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Karampatsas K, Hall T, Voysey M, Carreras-Abad C, Cochet M, Ramkhelawon L, Peregrine E, Andrews N, Heath PT, Le Doare K. Antibody kinetics between birth and three months of life in healthy infants with natural exposure to Group B streptococcus: A UK cohort study. Vaccine 2024; 42:3230-3238. [PMID: 38627147 DOI: 10.1016/j.vaccine.2024.04.014] [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: 11/26/2023] [Revised: 03/11/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
INTRODUCTION Capsular polysaccharide (CPS) serotype-specific Immunoglobulin G (IgG) in cord blood has been proposed as a correlate of protection against invasive Group B Streptococcus (iGBS) disease. Although protective levels are required in infants throughout the window of vulnerability up to 3 months of age, little is known regarding the kinetics of GBS-specific IgG over this period. METHODS We enrolled 33 healthy infants born to mothers colonized with GBS. We collected cord blood and infant blood samples either at one (21-35 days), two (49-63 days), or three months of age (77-91 days). We measured GBS serotype-specific CPS IgG concentrations and calculated the decay rate using a mixed-effects model. We further explored whether the antibody kinetics were affected by common maternal and infant factors and estimated the correlation between IgG concentration at birth and one, two, and three months of age. RESULTS The half-life estimate of IgG concentration for homologous and non-homologous GBS serotypes in paired samples with detectable IgG levels at both time points was 27.4 (95 % CI: 23.5-32.9) days. The decay rate did not vary by maternal age (p = 0.7), ethnicity (p = 0.1), gravida (p = 0.1), gestation (p = 0.7), and infant sex (p = 0.1). Predicted IgG titres above the assay lower limit of quantification on day 30 strongly correlated with titres at birth (Spearman correlation coefficient 0.71 [95 % CI: 0.60-0.80]). CONCLUSION Our results provide a basis for future investigations into the use of antibody kinetics in defining a serocorrelate of protection against late-onset iGBS disease.
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Affiliation(s)
- Konstantinos Karampatsas
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom.
| | - Tom Hall
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Merryn Voysey
- Oxford Vaccine Group, Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Clara Carreras-Abad
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Madeleine Cochet
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Laxmee Ramkhelawon
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Elisabeth Peregrine
- Department of Obstetrics and Gynaecology, Kingston Hospital NHS Foundation Trust, London, United Kingdom
| | - Nick Andrews
- UK Health Security Agency, London, United Kingdom
| | - Paul T Heath
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom
| | - Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, St. George's, University of London, London, United Kingdom; Pathogen Immunology Group, UK Health Security Agency, Porton Down, United Kingdom; Makerere University Johns Hopkins University, Kampala, Uganda
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Delettre N, Billion E, Guyonnet C, Jarreau PH, Patkaï J, Tazi A. Outbreak of group B Streptococcus in a neonatal care unit confirmed by whole-genome sequencing. Acta Paediatr 2024; 113:947-954. [PMID: 38183311 DOI: 10.1111/apa.17095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/08/2024]
Abstract
AIM Clusters of group B Streptococcus (GBS) infections in neonatal intensive care units (NICU) are poorly documented. We aimed to assess GBS cross-transmission during an outbreak of GBS sepsis. METHODS The study was carried out between October and November 2021 in a French University Hospital. Neonatal intensive care unit (NICU) patients with GBS sepsis were included. Clinical data were retrieved from electronic patient records. Group B Streptococcus isolates were characterized at the molecular level using capsular genotyping and whole-genome sequencing (WGS). RESULTS The outbreak of GBS sepsis affected three very preterm neonates with a gestational age of less than 26 weeks, including one recurrent male index case aged 26 days, and two female secondary cases aged 5 and 17 days. The microbiological investigation identified a GBS isolate of capsular type III and Sequence Type 17 as responsible for the four infectious episodes. Whole-genome sequencing confirmed the identity between the isolates. The outbreak and the results of the microbiological investigations led to an immediate reinforcement of hygiene measures. CONCLUSION Clustered cases of GBS infections in NICU and horizontal transmission of the hypervirulent GBS Sequence Type 17 are likely underestimated. Prospective investigation of all nosocomial cases using WGS should contribute to improving vigilance regarding GBS cross-transmission and infection prevention.
