1
|
Kovacec V, Di Gregorio S, Pajon M, Khan UB, Poklepovich T, Campos J, Crestani C, Bentley SD, Jamrozy D, Mollerach M, Bonofiglio L. Genomic characterization of group B Streptococcus from Argentina: insights into prophage diversity, virulence factors and antibiotic resistance genes. Microb Genom 2025; 11:001399. [PMID: 40266661 PMCID: PMC12046356 DOI: 10.1099/mgen.0.001399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2024] [Accepted: 03/18/2025] [Indexed: 04/24/2025] Open
Abstract
Group B Streptococcus (GBS) is a commensal bacterium that can cause severe infections in infants and adults with comorbidities. Resistance and reduced susceptibility to antibiotics are continually on the rise, and vaccines remain in development. Prophages have been reported to contribute to GBS evolution and pathogenicity. However, no studies are available to date on prophage contribution to the epidemiology of GBS isolates from humans in South America. In the context of an Argentinian multicentric study, we had previously phenotypically characterized 365 human GBS isolates from invasive disease, urinary infections and maternal colonization. These isolates had been whole-genome sequenced, and their prophage presence was bioinformatically determined. In this study, we genomically characterized the isolates and analysed the prophage content in the context of the epidemiological data. The phylogenetic analysis of the 365 genomes with 103 GBS from public databases revealed that Argentinian GBS were related to isolates from around the world. The most prevalent lineages, independent of the isolated source, were CC23/Ia and CC12/Ib. Genes encoding virulence factors involved in immune response evasion, tissue damage and adherence to host tissues, and invasion were found in all of the genomes in accordance with previously described lineage distribution. According to the prevalent capsular types and the distribution of specific virulence factors in Argentinian GBS, over 95% coverage would be expected from the vaccines currently under development. Antibiotic resistance determinants (ARDs) to at least one antibiotic class were found in 90% of the genomes, including novel mutations in pbp2x, while more than 15% carried ARDs to three or more classes. GBS collected from urinary infections carried a significantly higher proportion of ARDs to multiple antibiotic classes than the rest of the isolates. A total of 454 prophages were found among the 468 genomes analysed, which were classified into 23 prophage types. Prophage presence exhibited variations based on GBS clonal complex and capsular type. A possible association between an increased GBS pathogenicity and the carriage of prophages with integrase type GBSInt8 and/or the presence of genes that encode the Phox Homology domain has been observed. The highest prevalence of prophages per genome was found in lineages CC17/III and CC19/III, while the lowest amount was observed in CC12/Ib. Overall, the highest density of prophages, virulence factors and ARDs determinants was found in CC19 isolates, mostly of capsular type III, independent of the isolates' source. This is the first analysis of the human-associated GBS population in South America based on whole-genome sequencing data, which will make a significant contribution to future studies on the global GBS population structure.
Collapse
Affiliation(s)
- Veronica Kovacec
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Bacteriología y Virología Molecular, Buenos Aires C1113, Argentina
| | - Sabrina Di Gregorio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Bacteriología y Virología Molecular, Buenos Aires C1113, Argentina
- CONICET, Buenos Aires C1425, Argentina
| | - Mario Pajon
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Bacteriología y Virología Molecular, Buenos Aires C1113, Argentina
| | - Uzma Basit Khan
- Parasites and Microbes Programme, Wellcome Sanger Institute, Cambridgeshire CB10 1SA, UK
| | - Tomas Poklepovich
- Unidad Operativa Centro Nacional de Genómica y Bioinformática, ANLIS Dr. Carlos G. Malbrán, Buenos Aires C1282AFF, Argentina
| | - Josefina Campos
- Unidad Operativa Centro Nacional de Genómica y Bioinformática, ANLIS Dr. Carlos G. Malbrán, Buenos Aires C1282AFF, Argentina
| | - Chiara Crestani
- Global Health Department, Institut Pasteur, Paris 75015, France
| | - Stephen D. Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Cambridgeshire CB10 1SA, UK
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Cambridgeshire CB10 1SA, UK
| | - Marta Mollerach
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Bacteriología y Virología Molecular, Buenos Aires C1113, Argentina
- CONICET, Buenos Aires C1425, Argentina
| | - Laura Bonofiglio
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Instituto de Bacteriología y Virología Molecular, Buenos Aires C1113, Argentina
- CONICET, Buenos Aires C1425, Argentina
| |
Collapse
|
2
|
Uggen E, Olaisen C, Lyng RV, Simonsen GS, Bævre-Jensen RM, Gran FW, Åsvold BO, Nilsen TIL, Damås JK, Afset JE. Incidence of invasive infections with Group B streptococcus in adults in Norway 1996-2019: a nationwide registry-based case-control study. Infection 2024; 52:1745-1752. [PMID: 38483786 PMCID: PMC11499455 DOI: 10.1007/s15010-024-02210-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 10/24/2024]
Abstract
PURPOSE Group B streptococcus (GBS) colonizes the gastrointestinal and vaginal mucosa in healthy adults, but has also become an increasing cause of invasive infection. The aims of this study were to describe the incidence and factors associated with the occurrence of invasive GBS disease in adults in Norway. METHODS We performed a nationwide retrospective case-control study of invasive GBS infections during 1996-2019, with two control groups; invasive Group A streptococcal disease (GAS) to control for changes in surveillance and diagnostics, and a second representing the general population. RESULTS A total of 3710 GBS episodes were identified. The age-standardized incidence rate increased steadily from 1.10 (95% CI 0.80-1.50) in 1996 to 6.70 (95% CI 5.90-7.50) per 100,000 person-years in 2019. The incidence rate had an average annual increase of 6.44% (95% CI 5.12-7.78). Incidence rates of GAS varied considerably, and there was no evidence of a consistent change over the study period. GBS incidence was highest among adults > 60 years of age. Cardiovascular disease, cancer, and diabetes were the most common comorbid conditions. There was a shift in the distribution of capsular serotypes from three dominant types to more equal distribution among the six most common serotypes. CONCLUSIONS The incidence of invasive GBS disease in adults increased significantly from 1996 to 2019. The increasing age of the population with accompanying underlying comorbid conditions might contribute to the increasing burden of invasive GBS disease. Interestingly, type 1 diabetes was also associated with the occurrence of invasive GBS disease.
Collapse
Affiliation(s)
- Elise Uggen
- Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- Mid-Norway Centre of Sepsis Research, Trondheim, Norway.
| | - Camilla Olaisen
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Valsø Lyng
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
- Research Group for Host-Microbee Interaction, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | | | - Frode Width Gran
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjørn Olav Åsvold
- HUNT Center for Molecular and Clinical Epidemiology, Department of Public Health and Nursing, NTNU, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, NTNU, Levanger, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Jan Kristian Damås
- Mid-Norway Centre of Sepsis Research, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Infectious Diseases, Clinic of Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Jan Egil Afset
- Mid-Norway Centre of Sepsis Research, Trondheim, Norway
- Department of Medical Microbiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| |
Collapse
|
3
|
Imperi M, Gherardi G, Alfarone G, Creti R. Group B Streptococcus Infections in Non-Pregnant Adults, Italy, 2015-2019. Pathogens 2024; 13:807. [PMID: 39338998 PMCID: PMC11434888 DOI: 10.3390/pathogens13090807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/29/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
Group B Streptococcus (GBS, Streptococcus agalactiae) is a pathogen of increasing importance in adults. Severe and invasive cases in non-pregnant adults were collected during the period 2015-2019 by voluntary-based surveillance. In total, 108 GBS strains were phenotypically and genotypically characterized for the serotype, antimicrobial resistance, pili, surface protein genes, and the hyper-virulent adhesin hvgA. Patients were divided into two age groups: adults (18-64 years; n = 32) and older adults (≥65 years; n = 72). The average age was 70.8 years, with a male/female ratio of 1.7. Most isolates were recovered from cases of bacteremia (blood, n = 93), and a higher frequency of invasive GBS infections (iGBS) was found among older adults (66.7%). Serotype III was the most frequent (n = 41, 38%), followed by type Ia and type V (n = 20 each, 18.5%). Serotypes Ia, Ib, II, III, IV, and V accounted for all but one isolates (99.1%). The iGBS isolates were universally susceptible to penicillin, while the prevalence of resistance to clindamycin, erythromycin, tetracycline, and high-level gentamicin resistance was 26.8%, 24.1%, 85.2%, and 5.5%, respectively, with the predominance of the erm(B) gene for macrolide resistance and the tet(M) gene for tetracycline resistance. The associations between the serotypes/antimicrobial resistance/virulence traits underlined the increasing importance of serotype III and its contribution to antimicrobial resistance as well as the steady increase over time of serotype IV. This nationwide study confirmed the need for monitoring the GBS epidemiology in non-pregnant adults through continuous surveillance of GBS infections.
Collapse
Affiliation(s)
| | | | | | - Roberta Creti
- Department of Infectious Diseases, Antibiotic Resistance and Special Pathogens Unit, Istituto Superiore di Sanità, 00161 Rome, Italy; (M.I.); (G.G.); (G.A.)
| |
Collapse
|
4
|
Kawai S, Miyoshi-Akiyama T, Katano H, Sunagawa K. Invasive Streptococcus agalactiae (group B streptococcus) infection with toxic shock-like syndrome: A report of a fatal non-pregnant case and a review of the literature. J Infect Chemother 2024; 30:71-76. [PMID: 37716644 DOI: 10.1016/j.jiac.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/19/2023] [Accepted: 09/04/2023] [Indexed: 09/18/2023]
Abstract
Streptococcus agalactiae (group B streptococcus; GBS) is a Gram-positive coccus. It has emerged as a cause of significant infections in non-pregnant adults, particularly neonates and individuals aged 65 years or older, which can lead to fatal outcomes. Streptococcal toxic shock-like syndrome (STSS) is an acute illness, which is mainly caused by exotoxin-producing strains of Streptococcus pyogenes and may result in death. In this report, we present a fatal non-pregnant case of STSS induced by GBS in a 45-year-old healthy female. The patient presented with fever, polyarthralgia, myalgia, and skin erythema. Matrix Assisted Laser Desorption/Ionization‒Time of Flight Mass Spectrometry (MALDI-TOF-MS) and PCR identified GBS in colonies from her blood and urine cultures, and she was diagnosed with septicemia and STSS. On the sixth day of her illness, she died from acute respiratory distress syndrome and multiple organ dysfunction syndrome. Whole-genome sequencing revealed the presence of several virulence genes in the genome of the GBS strain detected in the blood cultures, which may have contributed to the development of STSS and the patient's death.
