Neonatal Granulicatella elegans Bacteremia, London, UK

References 1. Raoult D, Roux V. Rickettsioses as paradigms of new or emerging infectious diseases. Fuente J, et al. Ticks (Acari: Ixodidae) parasitizing Iberian red deer (Cervus elaphus hispanicus) and European wild boar (Sus scrofa) from Spain: geographical and temporal distribution. Raoult D. Proposal to create subspecies of Rickettsia conorii based on multi-locus sequence typing and an emended description of Rickettsia conorii. et al. Prevalence of tick-borne pathogens in ixodid ticks (Acari: Ixodidae) collected from European wild boar (Sus scrofa) and Iberian red deer (Cervus ela-phus hispanicus) in central Spain. To the Editor: Granulicatella el-egans, a bacterium found in normal human oral flora, is generally associated with infective endocarditis. We discuss the identification and possible source of neonatal G. elegans bacteremia. A 29-year-old woman sought care at Northwick Park Hospital (Lon-don, UK) at 41 weeks' gestation (first pregnancy) for spontaneous rupture of membranes and discharge of clear liquor. She had fever (37.6°C) and a heart rate of 98 beats/min; there was no evidence of fetal distress. The woman was released from the hospital. Twelve hours later, she returned because of discharge of meconium-stained liquor. Her white cell count was 18 × 10 9 /L (reference 3–10 × 10 9 /L), and her C-reactive protein level was 277 mg/L (reference <5 mg/L). Emergency cesarean section was performed after a diagnosis of fetal distress. A large amount of foul-smelling meconium was observed. A live male infant (3.05 kg) was delivered; Ap-gar score was normal. Blood samples were cultured for suspected sepsis, and the neonate was empirically administered intravenous benzylpeni-cillin and amikacin (6 days). He made a full clinical recovery. The mother remained generally well, although she had persistent tachycardia (120 beats/min) and fever (37.6°C). She was intravenously administered amoxicillin/clavulanic acid and amikacin; over the next 2 days, her white cell count became normal, but her C-reactive protein level remained >400 mg/L. By postdelivery day 10, her temperature and heart rate were normal. Antimicrobial drug treatment was stopped, and she was released without further treatment. We interviewed the mother 8 months later and established that she had no dental procedures/infection or endocarditis before, during, or after pregnancy. Placental swab samples were cultured on Columbia horse blood agar (CBA) and chocolated CBA (both in-cubated aerobically with 5% CO 2 at 37°C for 24 hours), cysteine lactose electrolyte deficient agar (incubated in air at 37°C for 24 hours), and fastidious anaerobic agar with and without …