A 19-year-old woman in labor had to be transferred from a local clinic to the tertiary hospital due to pregnancy-induced hypertension.  At the hospital, a baby girl was born via vaginal delivery at 37 weeks gestational age. The baby weighed 2560 grams at birth, cried well, and had an APGAR score of 9/10. Sadly, the day after her birth, the baby’s body turned blue and she became non-responsive. Cardiopulmonary resuscitation (CPR) and balloon mitral valvuloplasty (BMV) were attempted, but these efforts were unsuccessful, and the baby was pronounced deceased. The baby’s mother consented to participation in CHAMPS.

Uncovering the Cause

CHAMPS laboratory tests included blood and cerebrospinal fluid cultures and polymerase chain reaction (PCR) of blood, cerebrospinal fluid, lung, and nasopharyngeal swabs specimens for infectious agents, all of which were positive for Group B streptococcus (GBS). In addition, the histopathological examination using immunohistochemistry on the liver and lung samples were also positive for GBS. The CHAMPS panel determined that the baby died from GBS sepsis, with the infection present in the bloodstream, lungs, and brain.

Pathology Images 

Histopathological, histochemical (Gram stain), and immunohistochemical evidence of Streptococcus agalactiae in the lungs and CNS samples. Images show bronchopneumonia with Streptococcus agalactiae antigens detected by using immunohistochemical assay.

Lung: 

Family Follow-Up 

The CHAMPS team informed the mother of the laboratory findings and told her that the death of her baby was caused by a GBS infection. They advised her that, for future pregnancies, she should inform her healthcare workers that her previous child died of GBS sepsis and she should receive prophylactic antibiotics to prevent GBS sepsis in her next pregnancy. CHAMPS gave the mother a letter containing findings from her baby’s evaluation and recommendations for prevention that she can show healthcare workers in the future.

Public Health Implications

Group B Streptococcus (GBS; Streptococcus agalactiae) is the most common cause of early-onset neonatal sepsis. Maternal GBS colonization of the genitourinary tract is common, with an estimated prevalence of 18% worldwide among pregnant women; prevalence varies from 10%–40% depending on geographical region. GBS transmission in utero from the mother to the fetus can result in systemic infection and disease, leading to either stillbirths or the onset of disease observed at or shortly after birth. Invasive GBS disease typically presents as early-onset sepsis (appearing within the first week of life), with approximately 80% to 90% of early onset of disease presenting within 24 hours of birth.

Prevention of GBS infection during pregnancy remains a complex issue, with an urgent need for a global strategy to safeguard the most vulnerable populations against this devastating disease. The challenge of preventing GBS sepsis is particularly unresolved for low- and middle-income countries with high incidence rates, where conventional measures used in some high-income countries, such as screening of pregnant women for GBS colonization and administration of intrapartum antibiotic prophylaxis, are too costly and logistically complicated to be practical.  Vaccines are in development that could be given to women during pregnancy, with the goal of preventing stillbirths and GBS sepsis in newborns.  In the absence of available vaccines, ensuring that healthcare workers are proficient in recognizing early signs of neonatal sepsis and promptly initiating appropriate treatment may save lives.

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Email data@champshealth.org for information about CHAMPS pathology slide images.