Collapse
Affiliation(s)
- Shiori Kawai
- Internal Medicine, Saitama Cooperative Hospital, Saitama, Japan; Department of Diabetes, Endocrinology, and Hematology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan
| | - Keishin Sunagawa
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan; Department of Clinical Laboratory Medicine, Chiba Nishi General Hospital, Chiba, Japan.
| |
Collapse
|
5
|
Enany S, Tartor YH, Kishk RM, Gadallah AM, Ahmed E, Magdeldin S. Proteomics and metabolomics analyses of Streptococcus agalactiae isolates from human and animal sources. Sci Rep 2023; 13:20980. [PMID: 38017083 PMCID: PMC10684508 DOI: 10.1038/s41598-023-47976-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023] Open
Abstract
Streptococcus agalactiae (S. agalactiae), group B Streptococcus (GBS), a major cause of infection in a wide variety of diseases, have been compared in different human and animal sources. We aimed to compare the bacterial proteome and metabolome profiles of human and animal S. agalactiae strains to delineate biological interactions relevant to infection. With the innovative advancement in mass spectrometry, a comparative result between both strains provided a solid impression of different responses to the host. For instance, stress-related proteins (Asp23/Gls24 family envelope stress response protein and heat shock protein 70), which play a role in the survival of GBS under extreme environmental conditions or during treatment, are highly expressed in human and animal strains. One human strain contains ꞵ-lactamase (serine hydrolase) and biofilm regulatory protein (lytR), which are important virulence regulators and potential targets for the design of novel antimicrobials. Another human strain contains the aminoglycosides-resistance bifunctional AAC/APH (A0A0U2QMQ5) protein, which confers resistance to almost all clinically used aminoglycosides. Fifteen different metabolites were annotated between the two groups. L-aspartic acid, ureidopropionic acid, adenosine monophosphate, L-tryptophan, and guanosine monophosphate were annotated at higher levels in human strains. Butyric acid, fumaric acid, isoleucine, leucine, and hippuric acid have been found in both human and animal strains. Certain metabolites were uniquely expressed in animal strains, with fold changes greater than 2. For example, putrescine modulates biofilm formation. Overall, this study provides biological insights into the substantial possible bacterial response reflected in its macromolecular production, either at the proteomic or metabolomic level.
Collapse
Affiliation(s)
- Shymaa Enany
- Department of Microbiology and Immunology, Faculty of Pharmacy, Suez Canal University, Ismailia, 41522, Egypt.
- Biomedical Research Department, Armed Force College of Medicine, Cairo, Egypt.
| | - Yasmine H Tartor
- Department of Microbiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44511, Egypt
| | - Rania M Kishk
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Ahmed M Gadallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Eman Ahmed
- Proteomics and Metabolomics Unit, Department of Basic Research, Children's Cancer Hospital Egypt 57357, Cairo, 11441, Egypt
- Department of Pharmacology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| | - Sameh Magdeldin
- Proteomics and Metabolomics Unit, Department of Basic Research, Children's Cancer Hospital Egypt 57357, Cairo, 11441, Egypt
- Department of Physiology, Faculty of Veterinary Medicine, Suez Canal University, Ismailia, 41522, Egypt
| |
Collapse
|
6
|
Founou LL, Khan UB, Medugu N, Pinto TCA, Darboe S, Chendi Z, Founou RC, To KN, Jamrozy D, Karampatsas K, Carr VR, Pepper K, Dangor Z, Ip M, Le Doare K, Bentley SD. Molecular epidemiology of Streptococcus agalactiae in non-pregnant populations: a systematic review. Microb Genom 2023; 9. [PMID: 38019122 DOI: 10.1099/mgen.0.001140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) has recently emerged as an important pathogen among adults. However, it is overlooked in this population, with all global efforts being directed towards its containment among pregnant women and neonates. This systematic review assessed the molecular epidemiology and compared how the lineages circulating among non-pregnant populations relate to those of pregnant and neonatal populations worldwide. A systematic search was performed across nine databases from 1 January 2000 up to and including 20 September 2021, with no language restrictions. The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal Tool (PCAT) was used to assess the quality of included studies. The global population structure of GBS from the non-pregnant population was analysed using in silico typing and phylogenetic reconstruction tools. Twenty-four articles out of 13 509 retrieved across 9 databases were eligible. Most studies were conducted in the World Health Organization European region (12/24, 50 %), followed by the Western Pacific region (6/24, 25 %) and the Americas region (6/24, 25 %). Serotype V (23%, 2310/10240) and clonal complex (CC) 1 (29 %, 2157/7470) were the most frequent serotype and CC, respectively. The pilus island PI1 : PI2A combination (29 %, 3931/13751) was the most prevalent surface protein gene, while the tetracycline resistance tetM (55 %, 5892/10624) was the leading antibiotic resistance gene. This study highlights that, given the common serotype distribution identified among non-pregnant populations (V, III, Ia, Ib, II and IV), vaccines including these six serotypes will provide broad coverage. The study indicates advanced molecular epidemiology studies, especially in resource-constrained settings for evidence-based decisions. Finally, the study shows that considering all at-risk populations in an inclusive approach is essential to ensure the sustainable containment of GBS.
Collapse
Affiliation(s)
- Luria Leslie Founou
- Reproductive, Maternal, Newborn and Child Health (ReMARCH) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Bioinformatics and Applied Machine Learning Research Unit, EDEN Biosciences Research Institute (EBRI), EDEN Foundation, Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
| | - Uzma Basit Khan
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Nubwa Medugu
- Department of Medical Microbiology and Parasitology, National Hospital Abuja, Abuja, Nigeria
| | - Tatiana C A Pinto
- Instituto de Microbiologia Paulo de Goes, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Saffiatou Darboe
- Medical Research Council Unit at London School of Hygiene and Tropical Medicine, Banjul, Gambia
| | - Zhu Chendi
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Raspail Carrel Founou
- Antibiotic Resistance Infectious Diseases (ARID) Research Unit, Centre of Expertise and Biological Diagnostic of Cameroon Research Institute (CEDBCAM-RI), Yaoundé, Cameroon
- Antimicrobial Research Unit, School of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban, 4041, South Africa
- Department of Microbiology, Hematology and Immunology, Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
| | - Ka-Ning To
- Institute of Infection and Immunity, St George's University of London, London, UK
| | - Dorota Jamrozy
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | | | - Victoria R Carr
- Centre for Host-Microbiome Interactions, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, SE1 9RT, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Kevin Pepper
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| | - Ziyaad Dangor
- Vaccines and Infectious Diseases Analytics (VIDA) Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Margaret Ip
- Department of Microbiology, the Chinese University of Hong Kong, Hong Kong, PR China
| | - Kirsty Le Doare
- Medical Research Council Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Stephen D Bentley
- Department of Pathology, University of Cambridge, Cambridge, UK
- Parasites and Microbes, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton CB10 1SA, UK
| |
Collapse
|
7
|
Lee H, Kim ES, Song KH, Kim HB, Park JS, Park KU. Clinical and molecular epidemiology of invasive group B Streptococcus infections in adults in a referral center in Korea. Eur J Clin Microbiol Infect Dis 2022; 41:1407-1413. [PMID: 36207553 PMCID: PMC9546748 DOI: 10.1007/s10096-022-04505-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/30/2022] [Indexed: 12/01/2022]
Abstract
Invasive group B Streptococcus (GBS) infections are increasing among adults with underlying health conditions; however, clinical manifestations and serotype distribution remain unclear. This study investigated the molecular characteristics and antimicrobial resistance of invasive GBS in Korean adults. GBS isolates from patients with invasive diseases during 2006–2015 were investigated for capsular serotype, multilocus sequence type (ST), antimicrobial susceptibility, and resistance genes. Among the 74 isolates analyzed, the most common serotype was Ib (31.1%), followed by III (21.6%), V (20.3%), Ia (12.2%), and VI (12.2%). Thirteen STs were detected, with ST1, ST10, ST19, and ST23 as the most prevalent. The dominant capsular serotype exhibited by ST1 was V, and those expressed by ST10, ST19, and ST23 were Ib, III, and Ia, respectively. Erythromycin and levofloxacin resistance were observed in 33.8% and 31.1% of the isolates, respectively. ST10-Ib (n = 11/11, 100%) and ST654-Ib (n = 3/3, 100%) were dominant levofloxacin-resistant strains. Serotypes Ib, III, and V were most common among adults, which is inconsistent with recent reports in Korea where III, V, and Ia were predominant in infants. The difference in the serotype distribution between adults and children may be associated with the selective pressure imparted by antibiotics.
