Late-onset infant Group B Streptococcus infection

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.