Atypical form of early neonatal infection with Salmonella enterica: case report with literature review

Salmonella are rarely responsible for neonatal or perinatal infection. An annual incidence of 75/100000 births are reported in the USA. The authors present a case of a newborn with neonatal salmonellosis in the context of maternal infection in the days preceding the birth, documented retrospectively. This is a case of a 38-week male infant born via spontaneous vaginal delivery. There was a premature rupture of the membranes (13 hours). The mother gave a history of fever and diarrhea of ten days prior to delivery. She had fever of 38.3°C during labor. Prophylactic antibiotic treatment with amoxicillin was established. Thirty-two hours after birth, the baby developed fever, lethargy, and was not accepting feeds. On admission, physical examination showed fever, tachycardia, correct blood pressure and isolated jaundice. The blood count found a leukopenia, a thrombocytopenia, a CRP at 35mg/l. Parenteral antibiotic therapy with cefotaxime and amikacin was started. Apyrexia is obtained after 48 hours of intravenous treatment. Stool culture of the newborn grew after 48 hours and for the mother after 3 days. The germ identified was Salmonella enterica Serovar 4,5,12:i:-. Blood cultures were performed on the mothers and the baby, but the cultures were negative. The baby responded and was discharged on the 15th day of delivery. The mother’s condition was complicated by a Guillan Barré syndrome that required a transfer to neurology. Neonatal salmonellosis may have non-specific clinical symptoms. Management is based on early antibiotic therapy with a third-generation cephalosporin as first-line therapy. The measure in preventing the spread of infection in the neonatology is essential to avoid secondary cases

Materno-fetal outcomes in pre eclampsia in a rural hospital of Antananarivo Madagascar

Background: Pre-eclampsia is a human-pregnancy-specific disease defined as the occurrence of hypertension and significant proteinuria in a previously healthy woman on or after the 20th week of gestation. It is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The aim of this study is to determine the prevalence of pre-eclampsia and to evaluate its maternal and fetal outcomes in a rural area.Methods: This is a cross-sectional study carried out at the Bejofo Mahitsy hospital. It is a District Hospital Referral Center, which is located on the outskirts of the capital, 32 km from Antananarivo, Madagascar. This work was carried out during 24 months, from January 2014 to December 2016. We have included all hospitalized pregnant patients with SBP ≥140 or DBP ≥90mmHg, significant proteinuria> 300mg/24H with or without edema.Results: During this period, we recorded 97 cases of pre-eclampsia, frequency of 1.68%. The mean age of the parturient was 28 years old and 46.39% of the patients were primiparous. At the admission to the hospital, 37 (38,14%) did not show any particular signs. Concerning the severe high blood pressure, 47 pregnant patients (48,46%) had SBP greater than 160 mm Hg and 26 womens (26,80%) had DBP greater than 110 mm Hg. Caesarean section was the method of delivery widely adopted in 74.22 %. Maternal morbidity was represented by eclampsia in 21.65%, Retroplacentary Hematoma in 3% and HELLP syndrome in 4.12%. Fetal morbidity was important with 35% of premature newborns, 25.77% was small for gestational age and 12.37% was with neonatal asphyxia. Intra uterine fetal mortality was found in 11.34% and the perinatal mortality rate was 8.73%.Conclusions: There is a high frequency of pre-eclampsia in our setting and the consequences of pre-eclampsia for neonatal mortality and morbidity outcome are alarmingly high pre-eclampsia. Prevention necessarily involves quality prenatal follow-up such as screening, early and appropriate care of hypertension during pregnancy

Atypical form of early neonatal infection with Salmonella enterica: case report with literature review

Salmonella are rarely responsible for neonatal or perinatal infection. An annual incidence of 75/100000 births are reported in the USA. The authors present a case of a newborn with neonatal salmonellosis in the context of maternal infection in the days preceding the birth, documented retrospectively. This is a case of a 38-week male infant born via spontaneous vaginal delivery. There was a premature rupture of the membranes (13 hours). The mother gave a history of fever and diarrhea of ten days prior to delivery. She had fever of 38.3°C during labor. Prophylactic antibiotic treatment with amoxicillin was established. Thirty-two hours after birth, the baby developed fever, lethargy, and was not accepting feeds. On admission, physical examination showed fever, tachycardia, correct blood pressure and isolated jaundice. The blood count found a leukopenia, a thrombocytopenia, a CRP at 35mg/l. Parenteral antibiotic therapy with cefotaxime and amikacin was started. Apyrexia is obtained after 48 hours of intravenous treatment. Stool culture of the newborn grew after 48 hours and for the mother after 3 days. The germ identified was Salmonella enterica Serovar 4,5,12:i:-. Blood cultures were performed on the mothers and the baby, but the cultures were negative. The baby responded and was discharged on the 15th day of delivery. The mother’s condition was complicated by a Guillan Barré syndrome that required a transfer to neurology. Neonatal salmonellosis may have non-specific clinical symptoms. Management is based on early antibiotic therapy with a third-generation cephalosporin as first-line therapy. The measure in preventing the spread of infection in the neonatology is essential to avoid secondary cases

Materno-fetal outcomes in pre eclampsia in a rural hospital of Antananarivo Madagascar

Background: Pre-eclampsia is a human-pregnancy-specific disease defined as the occurrence of hypertension and significant proteinuria in a previously healthy woman on or after the 20th week of gestation. It is one of the leading causes of maternal and perinatal morbidity and mortality worldwide. The aim of this study is to determine the prevalence of pre-eclampsia and to evaluate its maternal and fetal outcomes in a rural area.Methods: This is a cross-sectional study carried out at the Bejofo Mahitsy hospital. It is a District Hospital Referral Center, which is located on the outskirts of the capital, 32 km from Antananarivo, Madagascar. This work was carried out during 24 months, from January 2014 to December 2016. We have included all hospitalized pregnant patients with SBP ≥140 or DBP ≥90mmHg, significant proteinuria> 300mg/24H with or without edema.Results: During this period, we recorded 97 cases of pre-eclampsia, frequency of 1.68%. The mean age of the parturient was 28 years old and 46.39% of the patients were primiparous. At the admission to the hospital, 37 (38,14%) did not show any particular signs. Concerning the severe high blood pressure, 47 pregnant patients (48,46%) had SBP greater than 160 mm Hg and 26 womens (26,80%) had DBP greater than 110 mm Hg. Caesarean section was the method of delivery widely adopted in 74.22 %. Maternal morbidity was represented by eclampsia in 21.65%, Retroplacentary Hematoma in 3% and HELLP syndrome in 4.12%. Fetal morbidity was important with 35% of premature newborns, 25.77% was small for gestational age and 12.37% was with neonatal asphyxia. Intra uterine fetal mortality was found in 11.34% and the perinatal mortality rate was 8.73%.Conclusions: There is a high frequency of pre-eclampsia in our setting and the consequences of pre-eclampsia for neonatal mortality and morbidity outcome are alarmingly high pre-eclampsia. Prevention necessarily involves quality prenatal follow-up such as screening, early and appropriate care of hypertension during pregnancy