Collapse
Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea.,Seoul National University College of Medicine, Seoul, South Korea
| | - Eu Suk Kim
- Seoul National University College of Medicine, Seoul, South Korea. .,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Kyoung-Ho Song
- Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong Bin Kim
- Seoul National University College of Medicine, Seoul, South Korea.,Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jeong Su Park
- Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Kyoung Un Park
- Seoul National University College of Medicine, Seoul, South Korea.,Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| |
Collapse
|
8
|
Andersen M, Smith B, Murra M, Nielsen SY, Slotved HC, Henriksen TB. Invasive group B Streptococcus strains and clinical characteristics in Danish infants from 1999 to 2009. Front Microbiol 2022; 13:1001953. [PMID: 36246253 PMCID: PMC9554412 DOI: 10.3389/fmicb.2022.1001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Group B Streptococcus (GBS) infection in infants may result in both respiratory, cardiovascular, and neurological dysfunction and ultimately death of the infant. Surveillance of GBS strains in infants and their clinical characteristics guide development of effective vaccines and other potential treatments and may have implications for future prognostics and infant care. Therefore, we aimed to study GBS serotypes and clonal complexes (CC) in Danish infants with early onset infection (EOD) (0-6 days of life) and late-onset infection (LOD) (7-89 days of life) and to estimate the association between GBS strain and different clinical outcomes. Methods We included Danish infants less than 3 months of age with GBS isolates from blood or cerebrospinal fluid between 1999 and 2009. GBS isolates were analyzed by serotyping and multilocus sequence typing with classification of isolates into clonal complexes. Clinical characteristics were obtained by questionnaires completed by tending pediatrician including gestational age, Apgar scores, age at onset, meningitis, symptom severity, treatment duration, and mortality. Symptom severities were reported within neurological symptoms, need for respiratory or circulatory support, and treatment of disseminated intravascular coagulation. Results A total of 212 GBS isolates were collected with 129 from EOD and 83 from LOD. The dominating GBS strains were III/CC17 (41%), Ia/CC23 (17%), III/CC19 (15%), Ib/CC8-10 (7%), and V/CC1 (6%). Strain Ia/CC23 was mostly found in EOD, while III/CC17 was widespread in LOD, though being the most common in both EOD and LOD. Strain III/CC17 and Ia/CC23 had highest percentage of samples from cerebrospinal fluid (26%), while III/CC19 had the least (8%). Strain III/CC19 had highest mortality with about one fifth of infected infants dying (22%) followed by Ia/CC23 (16%), Ib/CC8-10 (9%), and then III/CC17 (6%). The symptom severity varied between strains, but with no strain consistently resulting in more severe symptoms. Conclusion Some potential differences in disease severity were observed between the different strains. These findings emphasize the continuous need for multimodal surveillance of infant GBS strains and their clinical characteristics to optimize development of GBS vaccines and other potential treatments.
Collapse
Affiliation(s)
- Mads Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Birgitte Smith
- Department of Pediatrics and Adolescent Medicine, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - May Murra
- Department of Microbiology, Vejle Hospital, Vejle, Denmark
| | - Stine Yde Nielsen
- Department of Microbiology, Vejle Hospital, Vejle, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Hans-Christian Slotved
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Tine Brink Henriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
9
|
Han G, Zhang B, Luo Z, Lu B, Luo Z, Zhang J, Wang Y, Luo Y, Yang Z, Shen L, Yu S, Cao S, Yao X. Molecular typing and prevalence of antibiotic resistance and virulence genes in Streptococcus agalactiae isolated from Chinese dairy cows with clinical mastitis. PLoS One 2022; 17:e0268262. [PMID: 35522690 PMCID: PMC9075616 DOI: 10.1371/journal.pone.0268262] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
Bovine mastitis is a common disease occurring in dairy farms and can be caused by more than 150 species of pathogenic bacteria. One of the most common causative organisms is Streptococcus agalactiae, which is also potentially harmful to humans and aquatic animals. At present, research on S. agalactiae in China is mostly concentrated in the northern region, with limited research in the southeastern and southwestern regions. In this study, a total of 313 clinical mastitis samples from large-scale dairy farms in five regions of Sichuan were collected for isolation of S. agalactiae. The epidemiological distribution of S. agalactiae was inferred by serotyping isolates with multiplex polymerase chain reaction. Susceptibility testing and drug resistance genes were detected to guide the clinical use of antibiotics. Virulence genes were also detected to deduce the pathogenicity of S. agalactiae in Sichuan Province. One hundred and five strains of S. agalactiae (33.6%) were isolated according to phenotypic features, biochemical characteristics, and 16S rRNA sequencing. Serotype multiplex polymerase chain reaction analysis showed that all isolates were of type Ia. The isolates were up to 100% sensitive to aminoglycosides (kanamycin, gentamicin, neomycin, and tobramycin), and the resistance rate to β-lactams (penicillin, amoxicillin, ceftazidime, and piperacillin) was up to 98.1%. The TEM gene (β-lactam-resistant) was detected in all isolates, which was in accordance with a drug-resistant phenotype. Analysis of virulence genes showed that all isolates harbored the cfb, cylE, fbsA, fbsB, hylB, and α-enolase genes and none harbored bac or lmb. These data could aid in the prevention and control of mastitis and improve our understanding of epidemiological trends in dairy cows infected with S. agalactiae in Sichuan Province.
Collapse
Affiliation(s)
- Guangli Han
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Baohai Zhang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Zidan Luo
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Biao Lu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Zhengzhong Luo
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Jieru Zhang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Yin Wang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Yan Luo
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Zexiao Yang
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Liuhong Shen
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Shumin Yu
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
| | - Suizhong Cao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
- * E-mail: (SC); (XY)
| | - Xueping Yao
- College of Veterinary Medicine, Sichuan Agricultural University, Chengdu, Sichuan, China
- Key Laboratory of Animal Disease and Human Health of Sichuan Province, Chengdu, Sichuan, China
- * E-mail: (SC); (XY)
| |
Collapse
|
10
|
Slotved HC, Møller JK, Khalil MR, Nielsen SY. The serotype distribution of Streptococcus agalactiae (GBS) carriage isolates among pregnant women having risk factors for early-onset GBS disease: a comparative study with GBS causing invasive infections during the same period in Denmark. BMC Infect Dis 2021; 21:1129. [PMID: 34724923 PMCID: PMC8561911 DOI: 10.1186/s12879-021-06820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/25/2021] [Indexed: 01/12/2023] Open
Abstract
Background We describe the serotype distribution of Streptococcus agalactiae (GBS) carriage isolates from women in labor and among GBS isolates causing invasive infections during the same period to see if the distribution of carriage serotypes reflects the GBS serotypes causing invasive diseases including early-onset disease (EOGBS). Methods Data on invasive isolates from 2019 including serotype, erythromycin and clindamycin susceptibility was retrieved from the Danish national reference laboratory, Statens Serum Institut. Carriage isolates were collected from women with risk factors for EOGBS enrolled at delivery at the maternity ward at a Danish University Hospital, first half of 2019. Results Among carriage isolates, the dominant serotype was IX (21 %) followed by serotype III (19 %). The resistance to erythromycin and clindamycin was 21 and 26 %, respectively. Among invasive GBS isolates, no case of EOGBS with serotype IX was detected but the distribution of serotypes were otherwise similar to the GBS carrier strains. The corresponding resistance to erythromycin and clindamycin was 23 and 15 %, respectively. Penicillin resistance was not detected among carriage nor invasive isolates. Conclusions The distribution of serotypes among carriage and invasive GBS reflects the assumption that EOGBS occur following transmission of GBS from mother to newborn, with the exception of serotype IX. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06820-2.
Collapse
Affiliation(s)
- Hans-Christian Slotved
- Department of Bacteria, Parasites and, Fungi, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark.
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Mohammad Rohi Khalil
- Department of Gynecology and Obstetrics, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Stine Yde Nielsen
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
11
|
Navarro-Torné A, Curcio D, Moïsi JC, Jodar L. Burden of invasive group B Streptococcus disease in non-pregnant adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0258030. [PMID: 34591924 PMCID: PMC8483371 DOI: 10.1371/journal.pone.0258030] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Streptococcus agalactiae or group B Streptococcus (GBS) has emerged as an important cause of invasive disease in adults, particularly among the elderly and those with underlying comorbidities. Traditionally, it was recognised as an opportunistic pathogen colonising and causing disease in pregnant women, neonates, and young infants. Reasons for the upsurge of invasive GBS (iGBS) among the elderly remain unclear, although it has been related to risk factors such as underlying chronic diseases, immunosenescence, impaired inflammatory response, and spread of virulent clones. Antibiotics are successfully as treatment or prophylaxis against iGBS. Several candidate vaccines against iGBS are under development. Objectives To conduct a systematic review of the current literature on invasive GBS in order to determine disease incidence and case fatality ratio (CFR) among non-pregnant adults. Additionally, information on risk factors, clinical presentation, serotype distribution, and antimicrobial resistance was also retrieved. Methods Between January and June 2020, electronic searches were conducted in relevant databases: MEDLINE, EMBASE, Global Health, and SCOPUS. Studies were included in the systematic review if they met the inclusion/exclusion criteria. The authors assessed the selected studies for relevance, risk of bias, outcome measures, and heterogeneity. Meta-analyses on incidence and CFR were conducted after evaluating the quality of methods for assessment of exposure and outcomes. Results Pooled estimates of iGBS incidence in non-pregnant adults 15 years and older were 2.86 cases per 100.000 population (95% CI, 1.68–4.34). Incidence rates in older adults were substantially higher, 9.13 (95%CI, 3.53–17.22) and 19.40 (95%CI, 16.26–22.81) per 100.000 population ≥50 and ≥ 65 years old, respectively. Incidence rates ranged from 0.40 (95% CI, 0.30–0.60) in Africa to 5.90 cases per 100.000 population (95% CI, 4.30–7.70) in North America. The overall CFR was and 9.98% (95% CI, 8.47–11.58). CFR was highest in Africa at 22.09% (95% CI, 12.31–33.57). Serotype V was the most prevalent serotype globally and in North America accounting for 43.48% (n = 12926) and 46,72% (n = 12184) of cases, respectively. Serotype Ia was the second and serotype III was more prevalent in Europe (25.0%) and Asia (29.5%). Comorbidities were frequent among non-pregnant adult iGBS cases. Antimicrobial resistance against different antibiotics (i.e., penicillin, erythromycin) is increasing over time. Conclusions This systematic review revealed that iGBS in non-pregnant adults has risen in the last few years and has become a serious public health threat especially in older adults with underlying conditions. Given the current serotype distribution, vaccines including serotypes predominant among non-pregnant adults (i.e., serotypes V, Ia, II, and III) in their formulation are needed to provide breadth of protection. Continued surveillance monitoring potential changes in serotype distribution and antimicrobial resistance patterns are warranted to inform public health interventions.
