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Group B Streptococcal Cellulitis and Necrotizing Fasciitis in Infants

A Systematic Review

Wojtera, Monika, BMSc*; Cheng, Horace, MD†,‡; Fiorini, Kyle, MD*,‡; Coughlin, Kevin, MHSc, MD‡,§; Barton, Michelle, MSc, MD‡,§; Strychowsky, Julie E., MD†,‡

The Pediatric Infectious Disease Journal: September 2018 - Volume 37 - Issue 9 - p e241–e245
doi: 10.1097/INF.0000000000001931
Instructive Cases

Background: There is no consensus regarding approaches to infantile group B streptococcal (GBS) head and neck cellulitis and necrotizing fasciitis. We present a case of GBS necrotizing cellulitis and summarize the literature regarding the presentation and management of infantile head and neck GBS cellulitis and necrotizing fasciitis.

Methods: The literature was searched using PubMed, Web of Science, EMBASE and Medline (inception to April 2017) by 2 independent review authors. Inclusion criteria encompassed case reports or case series of infants less than 12 months of age with GBS cellulitis of the head and neck or with GBS necrotizing fasciitis without restriction to the head and neck. Data were extracted using tables developed a priori by 2 independent review authors, and discrepancies were resolved by consensus.

Results: An infant presenting at 33 days of age with GBS facial necrotizing fasciitis was successfully treated conservatively with antibiotics. Our literature search identified 40 infants with GBS head and neck cellulitis. Late-onset (98%), male gender (65%) and prematurity (58%) predominated. Penicillin is the main therapy used (97%). The 12 identified cases of necrotizing fasciitis were associated with polymicrobial etiology (36%) and broad-spectrum antibiotic use. Seventy-five percent required debridement, including 4 of 5 (80%) cases involving the head and neck.

Conclusions: Skin and soft tissue involvement is an uncommon manifestation of late-onset GBS infection which requires antibiotic therapy and possibly surgical debridement cases with necrotizing fasciitis.

From the *Schulich School of Medicine and Dentistry

Department of Otolaryngology-Head and Neck Surgery, Western University, London, Ontario, Canada

London Health Sciences Centre, London, Ontario, Canada

§Department of Paediatrics, Western University, London, Ontario, Canada.

Accepted for publication December 11, 2017.

The authors have no funding or conflicts of interest to disclose.

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Address for correspondence: Julie Strychowsky, MD, Department of Otolaryngology-Head and Neck Surgery, Western University, VH B3-444, 800 Commissioners Rd E, London, ON N6A 5W9, Canada. E-mail:

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