[Antimicrobial susceptibility and serotype distribution in perinatal group B Streptococcus isolates--a 1999-2009 multicenter study].

We determined temporary changes in group B Streptococcus antimicrobial susceptibility and serotype distribution from perinatal strains. We examined invasive microbiological isolates from neonates with early-onset group B streptococcal disease (n = 14), and colonized isolates from those born uneventfully (n = 55) and from the genital tracts of pregnant and puerperal women (n = 198), collected between 1999 and 2009. All isolates were susceptible to penicillin. No significant differences were seen in susceptibility of 12 antimicrobial agents examined between invasive and colonized isolates. MIC50, MIC90, and resistance did not differ between stage I (1999-2005) and II (2006-2009) isolates. Serotype distribution significantly differed, however, serotypes III and Ia predominated among invasive isolates, while serotypes Ib and VI were common among their colonized counterparts. These findings suggest that to date, penicillin remains effective in intrapartum prophylactic use in colonized pregnant women.

Ganciclovir therapy for congenital cytomegalovirus infection in six infants.

BACKGROUND: Congenital cytomegalovirus (CMV) infection is common, and its morbidity rate is high. Ganciclovir (GCV) treatment has been used for congenital CMV infection, but there are few reports on viral loads associated with GCV therapy. METHODS: A real-time PCR assay was used to monitor viral load in 6 cases of symptomatic CMV infection that received GCV therapy. Initially GCV was given at a dose of 5-12 mg/kg/d for 2-7 weeks. In 2 cases, additional doses were given as symptoms returned. RESULTS: After GCV administration, active signs of chorioretinitis, thrombocytopenia and anemia disappeared or improved in all cases. During GCV therapy, viral loads decreased while patients improved clinically and increased again when GCV therapy was stopped. Although CMV DNA continued to be detectable for a long period, clinical findings did not always worsen. In 2 cases, an improvement of hearing loss was observed. CONCLUSION: GCV therapy transiently suppresses the CMV concentrations. Subsequent increases of viral titers do not appear to be correlated with the clinical course or neurologic outcome.

The ratio of flow velocities in the middle cerebral and internal carotid arteries for the prediction of cerebral palsy in term neonates.

OBJECTIVE: This study evaluated whether the ratio of the mean flow velocities in the middle cerebral artery (MCA) and the internal carotid artery (ICA) of neonates in the first days of life can be used to identify future neurodevelopmental disabilities. METHODS: We observed 127 term neonates without congenital malformations, chromosomal aberrations, intracranial hemorrhage, or early onset sepsis. The mean cerebral blood flow velocities were measured in the right and left ICAs and in the right and left MCAs with a Doppler flowmeter once from day 1 to day 3. The Vm ratio was defined as the mean velocity in the right and left MCAs/mean velocity in the right and left ICAs. Neurologic examinations were performed at 12 months of age in the outpatient follow-up clinic to detect cerebral palsy (CP), and the subjects were divided into 4 groups according to the diagnosis of hypoxic-ischemic encephalopathy (HIE) and neurologic prognosis: HIE- and normal neurologic function, HIE- and CP, HIE+ and normal neurologic function, and HIE+ and CP. RESULTS: The Vm ratio in infants with the HIE- diagnosis and CP was significantly lower than that in infants with the HIE- diagnosis without CP (P < .05). There was no significant difference between the Vm ratios in infants with the HIE+ diagnosis without CP and infants with the HIE+ diagnosis and CP. CONCLUSIONS: The Vm ratio might be a useful index in estimating neurologic outcome at birth, especially in neonates without the diagnosis of HIE.

Quantitation of viral load in neonatal herpes simplex virus infection and comparison between type 1 and type 2.

Neonatal herpes simplex virus (HSV) infection is a severe disease with high mortality and morbidity in spite of the development of effective anti-viral therapies. The viral load in neonatal herpes simplex virus (HSV) infection was measured retrospectively in 37 patients. HSV DNA copy numbers in serum and cerebrospinal fluid (CSF) were quantified using a real-time PCR assay. Patients with disseminated infection had a higher viral load in their sera. whereas patients with central nervous system (CNS) infection exhibited a higher viral load in the CSF. The viral load was significantly higher in the serum of patients who died later. Interestingly, patients with HSV type-2 infection exhibited more CNS involvement and neurological impairment, together with a high viral load in the CSF, than did HSV type-1 patients. These results suggest that quantitation of HSV viral load may be useful for assessing the prognosis, and may provide additional information for the management of neonatal HSV infection.

Comparison of real-time and nested PCR assays for detection of herpes simplex virus DNA.

We performed a real-time PCR assay to detect herpes simplex virus (HSV) DNA, and compared it prospectively with a nested PCR assay in 164 clinical samples (109 cerebrospinal fluid and 55 sera) from patients suspected of having neonatal HSV infection or HSV encephalitis. In 25 of 164 samples, HSV DNA was detected by the nested PCR assay. All samples positive for HSV DNA in the nested PCR assay were also positive in the real-time PCR assay, and all but two samples negative for HSV DNA in the nested assay were negative in the real-time assay. The real-time PCR assay thus had a sensitivity of 100% and a specificity of 99%, when compared with the nested assay. Sequential assays in a case of disseminated HSV showed that a decrease in HSV DNA paralleled clinical improvement. Quantification of HSV DNA by real-time PCR was useful for diagnosing and monitoring patients with HSV encephalitis and neonatal HSV infection.