Collapse
Affiliation(s)
| | | | | | - Luis Jodar
- Pfizer Inc, Collegeville, PA, United States of America
| |
Collapse
|
12
|
Carra E, Russo S, Micheli A, Garbarino C, Ricchi M, Bergamini F, Bassi P, Prosperi A, Piva S, Cricca M, Schiavo R, Merialdi G, Serraino A, Arrigoni N. Evidence of Common Isolates of Streptococcus agalactiae in Bovines and Humans in Emilia Romagna Region (Northern Italy). Front Microbiol 2021; 12:673126. [PMID: 34177854 PMCID: PMC8226232 DOI: 10.3389/fmicb.2021.673126] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Streptococcus agalactiae (group B Streptococcus, GBS) is one of the most important agents of bovine mastitis and causes remarkable direct and indirect economic losses to the livestock sector. Moreover, this species can cause severe human diseases in susceptible individuals. To investigate the zoonotic potential of S. agalactiae, 203 sympatric isolates from both humans and cattle, isolated in the same time frame (2018) and in the same geographic area (Emilia Romagna region, Northern Italy), were characterized by molecular capsular typing (MCT), pilus island typing (PI), and multi-locus sequence typing (MLST). In addition, antibiotic-resistant phenotypes were investigated. The distribution of the allelic profiles obtained by combining the three genotyping methods (MCT-PI-MLST) resulted in 64 possible genotypes, with greater genetic variability among the human compared to the bovine isolates. Although the combined methods had a high discriminatory power (>96,2%), five genotypes were observed in both species (20,9% of the total isolates). Furthermore, some of these strains shared the same antibiotic resistance profiles. The finding of human and bovine isolates with common genotypes and antibiotic resistance profiles supports the hypothesis of interspecies transmission of S. agalactiae between bovines and humans.
Collapse
Affiliation(s)
- Elena Carra
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Simone Russo
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Alessia Micheli
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Chiara Garbarino
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Matteo Ricchi
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Federica Bergamini
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Patrizia Bassi
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Alice Prosperi
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Silvia Piva
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Monica Cricca
- Microbiology, DIMES, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Center for Applied Biomedical Research, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Roberta Schiavo
- Microbiology, Department of Clinical Pathology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Giuseppe Merialdi
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| | - Andrea Serraino
- Department of Veterinary Medical Sciences, University of Bologna, Bologna, Italy
| | - Norma Arrigoni
- Experimental Zooprophylactic Institute in Lombardy and Emilia Romagna, Brescia, Italy
| |
Collapse
|
13
|
Slotved HC, Fuursted K, Kavalari ID, Hoffmann S. Molecular Identification of Invasive Non-typeable Group B Streptococcus Isolates From Denmark (2015 to 2017). Front Cell Infect Microbiol 2021; 11:571901. [PMID: 33854981 PMCID: PMC8039440 DOI: 10.3389/fcimb.2021.571901] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 03/09/2021] [Indexed: 11/13/2022] Open
Abstract
The number of invasive Streptococcus agalactiae (GBS) non-typeable (NT) isolates in Denmark received since 1999 has in general accounted for 10% of all invasive GBS isolates. We present data on 55 clinical NT isolates based on clinical manifestations, clonal relationship, antimicrobial resistance (AMR) determinants, and virulence factors. The GBS isolates included in this study were phenotypic-based NT obtained from 2015 to 2017, as well as 10 reference isolates. Whole genome sequencing (WGS) was performed on all isolates and the data were analyzed for the presence of both species specific genes, capsular genes (genotype), and other relevant genes. We furthermore compared different procedures for detection of serotype specific capsular genes. Overall we were able to genotype 54 of the 55 isolates. After retesting the isolates a phenotype was detected for 20 (36%) isolates, of which the initial phenotyping problem for 13 isolates was found to be due to a problem with serotype Ia specific antiserum. Thirty-five isolates remained phenotypic non-typeable with a majority of genotype V isolates which do not express a capsular gene. From all the Danish invasive GBS isolates from 2015 to 2017, the 35 NT isolates were all detected in the age group above 21 years with bacteremia. The 35 NT isolates belonged to six different well-known human pathogenic clonal complexes. The CDC recommended sequences for capsule genotyping were the most optimal for serotype prediction, because of the sequence simplicity and clear cutoff values. However we recommend to also use other capsular sequences for the NT isolates, if they cannot be genotyped by the CDC method.
Collapse
Affiliation(s)
- Hans-Christian Slotved
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Kurt Fuursted
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ioanna Drakaki Kavalari
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
14
|
Slotved HC, Hoffmann S. The Epidemiology of Invasive Group B Streptococcus in Denmark From 2005 to 2018. Front Public Health 2020; 8:40. [PMID: 32211361 PMCID: PMC7076979 DOI: 10.3389/fpubh.2020.00040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/06/2020] [Indexed: 11/13/2022] Open
Abstract
Previous epidemiology reports on invasive Streptococcus agalactiae (GBS) infections in Denmark did not include all patient age groups. The aim of this study was therefore to analyze the GBS incidence in all age groups during the period 2005-2018 and to present the serotype distribution and the antibiotic susceptibility. Data were retrieved from the Danish laboratory surveillance system, and these included data on typing and susceptibility testing for erythromycin and clindamycin. Early-onset disease (EOD) (mean incidence 0.17 per 1,000 live births) and late-onset disease (LOD) (mean incidence 0.14 per 1,000 live births) showed a low level during the period. The incidence was stable in the age groups 91 days to 4 years, 5-19 years, and 20-64 years. From 2005 to 2018, the incidence in the elderly showed a significantly increasing trend (P < 0.05), that in the 65-74 years increased from 3.23 to 8.34 per 100,000, and that in the 75+ years increased from 6.85 to 16.01 per 100,000. Erythromycin and clindamycin resistance fluctuated over the period; however, the overall trend was increasing. Data showed that EOD and LOD incidence continued to be low, whereas an increasing trend in GBS infections in the elderly was observed. The prevalence of erythromycin and clindamycin resistance increased from 2005 to 2018.
Collapse
Affiliation(s)
- Hans-Christian Slotved
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| |
Collapse
|
15
|
Six A, Krajangwong S, Crumlish M, Zadoks RN, Walker D. Galleria mellonella as an infection model for the multi-host pathogen Streptococcus agalactiae reflects hypervirulence of strains associated with human invasive disease. Virulence 2020; 10:600-609. [PMID: 31230520 PMCID: PMC6592362 DOI: 10.1080/21505594.2019.1631660] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Streptococcus agalactiae, or group B Streptococcus (GBS), infects diverse hosts including humans and economically important species such as cattle and fishes. In the context of human health, GBS is a major cause of neonatal infections and an emerging cause of invasive disease in adults and of foodborne disease in Southeast Asia. Here we show that GBS is able to establish a systemic infection in Galleria mellonella larvae that is associated with extensive bacterial replication and dose-dependent larval survival. This infection model is suitable for use with GBS isolates from both homeothermic and poikilothermic hosts. Hypervirulent sequence types (ST) associated with invasive human disease in neonates (ST17) or adults (ST283) show increased virulence in this model, indicating it may be useful in studying GBS virulence determinants, albeit with limitations for some host-specific virulence factors. In addition, we demonstrate that larval survival can be afforded by antibiotic treatment and so the model may also be useful in the development of novel anti-GBS strategies. The use of G. mellonella in GBS research has the potential to provide a low-cost infection model that could reduce the number of vertebrates used in the study of GBS infection.
Collapse
Affiliation(s)
- Anne Six
- a Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Sakranmanee Krajangwong
- a Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | | | - Ruth N Zadoks
- c Institute of Biodiversity, Animal Health and Comparative Medicine, College of Medical, Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| | - Daniel Walker
- a Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences , University of Glasgow , Glasgow , UK
| |
Collapse
|
16
|
Jump RLP, Wilson BM, Baechle D, Briggs JM, Banks RE, Song S, Zappernick T, Perez F. Risk Factors and Mortality Rates Associated With Invasive Group B Streptococcus Infections Among Patients in the US Veterans Health Administration. JAMA Netw Open 2019; 2:e1918324. [PMID: 31880800 PMCID: PMC6991221 DOI: 10.1001/jamanetworkopen.2019.18324] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE The incidence of invasive infections caused by group B Streptococcus (GBS) continues to increase in the United States. Although diabetes is a key risk factor for invasive GBS, the influence of long-term glycemic control is not well characterized; other risk factors and mortality rates associated with specific types of invasive GBS infections are unknown. OBJECTIVE To investigate risk factors and mortality rates associated with specific invasive GBS infectious syndromes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used US Veterans Health Administration data to assess active users of the Veterans Affairs health care system between January 1, 2008, and December 31, 2017. Data analysis was conducted from April 2018 to August 2019. EXPOSURES Invasive GBS infections. MAIN OUTCOMES AND MEASURES The specific types of infectious syndromes and comorbid conditions among patients with an invasive GBS infection were evaluated. RESULTS Between 2008 and 2017, 5175 patients in the Veterans Affairs health care system experienced 5497 invasive GBS infections (5027 [97.1%] men, 3737 [72.2%] white, and 4545 [87.8%] non-Latino); all-cause 30-day mortality was 8.7% (451 of 5175). The most frequently observed infections were osteomyelitis (1171 [21.3%]), bacteremia without focus (1009 [18.4%]), skin or soft-tissue infections (919 [16.7%]), and pneumonia or empyema (694 [12.6%]). All-cause 30-day mortality following the index infection for each patient was highest among patients with peritonitis (38 of 138 [27.5%]) and pneumonia or empyema (116 of 664 [17.5%]) and lowest among those with osteomyelitis (15 of 1075 [1.4%]) or joint infection (17 of 501 [3.4%]). The most common comorbid conditions among patients with invasive GBS infections were diabetes (3364 [65.0%]), obesity (2669 [51.6%]), and chronic heart conditions (1633 [31.6%]). From 2008 to 2017, the incidence of invasive GBS infections increased from 9.23 to 11.67 cases per 100 000 person-years (P = .049). Stratification by body mass index showed the highest incidence of infections among patients at the extremes of body mass index (body mass index <18.5, 25.1 cases per 100 000 person-years; body mass index ≥40, 31.0 cases per 100 000 person-years). The incidence among patients with diabetes and poor long-term glycemic control (ie, hemoglobin A1c ≥9.5%) was 4-fold greater than among patients with diabetes and good glycemic control (ie, hemoglobin A1c <7.5%) (78.3 cases vs 19.0 cases per 100 000 person-years; unadjusted incident rate ratio, 4.1; 95% CI, 3.7-4.4; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, comorbid conditions and 30-day mortality varied among types of invasive GBS infections. Obesity and poor long-term glycemic control were associated with invasive GBS infections. Efforts to reverse the trend of an increased incidence of invasive GBS infections should continue to support reducing obesity and focus on improving glycemic control.
