Group B Streptococcus GBS in neonates

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Group B Streptococcus (GBS) in neonates
Group B Strep is the Number ONE Infectious
KILLER of newborns.

• Amber Bowser
• Joe Lehner
• Danielle Litzinger

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Streptococcus agalactiae

• (group B strep,
• beta strep)
• Classification
• facultative anaerobic
• gram positive bacteria
• cocci in chains
• beta hemolytic
• fastidious
• growth on blood agar
• bacitracin resistant
• catalase negative
• group B carbohydrate

From University of Florida College of Medicine,
Bugs Database
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Group B?

• The B in Group B Streptococcus refers to the
  Lancefield classification. This is based on the
  antigenicity of a carbohydrate which is soluble
  in dilute acid and called the C carbohydrate.
• Lancefield identified 13 types of C carbohydrate,
  designated A through O, that could be
  serologically differentiated.
• The organisms that most commonly infect humans
  are found in groups A, B, D, and G.

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Who is at risk?

• Once thought to infect only cows, where it
  produces mastitis, this organism is now known to
  be able to cause serious disease in
  immunocompromised individuals and neonates.
• Infections in newborns are the most common and
  are extremely serious.
• Group B Strep colonizes the vagina of about 25
  of young women, and approximately 1 of infants
  born via vaginal birth to colonized mothers will
  become infected. Mortality is high, between 50
  and 70.

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Symptoms

• Group B streptococci are often present in people
  who show no symptoms of disease
• These people are said to be colonized.
• Many infants are colonized before or during birth
  by mothers who unknowingly carry the bacteria.
• A small percentage of these develop disease,
  which can be life-threatening or can lead to
  lifelong neurological problems.

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Sites and Sources of Transmission

• Female genital tract, normal flora
• vagina
• GI tract, normal flora
• Vaginal delivery, source
• Perinatal, source
• Pathogen to infants and neonates
• Pathogen to uterus
• Pathogen in blood, brain, and meninges

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Streptococcus agalactiae/ Group B Streptococcus

• Causative agent in neonates for
• Neonatal sepsis
• (1-5 days of age)
• Neonatal pneumonia
• (1-5 days of age)
• Neonatal meningitis
• (10 -60 days of age)

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Neonatal sepsis (1-5 days of age)

• Symptoms include
• lethargy
• fever
• jaundice
• hypotension
• hypothermia
• tachypnea
• bacteremia
• Also characterized by low Apgar scores.

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Neonatal pneumonia (1-5 days of age)

• Symptoms include
• low Apgar scores
• lethargy
• fever
• apnea
• tachypnea
• cough
• cyanosis
• pulmonary infiltrates
• rales

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Neonatal meningitis (10 -60 days of age)

• lethargy
• fever
• jaundice
• hypotension
• hypothermia
• stiff neck
• nuchal rigidity
• seizures

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Pathogen in adults

• Endometritis
• fever, chills, malaise, pain, bacteremia 
• Osteomyelitis
• fever, bone pain, chills, erythema, swelling,
  inflammation
• Septic arthritis
• inflammation, joint pain, swelling, pus, erythema

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How is it diagnosed?

• Cultures from the genital areas of the mother, or
  her urine can detect the presence of GBS.
• If an infection is suspected, blood tests,
  cultures, and x-rays can help ensure the results.
• Diagnosis is confirmed through cultures of
  sterile body fluids including blood and spinal
  fluid.

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Treatment

• Intravenous antibiotics are the typical course of
  action.

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Who is at risk?

• Positive culture for GBS colonization at 35-37
  weeks of pregnancy
• Fever during labor
• History of GBS infection in previous births
• Membrane rupture more than 18 hours before
  delivery
• Labor or rupture of membranes before 37 weeks of
  gestation
• Black race
• Age less than 20 years

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Prevention?

• Women who have tested positive for GBS can be
  treated with intravenous antibiotics during labor
  and childbirth to decrease the chance of
  transmission to the child.

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http//aepoxdvwww.epo.cdc.gov/wonder/prevguid/m004
3277/m0043277.asp
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A Vaccine?

• Presently there is no vaccine, but rigorous
  research is being done.
• Women who would be vaccinated against GBS would
  produce antibodies, which would cross the
  placenta, protecting the baby during birth and
  early infancy.

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Complications

• Even after recovery, the danger of GBS is not
  over.
• Hearing or vision loss
• Varying degrees of physical and learning
  disabilities
• Cerebral palsy is possible

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References

• http//www.medinfo.ufl.edu/year2/mmid/bms5300/bugs
  /stragal.html
• http//www.encyclopedia.com/html/section/streptoc_
  GroupBStreptococcalInfections.asp
• http//www.groupbstrep.org/
• http//www.csc.liv.ac.uk/u1hh/members.htm
• http//www.obiakorobgyn.com/medical/crs/groupbst.h
  tm
• http//directory.google.com/Top/Health/Conditions_
  and_Diseases/Infectious_Diseases/Bacterial/Strepto
  coccal/Group_B/