Neonatal sepsis with group B Streptococcus

 

 Identification

Group B Strep. (Streptococcus agalactiae) can colonize the vagina and the cervix without giving symptoms and without requiring treatment. It is part of the normal flora of the female genital tract and may represent an important cause of sepsis and neonatal meningitis. It’s not a cause of the sexually transmitted infection. ^[1]Heymann D.L. Manual de management al bolilor transmisibile. 2012 ^[2]Popa GL, Popa MI. Microbiologie medicală curs – 2010.. ^[3]*** CDC 2017. Protect Your Baby from Group B Strep!.

 In adult

• The infection with group B strep occurs in tired persons (diabetics, elderly)
• Determines:

– Meningitis.

– Endocarditis.

– Urinary infections. ^[4]Popa GL, Popa MI. Microbiologie medicală curs – 2010.’.

To the pregnant woman

During childbirth, the woman colonized vaginally with Streptococcus Agalactiae may develop:

• Febrile endometritis with blood dissemination,
• Secondary endocardial or meningian localization.

In newborn, group B Strep (Streptococcus agalactiae) produces two distinct forms of invasive disease:

• Early onset disease occurs in the first week of life. The newborn develops one or more of the following:
  • Sepsis
  • Pneumonia
  • Meningitis
  • Osteomyelitis
  • Septic arthritis.

Early onset disease can be acquired in the uterus or at the time of birth. ^[5]Heymann D.L. Management Manual of communicable diseases. 2012` ^[6]CDC, MMWR 2010. Prevention of Perinatal Group B Streptococcal Disease: redreamed Guidelines from CDC, 2010..

• Late onset disease occurs after the first week of life, but may occur up to a few months of life. It is transmitted by human contact, and the newborn develops:
  • Meningitis
  • Sepsis.

Mortality is about 50%. The survivors present:

• Language Disorders,
• Hearing disorders,
• Visual disturbances,
• Psychomotor retard,
• Convulsions ^[7]Heymann D.L. Management Manual of communicable diseases. 2012′

 Diagnosis

 To the pregnant woman

• Gram staining of vaginal secretion
• Bacterial culture of secretions collected from the vagina/cervix and rectum in particular in the 3rd quarter, in  35-37 week of gestation. ^[8]Popa GL, Palm MI. Medical Microbiology Course – 2010.’ ^[9]CDC 2017. Protect Your Baby from Group B Strep!|.

 In newborn

• Depending on the symptomatology and the type of damage

 

Nota Bene. In this document, the laboratory diagnosis of the infection with Streprococcus of group B was not extensively treated, but there were several elements related to pregnancy and newborn. For the complete diagnosis of this infection, those interested will be addressing infectionists physicians and microbiologists.

Infectious agent

Streptococcus agalactiae, group B Strep belongs to group I, pyogenic Group of Streptococci ^[10]Popa GL, Palm MI. Medical Microbiology Course – 2010.|..

 

Incidence and prevalence

There are no extensive studies. Among 500 women and their newborns, in a study done in Turkey, group B Strep was isolated to 46 pregnant and 8 newborns. The maternal colonization was 9.2% and the fetal one of 1.6%. The vertical transmission rate was 15.2%. ^[11]Eren A et al. The carriage of group B Streptococci … serotype distribution. Turk J Pediatr. 2005 Jan 1; 47 (1), 28-33..

It is estimated that at global level approximately 10-30% of pregnant women are strep group B carriers in the genital tract. ^[12]Heymann D.L. Management Manual of communicable diseases. 2012.’|

It was noted that in the case of pregnant women with group B Strep bacteriuria there is a higher risk of:

• Premature birth (15.3% vs 7.9%)
• Premature membrane rupture (10.7 vs 7.9)
• Intrauterine growth restriction syndrome
• Abortion. ^[13]Kessous R et al. Bacteruria with … pregnancy outcomes?. The Journal of maternal-Fetal & Neonatal Medicine. 2012 OCT 1; 25 (10), 1983-6

 

Source

Strictly human, from the gastrointestinal, urinary and genital tract. ^[14]Heymann D.L. Management Manual of communicable diseases. 2012.| ^[15] Popa GL et al. Medical Microbiology Course – 2010.. ^[16]CDC 2017. Protect Your Baby from Group B Strep!”.