Collapse
Affiliation(s)
- Robin L. P. Jump
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Specialty Care Center of Innovation, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brigid M. Wilson
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel Baechle
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Janet M. Briggs
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Richard E. Banks
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Sunah Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Taissa Zappernick
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Federico Perez
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| |
Collapse
|
17
|
Francois Watkins LK, McGee L, Schrag SJ, Beall B, Jain JH, Pondo T, Farley MM, Harrison LH, Zansky SM, Baumbach J, Lynfield R, Snippes Vagnone P, Miller LA, Schaffner W, Thomas AR, Watt JP, Petit S, Langley GE. Epidemiology of Invasive Group B Streptococcal Infections Among Nonpregnant Adults in the United States, 2008-2016. JAMA Intern Med 2019; 179:479-488. [PMID: 30776079 PMCID: PMC6450309 DOI: 10.1001/jamainternmed.2018.7269] [Citation(s) in RCA: 141] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Accepted: 10/26/2018] [Indexed: 12/17/2022]
Abstract
Importance Group B Streptococcus (GBS) is an important cause of invasive bacterial disease. Previous studies have shown a substantial and increasing burden of GBS infections among nonpregnant adults, particularly older adults and those with underlying medical conditions. Objective To update trends of invasive GBS disease among US adults using population-based surveillance data. Design, Setting, and Participants In this population-based surveillance study, a case was defined as isolation of GBS from a sterile site between January 1, 2008, and December 31, 2016. Demographic and clinical data were abstracted from medical records. Rates were calculated using US Census data. Antimicrobial susceptibility testing and serotyping were performed on a subset of isolates. Case patients were residents of 1 of 10 catchment areas of the Active Bacterial Core surveillance (ABCs) network, representing approximately 11.5% of the US adult population. Patients were included in the study if they were nonpregnant, were 18 years or older, were residents of an ABCs catchment site, and had a positive GBS culture from a normally sterile body site. Main Outcomes and Measures Trends in GBS cases overall and by demographic characteristics (sex, age, and race), underlying clinical conditions of patients, and isolate characteristics are described. Results The ABCs network detected 21 250 patients with invasive GBS among nonpregnant adults from 2008 through 2016. The GBS incidence in this population increased from 8.1 cases per 100 000 population in 2008 to 10.9 in 2016 (P = .002 for trend). There were 3146 cases reported in 2016 (59% male; median age, 64 years; age range, 18-103 years). The GBS incidence was higher among men than women and among blacks than whites and increased with age. Projected to the US population, an estimated 27 729 cases of invasive disease and 1541 deaths occurred in the United States in 2016. Ninety-five percent of cases in 2016 occurred in someone with at least 1 underlying condition, most commonly obesity (53.9%) and diabetes (53.4%). Resistance to clindamycin increased from 37.0% of isolates in 2011 to 43.2% in 2016 (P = .02). Serotypes Ia, Ib, II, III, and V accounted for 86.4% of isolates in 2016; serotype IV increased from 4.7% in 2008 to 11.3% in 2016 (P < .001 for trend). Conclusions and Relevance The public health burden of invasive GBS disease among nonpregnant adults is substantial and continues to increase. Chronic diseases, such as obesity and diabetes, may contribute.
Collapse
Affiliation(s)
- Louise K. Francois Watkins
- Epidemic Intelligence Service Program, Centers for Disease Control and Prevention, Atlanta, Georgia
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lesley McGee
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stephanie J. Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bernard Beall
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer Hudson Jain
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica M. Farley
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Lee H. Harrison
- Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Maryland
| | | | | | | | | | - Lisa A. Miller
- Colorado School of Public Health, University of Colorado Denver, Aurora
- Colorado Department of Public Health and Environment, Denver
| | | | | | | | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Gayle E. Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
- Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
18
|
Wang R, Li L, Huang T, Huang W, Lei A, Chen M. Capsular Switching and ICE Transformation Occurred in Human Streptococcus agalactiae ST19 With High Pathogenicity to Fish. Front Vet Sci 2018; 5:281. [PMID: 30483518 PMCID: PMC6242859 DOI: 10.3389/fvets.2018.00281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/23/2018] [Indexed: 12/15/2022] Open
Abstract
Although Streptococcus agalactiae (GBS) cross-infection between human and fish has been confirmed in experimental and clinical studies, the mechanisms underlying GBS cross-species infection remain largely unclear. We have found different human GBS ST19 strains exhibiting strong or weak pathogenic to fish (sGBS and wGBS). In this study, our objective was to identify the genetic elements responsible for GBS cross species infection based on genome sequence data and comparative genomics. The genomes of 11 sGBS strains and 11 wGBS strains were sequenced, and the genomic analysis was performed base on pan-genome, CRISPRs, phylogenetic reconstruction and genome comparison. The results from the pan-genome, CRISPRs analysis and phylogenetic reconstruction indicated that genomes between sGBS were more conservative than that of wGBS. The genomic differences between sGBS and wGBS were primarily in the Cps region (about 111 kb) and its adjacent ICE region (about 106 kb). The Cps region included the entire cps operon, and all sGBS were capsular polysaccharide (CPS) type V, while all wGBS were CPS type III. The ICE region of sGBS contained integrative and conjugative elements (ICE) with IQ element and erm(TR), and was very conserved, whereas the ICE region of wGBS contained ICE with mega elements and the variation was large. The capsular switching (III–V) and transformation of ICE adjacent to the Cps region occurred in human GBS ST19 with different pathogenicity to fish, which may be related to the capability of GBS cross-infection.
Collapse
Affiliation(s)
- Rui Wang
- Guangxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, China.,Institute of Animal Science and Technology, Guangxi University, Nanning, China
| | - Liping Li
- Guangxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, China
| | - Ting Huang
- Guangxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, China
| | - Weiyi Huang
- Institute of Animal Science and Technology, Guangxi University, Nanning, China
| | - Aiying Lei
- Guangxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, China
| | - Ming Chen
- Guangxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Academy of Fishery Sciences, Nanning, China
| |
Collapse
|
19
|
Lyhs U, Kulkas L, Katholm J, Waller KP, Saha K, Tomusk RJ, Zadoks RN. Streptococcus agalactiae Serotype IV in Humans and Cattle, Northern Europe 1. Emerg Infect Dis 2018; 22:2097-2103. [PMID: 27869599 PMCID: PMC5189126 DOI: 10.3201/eid2212.151447] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Streptococcus agalactiae is an emerging pathogen of nonpregnant human adults worldwide and a reemerging pathogen of dairy cattle in parts of Europe. To learn more about interspecies transmission of this bacterium, we compared contemporaneously collected isolates from humans and cattle in Finland and Sweden. Multilocus sequence typing identified 5 sequence types (STs) (ST1, 8, 12, 23, and 196) shared across the 2 host species, suggesting possible interspecies transmission. More than 54% of the isolates belonged to those STs. Molecular serotyping and pilus island typing of those isolates did not differentiate between populations isolated from different host species. Isolates from humans and cattle differed in lactose fermentation, which is encoded on the accessory genome and represents an adaptation to the bovine mammary gland. Serotype IV-ST196 isolates were obtained from multiple dairy herds in both countries. Cattle may constitute a previously unknown reservoir of this strain.
Collapse
|
20
|
Slotved HC, Hoffmann S. Evaluation of procedures for typing of group B Streptococcus: a retrospective study. PeerJ 2017; 5:e3105. [PMID: 28321367 PMCID: PMC5357338 DOI: 10.7717/peerj.3105] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 02/18/2017] [Indexed: 12/05/2022] Open
Abstract
Background This study evaluates two procedures for typing of Streptococcus agalactiae (group B streptococci; GBS) isolates, using retrospective typing data from the period 2010 to 2014 with a commercial latex agglutination test (latex test) and the Lancefield precipitation test (LP test). Furthermore, the genotype distribution of phenotypically non-typable (NT) GBS isolates is presented. We also raise the awareness, that the difference in typing results obtained by phenotypical methods and genotype based methods may have implications on vaccine surveillance in case a GBS vaccine is introduced. Methods A total of 616 clinical GBS isolates from 2010 to 2014 were tested with both a latex test and the LP test. Among these, 66 isolates were genotyped by PCR, including 41 isolates that were phenotypically NT. Results The latex test provided a serotype for 83.8% of the isolates (95% CI [80.7–86.6]) compared to 87.5% (95% CI [84.6–90.0]) obtained by the LP method. The two assays provided identical capsular identification for all sero-typeable isolates (excluding NT isolates). The PCR assay provided a genotype designation to the 41 isolates defined as phenotypically NT isolates. Discussion We found that the latex test showed a slightly lower identification percentage than the LP test. Our recommendation is to use the latex agglutination as the routine primary assay for GBS surveillance, and then use the more labour intensive precipitation test on the NT isolates to increase the serotyping rate. A genotype could be assigned to all the phenotypically NT isolates, however, as a consequence genotyping will overestimate the coverage from possible future capsular polysaccharide based GBS vaccines.
Collapse
Affiliation(s)
- Hans-Christian Slotved
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut , Copenhagen , Denmark
| | - Steen Hoffmann
- Neisseria and Streptococcus Reference Laboratory, Department of Microbiology and Infection Control, Statens Serum Institut , Copenhagen , Denmark
| |
Collapse
|
21
|
Changing Epidemiology of Group B Streptococcus Susceptibility to Fluoroquinolones and Aminoglycosides in France. Antimicrob Agents Chemother 2016; 60:7424-7430. [PMID: 27736761 DOI: 10.1128/aac.01374-16] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 09/29/2016] [Indexed: 12/27/2022] Open
Abstract
Group B Streptococcus (GBS) is the leading cause of neonatal invasive infections and an emerging pathogen in the elderly. Our objectives were to describe the evolution of GBS resistance to antibiotics in France and to investigate the emergence of fluoroquinolone (FQ)-resistant isolates. A total of 8,757 unrelated GBS isolates were collected and tested for antibiotic susceptibility from 2007 to 2014 according to EUCAST recommendations. All isolates were susceptible to penicillin G, amoxicillin, and vancomycin. Resistance to macrolides decreased from 47.0% to 30.0%, whereas high-level resistance to aminoglycosides, especially amikacin, increased from 6.4% to 8.8% and 24 isolates (0.3%) were highly resistant to gentamicin. FQ resistance gradually increased from 0.2% in 2007 (n = 1) to 1.5% in 2014 (n = 18, P < 0.01). Capsular polysaccharide (CPS) genotyping, multilocus sequence typing, and sequencing of the quinolone resistance-determining region (QRDR) showed that GBS isolates of sequence type 19 (ST-19) CPS type V were largely overrepresented in FQ-resistant isolates (n = 30, 45.5%). All 30 strains displayed the same QRDR mutations and were often associated with cross-resistance to macrolides (93.3%) and gentamicin (30%). In conclusion, we report the rise of FQ- and aminoglycoside-resistant GBS in France over an 8-year study period, an evolution likely linked to the clonal expansion of ST-19 CPS V-resistant isolates. This study emphasizes the need for a continuous surveillance of GBS epidemiology and antibiotic susceptibility.
