Veillonella infection in the newborn

Many epidemics of subungual infection have been described among infants in postnatal wards and special care baby units. The number of fingers affected per patient ranged from one to ten; the thumbs are less frequently involved than other fingers; toe nails are not affected. Three stages occur: first, a small amount of clear fluid appears under the centre of the nail, along with mild inflammation at the distal end of the finger. This initial vesicle lasts approximately 24 hours; it sometimes enlarges but never extends to the edge of the nail. Some small lesions bypass the second, pustular stage, going directly to the third stage. As a rule the fluid becomes yellow after 24 hours, the pus remaining for 2448 hours, before gradually turning brown and being absorbed. The colour fades progressively over a period of 2-6 weeks, leaving the nail and nail bed completely normal.

Subungual pus obtained by aseptic puncture of the nails shows tiny, Gram-negative cocci about 0.4 ^m in diameter. These organisms resemble Veillonella, a group of anaerobes of dubious pathogenicity found as commensals in the saliva, vagina and respiratory tract. Systemic antibiotics do not change the clinical course of the nail lesions, which do not differ from those observed in other untreated and affected newborn children.

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