Neonatal Group B Streptococcal Meningitis: Predictors for Poor Neurologic Outcome at 18 Months

2021 ◽  
pp. 088307382110531
Author(s):  
Petja Fister ◽  
Jerneja Peček ◽  
Samo Jeverica ◽  
Zvonka Rener Primec ◽  
Darja Paro-Panjan
Keyword(s):  
Late Onset ◽  
Group B Streptococcus ◽  
Neurodevelopmental Outcome ◽  
Hemodynamic Instability ◽  
Early Predictors ◽  
Predominant Pathogen ◽  
Ophthalmologic Examination ◽  
Neonatal Group ◽  
Streptococcal Meningitis ◽  
Group B

Aim To find early predictors for poor neurodevelopmental outcome after neonatal group B streptococcal meningitis. Methods We retrospectively analyzed clinical characteristics of 23 patients with neonatal group B streptococcal meningitis and their neurodevelopmental outcome at 18 months. Available group B Streptococcus strains were serotyped and their genomes characterized. Results We found several differences between patients with early- (n = 5) and late-onset (n = 18) disease. Nine children had neurologic abnormalities at 18 months and 4 had epilepsy, all of them after late-onset disease. Most important risk factors for poor outcome were impaired consciousness at admission, hemodynamic instability, seizures, or abnormal electroencephalogram during the acute illness and abnormal neurologic and ophthalmologic examination at the end of treatment, whereas abnormalities in laboratory and imaging studies were not predictive. Hypervirulent serotype III, multilocus sequence type 17 group B Streptococcus was the predominant pathogen. Conclusions Neurodevelopmental impairment after neonatal group B streptococcal meningitis is likelier in those with clinical and neurophysiological features indicating worse disease severity.

scholarly journals The prevention of neonatal group B streptococcal disease: a report by a working group of the Medical Screening Society

2005 ◽  
Vol 12 (2) ◽  
pp. 60-68 ◽  
Author(s):  
MR Law ◽  
G Palomaki ◽  
Z Alfirevic ◽  
R Gilbert ◽  
P Heath ◽  
...  
Keyword(s):  
Late Onset ◽  
Effective Means ◽  
Group B Streptococcus ◽  
Neonatal Meningitis ◽  
Screening Performance ◽  
Alternative Means ◽  
Neonatal Group ◽  
Group B Streptococcal Disease ◽  
Group B ◽  
The Uk

Streptococcus agalactiae, or Lancefield group B streptococcus (GBS), is the most frequent cause of serious bacterial sepsis, including neonatal meningitis, in UK neonates. Early-onset neonatal GBS infection, but not late-onset, can be prevented by screening to identify high-risk pregnancies and administering penicillin during delivery. A vaccine has been developed as an alternative means of prevention but it is awaiting a randomized trial before being available for general use. In this review we examine the published literature to assess the morbidity and mortality attributable to neonatal GBS infection, quantify the screening performance of the two alternative modes of screening (microbiological and risk factor based), review the evidence on the efficacy of the vaccine, and estimate the numbers of deaths and cases of serious disability that each strategy in turn might prevent in the UK, in order to assess the most effective means of prevention for the UK.

Group B Streptococcus

1986 ◽  
Vol 7 (S2) ◽  
pp. 135-137 ◽  
Author(s):  
Charles S.F. Easmon
Keyword(s):  
United States ◽  
Early Onset ◽  
Western Europe ◽  
Late Onset ◽  
Group B Streptococcus ◽  
The United States ◽  
Group B Streptococci ◽  
Neonatal Group ◽  
Group B ◽  
Portal Of Entry

Over the past 25 years group B streptococci have become established as one of the main bacterial pathogens of the neonate in Western Europe and the United States. The attack rate of 0.25/1,000 live births found by Mayon White in Great Britain1 appears typical of many European countries. However, in some centers in the United States attack rates can be over 10 times higher.Two types of neonatal group B streptococcus (GBS) diseases exist, “early” and “late” onset. Early onset disease usually presents within the first few days of life. Often the most serious infections are present at birth or seen within a few hours. Early onset disease presents with pneumonia, respiratory distress and shock. Bacteremia is normally present and meningitis may occur. Mortality is high (50% to 75%). The portal of entry is probably the respiratory tract. Infants normally acquire the infecting organism from their mothers. Heavy maternal and infant colonization, prolonged rupture of membranes, prematurity, and obstetric complications are all risk factors.Delayed onset disease, as its name suggests, presents after the first week of life, primarily with bacteremia and meningitis. Mortality is much lower than for the early onset form, but still appreciable for a bacterial infection (14% to 18%). Its epidemiology is uncertain.

scholarly journals Cytokine Profiles Before and After Exchange Transfusions in Severe Late-Onset Neonatal Group B Streptococcus Meningitis: A Case Report

