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

Jessica E. Ericson, Kathy Burgoine, Elias Kumbakumba, Moses Ochora, Christine Hehnly, Francis Bajunirwe, Joel Bazira, Claudio Fronterre, Cornelia Hagmann, Abhaya V. Kulkarni, M. Senthil Kumar, Joshua Magombe, Edith Mbabazi-Kabachelor, Sarah U. Morton, Mercedeh Movassagh, John Mugamba, Ronald Mulondo, Davis Natukwatsa, Brian Nsubuga Kaaya, Peter Olupot-OlupotJustin Onen, Kathryn Sheldon, Jasmine Smith, Paddy Ssentongo, Peter Ssenyonga, Benjamin Warf, Emmanuel Wegoye, Lijun Zhang, Julius Kiwanuka, Joseph N. Paulson, James R. Broach, Steven J. Schiff

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)768-775
Number of pages8
JournalClinical Infectious Diseases
Volume77
Issue number5
DOIs
StatePublished - Sep 1 2023

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

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