Collapse
|
22
|
Kobayashi M, Vekemans J, Baker CJ, Ratner AJ, Le Doare K, Schrag SJ. Group B Streptococcus vaccine development: present status and future considerations, with emphasis on perspectives for low and middle income countries. F1000Res 2016; 5:2355. [PMID: 27803803 PMCID: PMC5070600 DOI: 10.12688/f1000research.9363.1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2016] [Indexed: 01/07/2023] Open
Abstract
Globally, group B Streptococcus (GBS) remains the leading cause of sepsis and meningitis in young infants, with its greatest burden in the first 90 days of life. Intrapartum antibiotic prophylaxis (IAP) for women at risk of transmitting GBS to their newborns has been effective in reducing, but not eliminating, the young infant GBS disease burden in many high income countries. However, identification of women at risk and administration of IAP is very difficult in many low and middle income country (LMIC) settings, and is not possible for home deliveries. Immunization of pregnant women with a GBS vaccine represents an alternate pathway to protecting newborns from GBS disease, through the transplacental antibody transfer to the fetus in utero. This approach to prevent GBS disease in young infants is currently under development, and is approaching late stage clinical evaluation. This manuscript includes a review of the natural history of the disease, global disease burden estimates, diagnosis and existing control options in different settings, the biological rationale for a vaccine including previous supportive studies, analysis of current candidates in development, possible correlates of protection and current status of immunogenicity assays. Future potential vaccine development pathways to licensure and use in LMICs, trial design and implementation options are discussed, with the objective to provide a basis for reflection, rather than recommendations.
Collapse
Affiliation(s)
- Miwako Kobayashi
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, USA
| | - Johan Vekemans
- Initiative for Vaccine Research, World Health Organization, Geneva, Switzerland
| | - Carol J. Baker
- Department of Pediatrics, Baylor College of Medicine, Houston, USA
- Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, USA
- Center for Vaccine Awareness and Research, Texas Children's Hospital, Houston, USA
| | - Adam J. Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York, USA
| | - Kirsty Le Doare
- Centre for International Child Health, Imperial College, London, UK
| | - Stephanie J. Schrag
- National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, USA
| |
Collapse
|
23
|
Ballard MS, Schønheyder HC, Knudsen JD, Lyytikäinen O, Dryden M, Kennedy KJ, Valiquette L, Pinholt M, Jacobsson G, Laupland KB. The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment. Infect Dis (Lond) 2016; 48:386-91. [PMID: 26759190 DOI: 10.3109/23744235.2015.1131330] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Population-based studies conducted in single regions or countries have identified significant changes in the epidemiology of invasive group B streptococcus (GBS) infection. However, no studies have concurrently compared the epidemiology of GBS infections among multiple different regions and countries over time. The study objectives were to define the contemporary incidence and determinants of GBS bloodstream infection (BSI) and assess temporal changes in a multi-national population. METHODS Population-based surveillance for GBS BSI was conducted in nine regions in Australia, Canada, Denmark, Sweden, Finland and the UK during 2000-2010. Incidence rates were age- and gender-standardised to the EU population. RESULTS During 114 million patient-years of observation, 3464 cases of GBS BSI were identified for an overall annual incidence of 3.4 patients per 100,000 persons. There were marked differences in the overall (range = 1.8-4.1 per 100,000 person-year) and neonatal (range = 0.19-0.83 per 1000 live births) incidences of GBS BSI observed among the study regions. The overall incidence significantly (p = 0.05) increased. Rates of neonatal disease were stable, while the incidence in individuals older than 60 years doubled (p = 0.003). In patients with detailed data (n = 1018), the most common co-morbidity was diabetes (25%). During the study period, the proportion of cases associated with diabetes increased. CONCLUSIONS While marked variability in the incidence of GBS BSI was observed among these regions, it was consistently found that rates increased among older adults, especially in association with diabetes. The burden of this infection may be expected to continue to increase in ageing populations worldwide.
Collapse
Affiliation(s)
- Mark S Ballard
- a Department of Medicine , University of Calgary , Calgary , Alberta , Canada
| | - Henrik C Schønheyder
- b Department of Clinical Microbiology , Aarhus University Hospital , Aalborg , Denmark ;,c Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Jenny Dahl Knudsen
- d Department of Clinical Microbiology , Copenhagen University Hospital, Hvidovre Hospital , Copenhagen , Denmark
| | - Outi Lyytikäinen
- e Department of Infectious Disease Surveillance and Control , National Institute for Health and Welfare , Helsinki , Finland
| | - Matthew Dryden
- f Department of Microbiology , Royal Hampshire County Hospital, Hampshire Hospitals NHS Foundation Trust , Winchester , UK
| | - Karina J Kennedy
- g Department of Infectious Disease and Microbiology , Canberra Hospital and Health Services, Australian National University Medical School , Australia
| | - Louis Valiquette
- h Department of Microbiology and Infectious Diseases , Université de Sherbrooke , Sherbrooke , Québec , Canada
| | - Mette Pinholt
- i Department of Clinical Microbiology , Copenhagen University Hospital, Herlev Hospital , Copenhagen , Denmark
| | - Gunnar Jacobsson
- j Department of Infectious Diseases , Skaraborg Hospital , Skövde , Sweden
| | - Kevin B Laupland
- a Department of Medicine , University of Calgary , Calgary , Alberta , Canada ;,k Department of Medicine , Royal Inland Hospital , Kamloops , British Columbia , Canada
| | | |
Collapse
|
24
|
Björnsdóttir ES, Martins ER, Erlendsdóttir H, Haraldsson G, Melo-Cristino J, Kristinsson KG, Ramirez M. Changing epidemiology of group B streptococcal infections among adults in Iceland: 1975-2014. Clin Microbiol Infect 2015; 22:379.e9-379.e16. [PMID: 26691681 DOI: 10.1016/j.cmi.2015.11.020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/19/2015] [Accepted: 11/27/2015] [Indexed: 11/29/2022]
Abstract
We studied the bacterial characteristics and incidence of invasive infections caused by group B streptococci (GBS) in adults in Iceland in 1975-2014. A total of 145 isolates were characterized by serotyping, antimicrobial susceptibility, multilocus sequence typing and surface protein gene profiling. Disease incidence increased during the studied period (p <0.001), reaching 2.17 cases/100 000 person-years in 2013-14. Overall, serotype Ia was the most frequently found (23%), but serotypes Ib, II, III and V showed similar prevalence (14%-17%). Although there were notable changes in the proportion of most serotypes during the study period, only the decline of serotype III was statistically supported (p = 0.003) and was reflected in a decrease of clonal complexes CC17 and CC19 that included most serotype III isolates (p <0.04). On the other hand, the increase in frequency of CC1 was caused by two lineages expressing distinct serotypes: ST1/V/alp3 and ST196/IV/eps. Underlying the relative stability of serotype Ia were major changes in the lineages expressing this serotype, with an increase in the relative importance of CC23, including both ST23/Ia/eps and ST24/Ia/bca lineages, and a decrease in CC7. Nine cases of invasive GBS disease were caused by ST7, of possible zoonotic origin. All isolates were susceptible to penicillin. Rates of erythromycin and clindamycin resistance were 8.3% and 9.7%, respectively. An over-representation of resistance solely to clindamycin was associated with the unusual lsaC gene and serotype III ST19/rib lineage (p <0.001).
Collapse
Affiliation(s)
- E S Björnsdóttir
- Department of Clinical Microbiology, Landspítali University Hospital, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - E R Martins
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - H Erlendsdóttir
- Department of Clinical Microbiology, Landspítali University Hospital, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - G Haraldsson
- Department of Clinical Microbiology, Landspítali University Hospital, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - J Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - K G Kristinsson
- Department of Clinical Microbiology, Landspítali University Hospital, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Reykjavik, Iceland
| | - M Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| |
Collapse
|
25
|
Gudjónsdóttir MJ, Hentz E, Berg S, Backhaus E, Elfvin A, Kawash S, Trollfors B. Serotypes of group B streptococci in western Sweden and comparison with serotypes in two previous studies starting from 1988. BMC Infect Dis 2015; 15:507. [PMID: 26553333 PMCID: PMC4640215 DOI: 10.1186/s12879-015-1266-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 11/05/2015] [Indexed: 11/26/2022] Open
Abstract
Background Group B Streptococci (GBS) are the most common neonatal pathogens and infect immunocompromised and elderly individuals. The species has 10 different serotypes. Serotypes have been studied in the south-west area of Sweden in 1988–1997 and 1998–2001. The aim of this study was to study serotypes in the same area from 2004 to 2009. Methods Invasive GBS isolates were collected prospectively from 2004 to 2009 in two counties in western Sweden with a population of 1.8 million, and were serotyped by latex agglutination. Clinical data were obtained from hospital records. During the study period 410 invasive GBS isolates from 398 patients were collected (multiple episodes ≥1 month apart). Clinical data were not available for two patients who are excluded. Four isolates were from stillborn neonates, 88 were from live born neonates and infants, and 318 from adults. Results Serotype III was the most common serotype (48 %) in neonates and infants followed by serotypes Ia (18 %) and V (16 %). In adults serotype V (39 %) dominated followed by serotypes III (20 %) and Ib (14 %). There was a significant increase of serotype V in comparison with the first study (1988–1997) but there were no significant changes in the serotype distribution between the present study and the second study (1998–2001). There were a few cases of serotype VI-IX, both in children and adults, not seen in the previous studies. Serotype V was more common among patients with arthritis than with any other manifestation. Conclusions Changes in GBS serotypes occur over time in the same region, which must be considered when GBS vaccines are formulated.
