Salman Wani, Ejaz A Khan, Anwarul Haq, Ibrar Hashmi, Yawar Najam.
Group A streptococcal sepsis and osteomyelitis of the skull in a neonate with cephalohematoma.
Infect Dis J Jan ;16(2):55-7.

A 33 day old girl of African origin born by ventouse extraction came with breathing difficulty, high grade fever up to 104°F, excessive crying and poor feeding for the previous 4 days. The mother noted a scalp swelling present since birth which gradually increased in size over the last 10 days and was discharging pus. Examination showed an irritable baby with tachycardia, tachypnea and fever of 102° F. Oxygen saturation was 92% in room air. There was a large scalp swelling 6x4 cm in size on right parietal area. It was tense, indurated and tender to touch with three pus discharging lesions. Anterior fontanelle was soft and not bulging. Rest of the examination was normal. Initial investigations and chest x-ray were normal. Skull Xray showed erosion of the parietal bone proximal to the soft tissue swelling. Empirical intravenous antibiotics included ceftazidime, cloxacillin and amikacin. Blood culture done at admission revealed Group A Streptococcus after 48 hours. A localized pus swab and aspiration fluid from cephalohematoma revealed serous aspirate that was culture negative. The baby improved clinically with resolution of cephalohematoma after 10 days. She received intravenous cloxacillin for 3 weeks. She was followed up in clinic and had remained well since discharge. Neonates can develop skull osteomyelitis. Group A streptococcus may be implicated along with other microorganisms. Skull x-rays are suggestive whereas CT scan is diagnostic. Prompt antibiotics and surgical drainage will have successful outcome.

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