2021 ◽  
Vol 253 (4) ◽  
pp. 269-273
Author(s):  
Mina Chishiki ◽  
Hayato Go ◽  
Kisei Endo ◽  
Nahoko Katayama Ueda ◽  
Hiroki Takehara ◽  
...  
Keyword(s):  
Case Report ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Cytokine Profiles ◽  
Before And After ◽  
Neonatal Group ◽  
Group B

Recurrent neonatal group B streptococcus cellulitis and adenitis syndrome with late-onset sepsis

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Alex Guri ◽  
Eric Scheier ◽  
Uri Balla ◽  
Mikhael Chigrinsky ◽  
Eli Shapiro
Keyword(s):  
Emergency Department ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Complete Recovery ◽  
Blood Cultures ◽  
Case Presentation ◽  
Late Onset Sepsis ◽  
Neonatal Group ◽  
Group B ◽  
The Right

AbstractObjectivesGroup-B streptococcus (GBS) continues to be a significant cause of late-onset neonatal illness. Rarely does it present as cellulitis-adenitis syndrome, and rarely does the infection recur in the same infant after complete recovery.Case presentationHere we report a case of recurrent late-onset cellulitis-adenitis GBS syndrome in a term 12-day-old neonate. The infant presented with fever and cellulitis of the right neck. Full sepsis workup was normal and the infant recovered completely with antibiotics. Three days after the completion of antibiotics the patient returned to the emergency department due to fever, toxic appearance and rapidly spreading cellulitis, and adenitis on the left side of the neck. Blood culture revealed GBS. The patient was re-admitted to the hospital and successfully treated with a prolonged course of antibiotics.ConclusionsThis case highlights the importance of treating neonatal cellulitis with fever as bacteremia, and reminds us of the rare possibility of recurrent invasive GBS disease. Moreover, this case illustrates that GBS cellulitis-adenitis syndrome is possibly underdiagnosed in mild cases. Physicians should be aware that neonatal cellulitis can precede the appearance of severe sepsis. Neonates with fever and cellulitis without a clear external port of entry should undergo a complete sepsis workup and receive antibiotic treatment appropriate for bacteremia, even if the blood cultures are negative. Although the recurrence of GBS sepsis is rare, physicians should be aware of this possibility in order to treat the infection early.

scholarly journals Changes in the incidence and epidemiology of neonatal group B Streptococcal disease over the last two decades in Crete, Greece

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Eleni Vergadi ◽  
Antonia Manoura ◽  
Emmanouil Chatzakis ◽  
Emmanouil Karavitakis ◽  
Sofia Maraki ◽  
...  
Keyword(s):  
Late Onset ◽  
Group B Streptococcus ◽  
Prevention Strategies ◽  
Effective Prevention ◽  
Neurological Sequelae ◽  
Neonatal Group ◽  
Group B Streptococcal Disease ◽  
Group B ◽  
Epidemiological Trends

Group B streptococcus (GBS) remains a leading cause of neonatal disease. However, GBS rates and prevention strategies vary considerably worldwide. Herein, we investigated the burden and epidemiological trends of neonatal GBS infections in our area (Greece) over the last two decades. We conducted a multicenter retrospective study that includes all cases of culture-proven GBS disease in infants <90 days old in the last 22 years. Neonatal GBS incidence was 0.17/1000 live births (95%CI: 0.11-0.21). A significant increase was noted during the second decade (0.23 vs 0.10/1000, P<0.05). Late onset disease (LOD) significantly increased during the second decade (0.08 vs 0.02, P<0.05). Infants in the LOD group had a higher risk of meningitis (RR 1.8, 95%CI: 1.23-2.71). Long-term neurological sequelae were reported in 42.8% of meningitis cases. The mortality rate was 8%. The incidence of neonatal GBS disease in our area is among the lowest reported, but an increase was noted the last decade mainly due a rise in the LOD. The burden of LOD, the mortality and long-term disability are still substantial, thus effective prevention strategies − including maternal vaccination for neonatal GBS − are needed.

scholarly journals Neonatal Group B streptococcal osteomyelitis and suppurative arthritis: A case report

2021 ◽  
Vol 35 ◽  
pp. 117-120
Author(s):  
Ashwath Duraiswamy ◽  
Veerappan Somu
Keyword(s):  
Neonatal Sepsis ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Neonatal Morbidity ◽  
Sternoclavicular Joint ◽  
Unusual Site ◽  
Late Onset Sepsis ◽  
Focal Infection ◽  
Neonatal Group ◽  
Group B

Neonatal sepsis contributes significantly to neonatal morbidity and mortality. Group B streptococcus (GBS) is not a frequent cause of neonatal sepsis in India. Late onset sepsis by GBS presenting as focal infection like osteomyelitis is seen in only 3% of the total GBS sepsis profile in neonates. Here, we report a rare case of neonatal osteomyelitis with septic arthritis caused by GBS at an unusual site, the clavicle and sternoclavicular joint.

