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. 2023 Sep 11;77(5):768-775.
doi: 10.1093/cid/ciad337.

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

Jessica E Ericson  1 , Kathy Burgoine  2   3   4 , Elias Kumbakumba  5 , Moses Ochora  5 , Christine Hehnly  1 , Francis Bajunirwe  5 , Joel Bazira  5 , Claudio Fronterre  6 , Cornelia Hagmann  7 , Abhaya V Kulkarni  8 , M Senthil Kumar  9 , Joshua Magombe  10 , Edith Mbabazi-Kabachelor  10 , Sarah U Morton  11 , Mercedeh Movassagh  9   12 , John Mugamba  10 , Ronald Mulondo  10 , Davis Natukwatsa  10 , Brian Nsubuga Kaaya  10 , Peter Olupot-Olupot  4   13 , Justin Onen  10 , Kathryn Sheldon  1 , Jasmine Smith  1 , Paddy Ssentongo  1 , Peter Ssenyonga  10 , Benjamin Warf  11 , Emmanuel Wegoye  10 , Lijun Zhang  14 , Julius Kiwanuka  5 , Joseph N Paulson  15 , James R Broach  1 , Steven J Schiff  12
Affiliations

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

Jessica E Ericson et al. Clin Infect Dis. .

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.

Keywords: ampicillin; empirical antibiotic; hydrocephalus; meningitis; mortality.

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Conflict of interest statement

Potential conflicts of interest. J. N. P. received salary support and stock/stock options from Genentech and N-Power Medicine. He has patents planned, issued, or pending with Genentech and N-Power Medicine. He received honoraria for lectures from the International Human Microbiome Consortia. J. E. E. received consulting fees from AbbVie for participation in a data safety and monitoring board unrelated to the current work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Graphical Abstract
Graphical Abstract
This graphical abstract is also available at Tidbit: https://tidbitapp.io/tidbits/neonatal-paenibacilliosis-paenibacillus-infection-as-a-novel-cause-of-sepsis-in-term-neonates-with-high-risk-of-sequelae-in-uganda
Figure 1.
Figure 1.
Presenting signs and outcomes for neonates with Paenibacillus species detected by qPCR during clinical sepsis. Number of neonates presenting to each site with each sign of infection. Numbers at the end of each bar indicate the proportion of neonates at each site who had the corresponding sign of infection. Neonates with the composite poor outcome of death, postinfectious hydrocephalus or moderate/severe neurodevelopmental impairment are indicated in red. Abbreviation: qPCR, quantitative polymerase chain reaction.
Figure 2.
Figure 2.
Outcomes for neonates with clinical sepsis with Paenibacillus negative (PN) and Paenibacillus positive (PP) qPCR results for Paenibacillus thiaminolyticus detection in the CSF at both sites and at Mbarara and Mbale. Abbreviations: CSF, cerebrospinal fluid; qPCR, quantitative polymerase chain reaction.
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