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

Paenibacillus thiaminolyticus may be an underdiagnosed cause of neonatal sepsis. We prospectively enrolled a cohort of 800 neonates presenting with a clinical diagnosis of sepsis at two 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 virus 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 paenibacillosis vs. clinical sepsis. Median age at presentation was 3 (interquartile range 1, 7) days. Fever (92%), irritability (84%) and 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 and one (3%) additional survivor had neurodevelopmental impairment without hydrocephalus. These results highlight the need to consider local pathogen prevalence and the possibility of unusual pathogens when determining antibiotic choice for neonatal sepsis. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study and the parent neonatal sepsis study were funded by the National Institutes of Health under 1DP1HD086071(S.J.S) and 1R01AI145057 (S.J.S). J.E.E. was supported by National Center for Advancing Translational Sciences grant KL2 TR002015. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Human Subjects Protection Program at The Pennsylvania State University gave ethical approval for this work. The CURE Childrens Hospital of Uganda Institutional Review Board gave ethical approval for this work. The Mbarara University of Science and Technology Research Ethics Committee gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the current study are available upon reasonable request to the authors and will be made publicly available once the parent neonatal sepsis study is published.