Neonatal Paenibacilliosis : Paenibacillus infection as a Novel Cause of Sepsis in Term Neonates with High Risk of Sequelae in Uganda

Ericson, Jessica E and Burgoine, Kathy and Kumbakumba, Elias and Ochora, Moses and Hehnly, Christine and Bajunirwe, Francis and Bazira, Joel and Fronterre, Claudio and Hagmann, Cornelia and Kulkarni, Abhaya V and Kumar, M Senthil and Magombe, Joshua and Mbabazi-Kabachelor, Edith and Morton, Sarah U and Movassagh, Mercedeh and Mugamba, John and Mulondo, Ronald and Natukwatsa, Davis and Nsubuga Kaaya, Brian and Olupot-Olupot, Peter and Onen, Justin and Sheldon, Kathryn and Smith, Jasmine and Ssentongo, Paddy and Ssenyonga, Peter and Warf, Benjamin and Wegoye, Emmanuel and Zhang, Lijun and Kiwanuka, Julius and Paulson, Joseph N and Broach, James R and Schiff, Steven J (2023) Neonatal Paenibacilliosis : Paenibacillus infection as a Novel Cause of Sepsis in Term Neonates with High Risk of Sequelae in Uganda. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 77 (5). pp. 768-775. ISSN 1058-4838

Abstract

Background Paenibacillus thiaminolyticus may be an underdiagnosed cause of neonatal sepsis. Methods We prospectively enrolled a cohort of 800 full-term neonates presenting with a clinical diagnosis of sepsis at 2 Ugandan hospitals. Quantitative polymerase chain reaction specific to P. thiaminolyticus and to the Paenibacillus genus were performed on the blood and cerebrospinal fluid (CSF) of 631 neonates who had both specimen types available. Neonates with Paenibacillus genus or species detected in either specimen type were considered to potentially have paenibacilliosis, (37/631, 6%). We described antenatal, perinatal, and neonatal characteristics, presenting signs, and 12-month developmental outcomes for neonates with paenibacilliosis versus clinical sepsis due to other causes. Results Median age at presentation was 3 days (interquartile range 1, 7). Fever (92%), irritability (84%), and clinical signs of seizures (51%) were common. Eleven (30%) had an adverse outcome: 5 (14%) neonates died during the first year of life; 5 of 32 (16%) survivors developed postinfectious hydrocephalus (PIH) and 1 (3%) additional survivor had neurodevelopmental impairment without hydrocephalus. Conclusions Paenibacillus species was identified in 6% of neonates with signs of sepsis who presented to 2 Ugandan referral hospitals; 70% were P. thiaminolyticus. Improved diagnostics for neonatal sepsis are urgently needed. Optimal antibiotic treatment for this infection is unknown but ampicillin and vancomycin will be ineffective in many cases. These results highlight the need to consider local pathogen prevalence and the possibility of unusual pathogens when determining antibiotic choice for neonatal sepsis.