Pneumococcal sepsis in the newborn--an emerging problem?

There has been increasing global interest in Streptococcus pneumoniae in recent years because of the emergence of penicillin resistance in this organism. Although the most common manifestation of the organism is with respiratory infection, it can cause meningitis and septicemia3 Pneumococcal sepsis in the newborn period is however rare and only sporadic cases have been described from several centers in the literature. Several of these reports have also highlighted the virulence and high mortality associated with the infection. Geelen et al in a comprehensive review of 43 newborns with Pneumococcal sepsis reported between 1972 and 1990, found an overall mortality of 50-60% and a similarity of the infection in several respects to early onset group B streptococcal (GBS) sepsis.In contrast to western literature, GBS is an unusual pathogen in the developing world. On the other hand, Streptococcus pneumoniae is ubiquitous in developing countries and although neonatal pneumoniae with this organism hasbeendescribed, ithasvery rarely beenreported asacause of neonatal sepsis. As a part of a larger study of neonatal sepsis, we have pmspectively monitored the spectrum of newborn infections presenting to the AKUMC in Karachi since 1989. Of a total of 303 consecutive cases of culture-proven neontal sepsis, infection with Streptococcus pneumoniae was documented in four cases.