Late-onset infant Group B Streptococcus infection

Status: 
Ready to upload
Record number: 
1801
Adverse Occurrence type: 
Estimated frequency: 
Unknown; ingestion of placenta is not common
Time to detection: 
16 days after birth which was only 5 days after completion of 11-day treatment for early-onset GBS bacteremia.
Alerting signals, symptoms, evidence of occurrence: 
Irritability; re-admission to a second hospital only 16 days after birth. A blood culture yielded penicillin-sensitive, clindamycin-sensitive group B Streptococcus agalactiae (GBS).
Demonstration of imputability or root cause: 
Shortly after birth, the infant developed signs of respiratory distress and was transferred to the neonatal intensive care unit where blood and cerebrospinal fluid (CSF) were obtained for culture; antibiotics were initiated for presumed sepsis. The blood culture was positive for penicillin-sensitive, clindamycin-intermediate GBS. CSF culture was negative. The infant was discharged and went home after completing an 11-day course of ampicillin (200 mg/kg/day). Five days later, the infant was taken to the emergency department because of irritability and was admitted to a second hospital. A blood culture yielded penicillin-sensitive, clindamycin-sensitive GBS. CSF was sterile, expressed breast milk did not yield GBS, and serial exams did not reveal a source. It was discovered that three days after the infant’s birth, the mother had received the baby's dehydrated, encapsulated placenta and began ingesting two capsules three times daily. A sample of the capsules was cultured, yielding penicillin-sensitive, clindamycin-sensitive group B Streptococcus agalactiae (GBS). The three GBS isolates (one from each blood infection, and one from the placenta capsules) were indistinguishable by pulsed-field gel electrophoresis. In addition, the processing of the placenta to make capsules included dehydration at 115°F–160°F (46°C–71°C) which might not have been sufficient to decrease GBS bacterial counts.
Imputability grade: 
3 Definite/Certain/Proven
Groups audience: 
Suggest references: 
1. Genevieve L. Buser, et al. Late-Onset Infant Group B Streptococcus Infection Associated with Maternal Consumption of Capsules Containing Dehydrated Placenta — Oregon, 2016 https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6625.pdf 2. Marraccini ME, Gorman KS. Exploring placentophagy in humans: problems and recommendations. J Midwifery Womens Health, 2015;60:371–9. https://doi.org/10.1111/jmwh.12309 3. Hayes EH. Consumption of the placenta in the postpartum period. J Obstet Gynecol Neonatal Nurs 2016;45:78–89. https://doi.org/10.1016/j. jogn.2015.10.008
Expert comments for publication: 
Clinicians should inquire about a history of placenta ingestion in cases of late-onset GBS infection in an infant and educate mothers interested in placenta encapsulation about the potential risks. No standards or regulations exist for processing placenta for consumption. The placenta encapsulation process does not per se eradicate infectious pathogens; thus, placenta capsule ingestion should be avoided.