Collapse
Affiliation(s)
- Margrét Johansson Gudjónsdóttir
- Division of Neonatology, Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. .,Department of Pediatrics, Neonatology, Sahlgrenska University Hospital, 41685, Gothenburg, Sweden.
| | - Elisabet Hentz
- Division of Neonatology, Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. .,Department of Pediatrics, Neonatology, Sahlgrenska University Hospital, 41685, Gothenburg, Sweden.
| | - Stefan Berg
- Department of Pediatrics, Queen Silvia Childrens' Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Erik Backhaus
- Department of Infectious Diseases, Skaraborg Hospital, Skövde, Sweden.
| | - Anders Elfvin
- Division of Neonatology, Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. .,Department of Pediatrics, Neonatology, Sahlgrenska University Hospital, 41685, Gothenburg, Sweden.
| | - Samir Kawash
- Department of Bacteriology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Birger Trollfors
- Department of Pediatrics, Queen Silvia Childrens' Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| |
Collapse
|
26
|
Nuccitelli A, Rinaudo CD, Maione D. Group B Streptococcus vaccine: state of the art. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:76-90. [PMID: 26288735 DOI: 10.1177/2051013615579869] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Group B Streptococcus (GBS) is cause of neonatal invasive diseases as well as of severe infections in the elderly and immune-compromised patients. Despite significant advances in the prevention and treatment of neonatal disease, sepsis and meningitis caused by GBS still represent a significant public health care concern globally and additional prevention and therapeutic strategies against infection are highly desirable. The introduction of national recommended guidelines in several countries to screen pregnant women for GBS carriage and the use of antibiotics during delivery significantly reduced disease occurring within the first hours of life (early-onset disease), but it has had no effect on the late-onset diseases occurring after the first week and is not feasible in most countries. Availability of an effective vaccine against GBS would provide an effective means of controlling GBS disease. This review provides an overview of the burden of invasive disease caused by GBS in infants and adults, and highlights the strategies for the development of an effective vaccine against GBS infections.
Collapse
Affiliation(s)
| | | | - Domenico Maione
- Novartis Vaccines and Diagnostics, via Fiorentina 1, 53100 Siena, Italy
| |
Collapse
|
27
|
Emergence of Serotype IV Group B Streptococcus Adult Invasive Disease in Manitoba and Saskatchewan, Canada, Is Driven by Clonal Sequence Type 459 Strains. J Clin Microbiol 2015; 53:2919-26. [PMID: 26135871 DOI: 10.1128/jcm.01128-15] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 06/24/2015] [Indexed: 01/06/2023] Open
Abstract
Serotype IV group B Streptococcus (GBS) is emerging in Canada and the United States with rates as high as 5% of the total burden of adult invasive GBS disease. To understand this emergence, we studied the population structure and assessed the antimicrobial susceptibility of serotype IV isolates causing adult invasive infection in Manitoba and Saskatchewan, Canada, between 2010 and 2014. Whole-genome sequencing was used to determine multilocus sequence typing information and identify genes encoding antimicrobial resistance in 85 invasive serotype IV GBS strains. Antimicrobial susceptibility testing was performed by standard methods. Strain divergence was assessed using genome-wide single-nucleotide polymorphism analysis. Serotype IV strains were responsible for 16.9% of adult invasive GBS infections in Manitoba and Saskatchewan during the period. The majority of serotype IV isolates (89%) were clonally related, tetracycline-, erythromycin-, and clindamycin-resistant sequence type 459 (ST459) strains that possessed genes tetM and ermTR. Genome comparisons between ST459 and serotype V ST1 GBS identified several areas of recombination in an overall similar genomic background. Serotype IV ST459 GBS strains are expanding and causing a substantial percentage of adult invasive GBS disease. This emergence may be linked to the acquisition of resistance to tetracycline, macrolides, and lincosamides.
Collapse
|
28
|
Evaluation of streptococcal toxic shock-like syndrome caused by group B streptococcus in adults in Japan between 2009 and 2013. J Infect Chemother 2014; 21:207-11. [PMID: 25592810 DOI: 10.1016/j.jiac.2014.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 11/05/2014] [Accepted: 12/04/2014] [Indexed: 11/20/2022]
Abstract
Infection with Streptococcus agalactiae has long been recognized in infants. In recent years, S. agalactiae is an important cause of morbidity and mortality among adults and among those with underlying medical condition. Several cases of GBS infection and more fulminant disease similar to streptococcal toxic shock syndrome have recently been reported. We report here that 19 S. agalactiae strains were isolated from streptococcal toxic shock-like syndrome cases involving adult patients in Japan between 2009 and 2013. The average age of the patients was 66.3 years. At least one underlying disease was present in 47.4% (9/19) of the patients. The most prevalent serotype among these strains was Ib. All serotype Ib strains belonged to clonal complex 10 and were ciprofloxacin resistant. In contrast, all strains were susceptible to penicillin G, ampicillin, cefazolin, cefotaxime, imipenem, panipenem, and linezolid. The characteristic type distributions of streptococcal toxic shock-like syndrome isolates differed between isolates obtained from vaginal swabs of women and infants with invasive infections.
Collapse
|
29
|
Teatero S, McGeer A, Low DE, Li A, Demczuk W, Martin I, Fittipaldi N. Characterization of invasive group B streptococcus strains from the greater Toronto area, Canada. J Clin Microbiol 2014; 52:1441-7. [PMID: 24554752 PMCID: PMC3993709 DOI: 10.1128/jcm.03554-13] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 02/12/2014] [Indexed: 11/20/2022] Open
Abstract
We determined the capsular polysaccharide (CPS) type of 600 group B Streptococcus (GBS) (also known as Streptococcus agalactiae) strains recovered from patients with invasive infections in the greater Toronto area, Canada, between 2009 and 2012. GBS strains of CPS type III were the most prevalent among infants (44% in those with early-onset disease, 75% in those with late-onset disease), while type V strains were most frequently isolated from adult patients (26% in patients≥19 years old). We next investigated the presence in our collection of GBS strains belonging to the hypervirulent multilocus sequence typing clonal complex 17 (CC17). We used a PCR test described as specific for the detection of CC17 strains, which targets the gene encoding the major virulence factor HvgA. We identified 91 hvgA-positive strains; of these, 88 were CPS type III, 2 were CPS type IV, and 1 was CPS type V. Using whole-genome sequencing, we showed that the two hvgA-positive CPS type IV strains are CC17 strains which underwent capsular switching. However, sequence analysis revealed that the hvgA-positive CPS type V strain does not belong to CC17 but instead is a bona fide CC1 strain which acquired hvgA, probably by recombination from a CC17 donor. Our findings underline the importance of recombination in GBS pathogenesis and caution against the use of single-gene-based PCR tests to detect CC17 GBS strains.
Collapse
Affiliation(s)
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Donald E. Low
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aimin Li
- Public Health Ontario, Toronto, Ontario, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Nahuel Fittipaldi
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
30
|
Steens A, Eriksen HM, Blystad H. What are the most important infectious diseases among those ≥65 years: a comprehensive analysis on notifiable diseases, Norway, 1993-2011. BMC Infect Dis 2014; 14:57. [PMID: 24495775 PMCID: PMC3923236 DOI: 10.1186/1471-2334-14-57] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 01/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As the population ages, the burden on the healthcare system might increase and require changed public health priorities. As infections are often more severe at older age, we rank notifiable infectious diseases (ID) and describe trends of ID among the general population aged ≥65 years in Norway in order to inform public health priorities for the aging population. METHODS We included all eligible cases of the 58 IDs notified between 1993 and 2011 (n = 223,758; 12% ≥65 years) and determined annual notification rates as the number of notified cases divided by the number of inhabitants of the corresponding year. We ranked diseases using their average annual notification rate for 2007-2011. Trends in notification rates from 1993 onwards were determined with a non-parametric test for trend. Using notification rate ratios (NRR), we compared results in those aged ≥65 years to those aged 20-64 years. RESULTS Invasive pneumococcal disease was the most common ID among the population ≥65 years (notification rate 58/100,000), followed by pertussis (54/100,000) and campylobacteriosis (30/100,000). Most ID notification rates did not change over time, though the notification rate of symptomatic MRSA infections increased from 1/100,000 in 1995 (first year of notification) to 14/100,000 in 2011.Overall, fewer cases were notified among the population ≥65 years compared to 20-64 year olds (NRR = 0.73). The NRR of each of the invasive bacterial diseases and antibiotic-resistant infections were above 1.5 (i.e. more common in ≥65), while the NRR of each food- and waterborne disease, blood-borne disease/STI and (non-invasive) vaccine preventable disease was below 1. CONCLUSIONS Based on our results, we emphasise the importance of focusing public health efforts for those ≥65 years on preventing invasive bacterial infections. This can be achieved by increasing pneumococcal and influenza vaccine uptake, and risk communication including encouraging those aged ≥65 years and their caretakers to seek healthcare at signs of systemic infection. Furthermore, good compliance to infection control measures, screening of the at-risk population, and careful use of antibiotics may prevent further increase in antibiotic-resistant infections.