Method of transmission

It can be transmitted:

• In the womb (antepartum),
• During childbirth (intrapartum),
• After birth, through direct contact (postpartum).

Risk groups

• Premature newborns or those at gestational age under 37 weeks.
• Newborns with natural birth with ruptured membranes of more than 18 hours before birth.
• Any newborn, by naturally birth, if the mother is carrying Streptococcus of group B.

The risk of congenital infection varies according to studies up to 15% and is correlated with the presence of group B streptococcus in urine. ^[17] Heymann D.L. Management Manual of communicable diseases. 2012.~ ^[18] CDC 2017. Protect Your Baby from Group B Strep!~. ^[19]Kessous R et al. Bacteruria … adverse pregnancy outcomes?. The Journal of maternal-Fetal & Neonatal Medicine. 2012 OCT 1; 25 (10), 1983-6

Incubation period

Between 1-6 days.

Infectiousness Period

During labor, the intrapartum period (during birth).

 

Prophylaxis

• Screening of vaginal secretion and rectal fingerprint for group B strep in all pregnant women at weeks 35-37 of gestation. ^[20] CDC, MMWR 2010. Prevention of Perinatal Group B … Guidelines from CDC, 2010.. ^[21]Popa GL et al. Antibiotic susceptibility … of perinatal Group B Streptococcal Disease. Gineco.ro. 2009;5(3):146-155
• Chemo-prophylaxis with ampicillin or penicillin administered intravenously to pregnant group B strep, at the onset and during the duration of labor, at birth by natural way. Erythromycin, Clindamycin, Cefazolin are recommended in pregnant women allergic to penicillin. ^[22]Heymann D.L. Management Manual of communicable diseases. 2012`~ ^[23] CDC 2017. Recommended regimens … early-onset group B streptococcal (GBS).. ^[24] CDC, MMWR 2010. Prevention of … redreamed Guidelines from CDC, 2010..
• Caesarean. ^[25] CDC, MMWR 2010. Prevention of Perinatal … redreamed Guidelines from CDC, 2010..

Vaccination

There’s no vaccine yet.

Birth to the female genitally infected with Streptococcus agalactie or group B strep

It is recommended: I.V. antibiotic during labor or caesarean. ^[26] CDC 2017. Recommended regimens for intrapartum … group B streptococcal (GBS).

Breastfeeding

There are no special recommendations.

Treatment

Specificity for each condition acquired by the newborn.

Bibliography

1. Heymann D.L. Management Manual of communicable diseases. 2012
2. Popa GL, Palm MI. Medical Microbiology Course – 2010. Retrieved from: http://www.microbiologie.ro
3. CDC 2017. Protect Your Baby from Group B Strep! Retrieved from: https://www.cdc.gov/Features/GroupBStrep/
4. CDC 2017. Recommended regimens for intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal (GBS). Retrieved: Disease https://www.cdc.gov/groupbstrep/guidelines/downloads/recommended-regimens.pdf
5. Eren A, Kucukercan M, Oguzoglu N, et al. The carriage of group B Streptococci in Turkish pregnant women and its transmission rate in newborns and serotype distribution. Turk J Pediatr. 2005 Jan 1; 47 (1): 28-33
6. Kessous R, Weintraub AY, Sergienko R, Lazer T, Press F, Wiznitzer A, Sheiner E. Bacteruria with group-B Streptococcus: Is it A risk factor for adverse pregnancy outcomes?. The Journal of maternal-Fetal & Neonatal Medicine. 2012 OCT 1; 25 (10): 1983-6
7. CDC, MMWR 2010. Prevention of Perinatal Group B Streptococcal Disease: redreamed Guidelines from CDC, 2010. Retrieved from: https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm
8. Popa GL, Vizitiu O, Georgescu R, Grigore L, Iarca C, Beldescu N, Popa MI. Antibiotic susceptibility of Group B Streptococcal strains in women of child-bearing age; Recommendations for prevention and control of perinatal Group B Streptococcal Disease. Gineco.ro. 2009;5(3):146-155