Cellulitis-adenitis syndrome is an established but uncommon presentation of group B streptococcus (GBS) infection in neonates and young infants.^1,2 The pathogenesis involves either GBS mucus membrane colonization with subsequent bacteremia and seeding of the soft tissues, or in the context of GBS facial cellulitis, ipsilateral otitis media with secondary lymphatic spread and ensuing bacteremia.^2,3 While meningitis accompanying cellulitis or adenitis in young infants occurs, it is described as rare.⁴ Because cellulitis-adenitis is an infrequent manifestation of GBS disease during infancy, the incidence of associated central nervous system (CNS) involvement is unknown. Debate currently exists over the need for lumbar puncture in neonates in other clinical situations.^5-8 In addition there is increasing use of algorithms to define the extent of evaluation needed for the infant with suspected bacterial infection. These issues raise concern that the lumbar puncture in the initial diagnostic evaluation may be overlooked. This is particularly significant for general pediatricians and emergency room physicians.

We present two neonates with GBS cellulitis-adenitis syndrome who were afebrile and well-appearing initially and were subsequently confirmed to have CNS involvement. Our purpose is to emphasize the importance of considering meningitis in the initial diagnostic evaluation. Our patients are reminders of the need to exclude CNS involvement in neonates and young infants with suspected bacterial infection (focal or nonfocal) because choice and dosage of empiric antimicrobial therapy in infants with meningitis varies from that for nonmeningeal infection.⁵

Case 1

A 14-day-old African-American female infant with a previously uncomplicated neonatal course presented with a 3-day history of right inguinal erythema and swelling. No fever or irritability was noted and she maintained a good appetite. An outpatient evaluation included a blood culture . . . [Full Text of this Article]