Collapse
Affiliation(s)
- Anneke Steens
- Norwegian Institute of Public Health, Oslo, Norway
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | | | - Hans Blystad
- Norwegian Institute of Public Health, Oslo, Norway
| |
Collapse
|
31
|
Kemp M, Bangsborg J, Kjerulf A, Schmidt TA, Christensen J, Irmukhamedov A6, Bruun NE, Dargis R, Andresen K, Christensen JJ. Advantages and limitations of ribosomal RNA PCR and DNA sequencing for identification of bacteria in cardiac valves of danish patients. Open Microbiol J 2013; 7:146-51. [PMID: 24403979 PMCID: PMC3883160 DOI: 10.2174/1874285801307010146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/14/2013] [Accepted: 11/14/2013] [Indexed: 11/29/2022] Open
Abstract
Studies on the value of culture-independent molecular identification of bacteria in cardiac valves are mostly restricted to comparing agreement of identification to what is obtained by culture to the number of identified bacteria in culture-negative cases. However, evaluation of the usefulness of direct molecular identification should also address weaknesses, their relevance in the given setting, and possible improvements. In this study cardiac valves from 56 Danish patients referred for surgery for infective endocarditis were analysed by microscopy and culture as well as by PCR targeting part of the bacterial 16S rRNA gene followed by DNA sequencing of the PCR product. PCR and DNA sequencing identified significant bacteria in 49 samples from 43 patients, including five out of 13 culture-negative cases. No rare, exotic, or intracellular bacteria were identified. There was a general agreement between bacterial identity obtained by ribosomal PCR and DNA sequencing from the valves and bacterial isolates from blood culture. However, DNA sequencing of the 16S rRNA gene did not discriminate well among non-haemolytic streptococci, especially within the Streptococcus mitis group. Ribosomal PCR with subsequent DNA sequencing is an efficient and reliable method of identifying the cause of IE, but exact species identification of some of the most common causes, i.e. non-haemolytic streptococci, may be improved with other molecular methods.
Collapse
Affiliation(s)
- Michael Kemp
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | - Anne Kjerulf
- Department of Clinical Microbiology, Herlev University hospital, Copenhagen, Denmark
| | | | - John Christensen
- Department of Cardiothoracic Surgery, Gentofte University Hospital, Copenhagen, Denmark
| | | | - Niels Eske Bruun
- Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
| | - Rimtas Dargis
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Keld Andresen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jens Jørgen Christensen
- Microbiological Surveillance & Research, Statens Serum Institut, Copenhagen, Denmark ; Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| |
Collapse
|
32
|
Li L, Wang R, Liang W, Gan X, Huang T, Huang Y, Li J, Shi Y, Chen M, Luo H. Rare serotype occurrence and PFGE genotypic diversity of Streptococcus agalactiae isolated from tilapia in China. Vet Microbiol 2013; 167:719-724. [PMID: 24064381 DOI: 10.1016/j.vetmic.2013.09.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 06/27/2013] [Accepted: 09/02/2013] [Indexed: 11/30/2022]
Abstract
Previously, we reported 10 PEGE types of 85 tilapia Streptococcus agalactiae (GBS), which shifted from Streptococcus iniae in China, by using PEGE method. Presently, larger and more representative tilapia GBS were isolated, for the first time in China, to characterize their serotypes and genetic diversities more precisely than had done before. 168 GBS strains were distributed in five provinces of China, in which Guangdong, Guangxi and Hainan were the major ones, holding 36.9% (62/168), 37.5% (63/168) and 19.6% (33/168), respectively. Serotypes, Ia, Ib and III, were observed in these strains and the most predominant one was Ia (95.2%), which mainly distributed in Guangdong, Guangxi and Hainan. Ia initially occurred in 2009, it shoot up to 32.1% in 2010, but decreased to 16.1% in 2011 before went up to 45.2% in 2012. Ib sporadically occurred during 2007-2011, III only occurred in 2012. 14 different PFGE types, including 4 new types (N, O, P and Q), were observed, in which B, D, F and G were the predominant types, holding 83.9% (141/168) of the total GBS strains. Ia corresponded to 11 PFGE types (A-H, N-P), in which type D predominated (51%). Ib represented 3 genotypes (I, J and Q) and III harbored only 2 genotypes (N and F). Type N and F synchronously presented in Ia and III. In summary, the genetic diversity of tilapia GBS varied by serotypes and changed with geographical locations and years. Although Ia still predominated, new rare serotype III already occurred in China.
Collapse
Affiliation(s)
- Liping Li
- Guanxi Key Laboratory for Aquatic Genetic Breeding and Healthy Aquaculture, Guangxi Institute of Fisheries, Nanning, Guangxi 530021, China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Delannoy CMJ, Crumlish M, Fontaine MC, Pollock J, Foster G, Dagleish MP, Turnbull JF, Zadoks RN. Human Streptococcus agalactiae strains in aquatic mammals and fish. BMC Microbiol 2013. [PMID: 23419028 DOI: 10.1186/1471–2180–13–41] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In humans, Streptococcus agalactiae or group B streptococcus (GBS) is a frequent coloniser of the rectovaginal tract, a major cause of neonatal infectious disease and an emerging cause of disease in non-pregnant adults. In addition, Streptococcus agalactiae causes invasive disease in fish, compromising food security and posing a zoonotic hazard. We studied the molecular epidemiology of S. agalactiae in fish and other aquatic species to assess potential for pathogen transmission between aquatic species and humans. METHODS Isolates from fish (n = 26), seals (n = 6), a dolphin and a frog were characterized by pulsed-field gel electrophoresis, multilocus sequence typing and standardized 3-set genotyping, i.e. molecular serotyping and profiling of surface protein genes and mobile genetic elements. RESULTS Four subpopulations of S. agalactiae were identified among aquatic isolates. Sequence type (ST) 283 serotype III-4 and its novel single locus variant ST491 were detected in fish from Southeast Asia and shared a 3-set genotype identical to that of an emerging ST283 clone associated with invasive disease of adult humans in Asia. The human pathogenic strain ST7 serotype Ia was also detected in fish from Asia. ST23 serotype Ia, a subpopulation that is normally associated with human carriage, was found in all grey seals, suggesting that human effluent may contribute to microbial pollution of surface water and exposure of sea mammals to human pathogens. The final subpopulation consisted of non-haemolytic ST260 and ST261 serotype Ib isolates, which belong to a fish-associated clonal complex that has never been reported from humans. CONCLUSIONS The apparent association of the four subpopulations of S. agalactiae with specific groups of host species suggests that some strains of aquatic S. agalactiae may present a zoonotic or anthroponotic hazard. Furthermore, it provides a rational framework for exploration of pathogenesis and host-associated genome content of S. agalactiae strains.
Collapse
Affiliation(s)
- Christian M J Delannoy
- Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirling, UK
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Delannoy CMJ, Crumlish M, Fontaine MC, Pollock J, Foster G, Dagleish MP, Turnbull JF, Zadoks RN. Human Streptococcus agalactiae strains in aquatic mammals and fish. BMC Microbiol 2013; 13:41. [PMID: 23419028 PMCID: PMC3585737 DOI: 10.1186/1471-2180-13-41] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 02/11/2013] [Indexed: 11/17/2022] Open
Abstract
Background In humans, Streptococcus agalactiae or group B streptococcus (GBS) is a frequent coloniser of the rectovaginal tract, a major cause of neonatal infectious disease and an emerging cause of disease in non-pregnant adults. In addition, Streptococcus agalactiae causes invasive disease in fish, compromising food security and posing a zoonotic hazard. We studied the molecular epidemiology of S. agalactiae in fish and other aquatic species to assess potential for pathogen transmission between aquatic species and humans. Methods Isolates from fish (n = 26), seals (n = 6), a dolphin and a frog were characterized by pulsed-field gel electrophoresis, multilocus sequence typing and standardized 3-set genotyping, i.e. molecular serotyping and profiling of surface protein genes and mobile genetic elements. Results Four subpopulations of S. agalactiae were identified among aquatic isolates. Sequence type (ST) 283 serotype III-4 and its novel single locus variant ST491 were detected in fish from Southeast Asia and shared a 3-set genotype identical to that of an emerging ST283 clone associated with invasive disease of adult humans in Asia. The human pathogenic strain ST7 serotype Ia was also detected in fish from Asia. ST23 serotype Ia, a subpopulation that is normally associated with human carriage, was found in all grey seals, suggesting that human effluent may contribute to microbial pollution of surface water and exposure of sea mammals to human pathogens. The final subpopulation consisted of non-haemolytic ST260 and ST261 serotype Ib isolates, which belong to a fish-associated clonal complex that has never been reported from humans. Conclusions The apparent association of the four subpopulations of S. agalactiae with specific groups of host species suggests that some strains of aquatic S. agalactiae may present a zoonotic or anthroponotic hazard. Furthermore, it provides a rational framework for exploration of pathogenesis and host-associated genome content of S. agalactiae strains.
Collapse
Affiliation(s)
- Christian M J Delannoy
- Institute of Aquaculture, School of Natural Sciences, University of Stirling, Stirling, UK
| | | | | | | | | | | | | | | |
Collapse
|
35
|
|
36
|
Dominance of serotype Ia among group B Streptococci causing invasive infections in nonpregnant adults in Portugal. J Clin Microbiol 2012; 50:1219-27. [PMID: 22219307 DOI: 10.1128/jcm.05488-11] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The population of group B streptococci (GBS) associated with invasive infections in nonpregnant adults from 2001 to 2008 was analyzed in isolates submitted from 24 hospital laboratories in Portugal (n = 225). The isolates were characterized by antimicrobial susceptibility, pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and surface protein gene profiling. GBS invasive cases were found more frequently among men in all age groups. In addition, serotype Ia was the most frequent in our collection, whereas serotype V is dominant elsewhere. Serotype Ia was represented mainly by a single PFGE cluster defined by sequence type 23 (ST23) and surface protein gene eps and by ST24 and bca, similarly to neonatal invasive infections in Portugal, indicating that the same genetic lineages can be responsible for both vaginal colonization and invasive disease in all age groups. In contrast, the hypervirulent serotype III/ST17 neonatal lineage was responsible for a minority of infections. Serotype V isolates were distributed into two genetic lineages, one defined by ST1 and surface protein gene alp3 and macrolide resistant, and another presenting with ST2 and eps and fully susceptible to all antimicrobials tested. The erm(TR) gene was the most frequently found among erythromycin-resistant isolates, while the bovine-associated tet(O) gene was found in a minority of tetracycline-resistant isolates. Our data emphasize the importance of local identification of the genetic lineages responsible for GBS invasive infections in nonpregnant adults. The dominance of serotype Ia in invasive disease in Portugal highlights the importance of this serotype in GBS pathogenesis.
Collapse
|
37
|
Tazi A, Morand P, Réglier-Poupet H, Dmytruk N, Billoët A, Antona D, Trieu-Cuot P, Poyart C. Invasive group B streptococcal infections in adults, France (2007–2010). Clin Microbiol Infect 2011; 17:1587-9. [DOI: 10.1111/j.1469-0691.2011.03628.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|