. Stroke in community-acquired bacterial meningitis: a Danish populationbased study. Int J Infect Dis 2014;20:18-22.   DOI
14 Chang CJ, Chang WN, Huang LT, Chang YC, Huang SC, Hung PL, et al. Cerebral infarction in perinatal and childhood bacterial meningitis. QJM 2003;96:755-62.   DOI
15 Takeoka M, Takahashi T. Infectious and inflammatory disorders of the circulatory system and stroke in childhood. Curr Opin Neurol 2002; 15:159-64.   DOI
16 Chatue Kamga HB. Neuroimaging complication of neonatal meningitis in full-term and near-term newborns: a retrospective study of one center. Glob Pediatr Health 2016;3:2333794X16681673.
17 Lee BK, Song YR, Kim MY, Yang JH, Shin JH, Seo YS, et al. Epidemiology of group B streptococcus in Korean pregnant women. Epidemiol Infect 2010;138:292-8.   DOI
18 Arrumugham R, Katariya S, Singhi P, Singhi S, Suri S, Walia BN. Sonography in pyogenic meningitis. Indian Pediatr 1994;31:1329-36.
19 Abels L, Lequin M, Govaert P. Sonographic templates of newborn perforator stroke. Pediatr Radiol 2006;36:663-9.   DOI
20 Roelants-van Rijn AM, Groenendaal F, Beek FJ, Eken P, van Haastert IC, de Vries LS. Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome. Neuropediatrics 2001;32:80-9.   DOI
21 Choi KU, Koh SK, Lee JY, Park JH, Hwang SO, Lee BI, et al. Clinical significance of group B streptococcal infection in pregnant women. Korean J Obstet Gynecol 2002;45:811-5.
22 Madhi SA, Dangor Z, Heath PT, Schrag S, Izu A, Sobanjo-Ter Meulen A, et al. Considerations for a phase-III trial to evaluate a group B Streptococcus polysaccharide-protein conjugate vaccine in pregnant women for the prevention of early- and late-onset invasive disease in young-infants. Vaccine 2013;31 Suppl 4:D52-7.   DOI
23 Tibussek D, Sinclair A, Yau I, Teatero S, Fittipaldi N, Richardson SE, et al. Late-onset group B streptococcal meningitis has cerebrovascular complications. J Pediatr 2015;166:1187-92.   DOI
24 Hernández MI, Sandoval CC, Tapia JL, Mesa T, Escobar R, Huete I, et al. Stroke patterns in neonatal group B streptococcal meningitis. Pediatr Neurol 2011;44:282-8.   DOI
25 Katchanov J, Heuschmann PU, Endres M, Weber JR. Cerebral infarction in bacterial meningitis: predictive factors and outcome. J Neurol 2010;257:716-20.   DOI
26 Snyder RD, Stovring J, Cushing AH, Davis LE, Hardy TL. Cerebral infarction in childhood bacterial meningitis. J Neurol Neurosurg Psychiatry 1981;44:581-5.   DOI
27 May M, Daley AJ, Donath S, Isaacs D; Australasian Study group for neonatal infections. Early onset neonatal meningitis in Australia and New Zealand, 1992-2002. Arch Dis Child Fetal Neonatal Ed 2005; 90:F324-7.   DOI
28 Synnott MB, Morse DL, Hall SM. Neonatal meningitis in England and Wales: a review of routine national data. Arch Dis Child 1994;71:F75-80.   DOI
29 Mineyko A, Kirton A. Mechanisms of pediatric cerebral arteriopathy: an inflammatory debate. Pediatr Neurol 2013;48:14-23.   DOI
30 Amayo EO, Kayima JK, Joshi MD. Platelet functions in patients with meningococcal meningitis at the Kenyatta National Hospital, Nairobi. East Afr Med J 2002;79:405-7
31 Rademaker KJ, Uiterwaal CS, Beek FJ, van Haastert IC, Lieftink AF, Groenendaal F, et al. Neonatal cranial ultrasound versus MRI and neurodevelopmental outcome at school age in children born preterm. Arch Dis Child Fetal Neonatal Ed 2005;90:F489-93.   DOI
32 Han BK, Babcock DS, McAdams L. Bacterial meningitis in infants: sonographic findings. Radiology 1985;154:645-50.   DOI
33 Gupta N, Grover H, Bansal I, Hooda K, Sapire JM, Anand R, et al. Neonatal cranial sonography: ultrasound findings in neonatal meningitis-a pictorial review. Quant Imaging Med Surg 2017;7:123-31.   DOI