Pyomyositis as a manifestation of late‐onset group B Streptococcus disease

2021 ◽  
Author(s):  
Akihiko Shimizu ◽  
Mariko Shimizu ◽  
Shigeru Nomura ◽  
Yoshiyuki Yamada
Keyword(s):  
Late Onset ◽  
Group B Streptococcus ◽  
Group B ◽  
Onset Group

scholarly journals Trends in molecular characteristics and antimicrobial resistance of group B streptococci: a multicenter study in Serbia, 2015–2020

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Dusan Kekic ◽  
Ina Gajic ◽  
Natasa Opavski ◽  
Milan Kojic ◽  
Goran Vukotic ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Neonatal Morbidity ◽  
Disease Rate ◽  
Molecular Characteristics ◽  
Group B Streptococci ◽  
Live Births ◽  
Invasive Infections ◽  
Group B

AbstractGroup B Streptococcus (GBS) is a major cause of neonatal morbidity and mortality. Serbia has not fully implemented preventive measures against GBS neonatal diseases. Therefore, we aimed to assess the maternal GBS colonisation and invasive neonatal disease rate, to reveal the trends of antimicrobial resistance and serotype distribution of GBS from various patient groups. Randomly selected non-invasive (n = 991) and all invasive GBS (n = 80) collected throughout Serbia from 2015 to 2020 were tested for antimicrobial susceptibility, capsular typing, and hvgA detection. Overall, 877/5621 (15.6%) pregnant women were colonised with GBS. Invasive GBS infections incidence in infants (0.18/1000 live births) showed a decreasing trend (0.3 to 0.1/1000 live births). Type III was overrepresented in infants with invasive infections (n = 35, 58.3%), whereas type V predominated among colonised adults (n = 224, 25.5%) and those with noninvasive (n = 37, 32.5%) and invasive infections (n = 8, 40%). The hypervirulent clone III/ST17 was highly associated with invasive infections (n = 28, 35%), particularly late-onset disease (n = 9, 47.4%), showing an increase from 12.3 to 14.8%. The GBS resistance to erythromycin and clindamycin was 26.7% and 22.1%, respectively, with an upward trend. The emergence of the hypervirulent clone III/ST17 and the escalation in GBS resistance highlight an urgent need for continuous monitoring of GBS infections.

scholarly journals Poor Adherence to the Screening-Based Strategy of Group B Streptococcus Despite Colonization of Pregnant Women in Greece

Pathogens ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 418
Author(s):  
Maria Maroudia Berikopoulou ◽  
Aikaterini Pana ◽  
Theodota Liakopoulou-Tsitsipi ◽  
Nikos F. Vlahos ◽  
Vasiliki Papaevangelou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Pregnant Women ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Culture Collection ◽  
Carrier Status ◽  
Cross Sectional ◽  
Screening Guidelines ◽  
Group B

Group B streptococcus (GBS) is a leading cause of serious neonatal infections. Maternal GBS colonization is associated with early- and late-onset neonatal disease (EOD/LOD). In Greece, a screening-based strategy is recommended, in which concurrent vaginal-rectal cultures should be obtained between 36 0/7 and 37 6/7 weeks’ gestation. We sought to examine the level of adherence to the GBS screening guidelines and estimate the prevalence of GBS colonization among pregnant women. Although in Greece the screening-based strategy is followed, we also examined known EOD risk factors and linked them to GBS colonization. A cross-sectional study of 604 women postpartum in three hospitals and maternity clinics was conducted. Following written informed consent, data were collected via a short self-completed questionnaire and review of patients’ records. In 34.6% of the enrolled pregnant women, no culture had been taken. Of the remaining, 12.8% had proper vaginal-rectal sample collections. The overall maternal colonization rate was 9.6%. At least one risk factor for EOD was identified in 12.6% of participants. The presence of risk factors was associated with positive cultures (p = 0.014). The rate of culture collection did not differ between women with or without an EOD risk factor. Adherence to a universal screening of pregnant women with vaginal-rectal cultures was poor. Despite probable underestimation of GBS carrier status, almost 1 in 10 participants were GBS positive during pregnancy. Screening of women with risk factors for EOD should, at least, be prioritized to achieve prevention and prompt intervention of EOD.

scholarly journals Genomic and phenotypic characterisation of invasive neonatal and colonising group B Streptococcus isolates from Slovenia, 2001–2018

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Tina Perme ◽  
Daniel Golparian ◽  
Maja Bombek Ihan ◽  
Andrej Rojnik ◽  
Miha Lučovnik ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Virulence Factors ◽  
Late Onset ◽  
Group B Streptococcus ◽  
Genomic Diversity ◽  
Neonatal Disease ◽  
Phenotypic Characterisation ◽  
High Prevalence ◽  
Group B ◽  
The Impact

Abstract Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. Methods GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. Results Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons. Conclusions A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.

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