title: Recurrent sepsis and neuroinvasive disease in a neonate culture-positive for a Group B Streptococcus CPS III serotype,hvgA+ strain.
abstract: BACKGROUND
  Late-onset disease with Group B Streptococcus (GBS LOD) remains a significant problem in neonates. Unlike early-onset disease, rates of GBS LOD have not changed with prenatal testing. Effects of GBS LOD can be severe and thus identifying risk factors for severe GBS LOD, such as hypervirulence genes, may help in managing these infants.
  
  
  METHODS
  We present a case of a neonate with capsular serotype III GBS sepsis without meningitis that recurred 6 days after a 10-day-treatment period with IV ampicillin. The second episode was characterized by sepsis, neuroinvasion, meningitis and subsequent profound encephalomalacia. The short duration between the two episodes suggested recrudescence rather than reinfection. The GBS isolate was ultimately found to be positive for hypervirulence genehvgA+, which encodes for a protein known to mediate meningeal tropism and neuroinvasion.
  
  
  CONCLUSIONS
  hvgApositivity may thus potentially serve as an important biomarker for severe and neuroinvasive GBS LOD that can influence treatment decisions.
authors.affiliation: University of Alberta , Edmonton , Canada.
authors.forename: Sneha
authors.initials: S
authors.lastname: Suresh
authors.affiliation: University of Alberta , Edmonton , Canada.
authors.forename: Gregory
authors.initials: G
authors.lastname: Tyrrell
authors.affiliation: University of Alberta , Edmonton , Canada.
authors.forename: Areej
authors.initials: A
authors.lastname: Alhhazmi
authors.affiliation: University of Alberta , Edmonton , Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Escoredo
authors.affiliation: University of Alberta , Edmonton , Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Hawkes
keywords: GBS; HvgA protein; meningitis; neonate; recurrence