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Affiliation(s)
- Nicolas Delettre
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
| | - Elodie Billion
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
| | - Cécile Guyonnet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Pierre-Henri Jarreau
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Juliana Patkaï
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Médecine et Réanimation néonatales de Port-Royal, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
| | - Asmaa Tazi
- Université Paris Cité, CNRS, INSERM, Institut Cochin, Paris, France
- Assistance Publique - Hôpitaux de Paris Centre Université Paris Cité, Service de Bactériologie, Centre National de Référence des Streptocoques, Paris, France
- Fédération Hospitalo-Universtaire Préma (Fighting Prematurity), Paris, France
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Bourrel AS, Picart A, Fernandez JC, Hays C, Mignon V, Saubaméa B, Poyart C, Fouet A, Tazi A, Guignot J. Specific interaction between Group B Streptococcus CC17 hypervirulent clone and phagocytes. Infect Immun 2024; 92:e0006224. [PMID: 38514466 PMCID: PMC11003227 DOI: 10.1128/iai.00062-24] [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: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/23/2024] Open
Abstract
Streptococcus agalactiae also named Group B Streptococcus (GBS) is the most significant pathogen causing invasive infections, such as bacteremia and meningitis, in neonates. Worldwide epidemiological studies have shown that a particular clonal complex (CC) of capsular serotype III, the CC17, is strongly associated with meningitis in neonates and is therefore, designated as the hypervirulent clone. Macrophages are a permissive niche for intracellular bacteria of all GBS clones. In this study, we deciphered the specific interaction of GBS CC17 strains with macrophages. Our study revealed that CC17 strains are phagocytosed at a higher rate than GBS non-CC17 strains by human monocytes and macrophages both in cellular models and in primary cells. CC17-enhanced phagocytosis is due to an initial enhanced-attachment step to macrophages mediated by the CC17-specific surface protein HvgA and the PI-2b pilus (Spb1). We showed that two different inhibitors of scavenger receptors (fucoidan and poly(I)) specifically inhibited CC17 adhesion and phagocytosis while not affecting those of non-CC17 strains. Once phagocytosed, both CC17 and non-CC17 strains remained in a LAMP-1 positive vacuole that ultimately fuses with lysosomes where they can survive at similar rates. Finally, both strains displayed a basal egress which occurs independently from actin and microtubule networks. Our findings provide new insights into the interplay between the hypervirulent GBS CC17 and major players of the host's innate immune response. This enhanced adhesion, leading to increased phagocytosis, could reflect a peculiar capacity of the CC17 lineage to subvert the host immune defenses, establish a niche for persistence or disseminate.
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Affiliation(s)
- Anne-Sophie Bourrel
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Amandine Picart
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | | | - Constantin Hays
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Virginie Mignon
- Plateforme PICMO, US25 INSERM, UAR3612 CNRS, Faculté de Pharmacie, Université Paris Cité, Paris, France
| | - Bruno Saubaméa
- Plateforme PICMO, US25 INSERM, UAR3612 CNRS, Faculté de Pharmacie, Université Paris Cité, Paris, France
| | - Claire Poyart
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Agnès Fouet
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Asmaa Tazi
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
- Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, Paris, France
- Centre National de Référence des Streptocoques, Paris, France
| | - Julie Guignot
- Université Paris Cité, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
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Hilpipre G, Furfaro LL, Porter M, Blyth CC, Yeoh DK. Characterization of invasive Group B Streptococcus isolates from Western Australian infants, 2004-2020. J Med Microbiol 2024; 73. [PMID: 38567639 DOI: 10.1099/jmm.0.001822] [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] [Indexed: 04/04/2024] Open
Abstract
Background. Invasive Group B Streptococcus (GBS; Streptococcus agalactiae) remains a leading cause of infant morbidity and mortality. Intrapartum antibiotic prophylaxis (IAP) has been implemented in many countries with a reduction in early-onset disease, but an effective vaccine may further reduce the disease burden. Candidate vaccines targeting capsular polysaccharides and surface proteins are now in clinical trials.Methods. Using whole-genome sequencing and phenotypic antimicrobial susceptibility testing, we characterized sterile-site GBS isolates recovered from Western Australian infants between 2004 and 2020. Characteristics were compared between three time periods: 2004-2008, 2009-2015 and 2016-2020.Results. A total of 135 isolates were identified. The proportion of serotype III (22.7 % in Period 1 to 47.9 % in Period 3, P=0.04) and clonal complex 17 (13.6-39.6 %, P=0.01) isolates increased over time. Overall coverage of vaccines currently being trialled was >95 %. No isolates were penicillin resistant (MIC>0.25 mg l-1), but 21.5 % of isolates had reduced penicillin susceptibility (MIC>0.12 mg l-1) and penicillin MIC increased significantly over time (P=0.04). Clindamycin resistance increased over time to 45.8 % in the latest period.Conclusions. Based on comprehensive characterization of invasive infant GBS in Western Australia, we found that coverage for leading capsular polysaccharide and surface protein vaccine candidates was high. The demonstrated changes in serotype and molecular type highlight the need for ongoing surveillance, particularly with regard to future GBS vaccination programmes. The reduced susceptibility to IAP agents over time should inform changes to antibiotic guidelines.
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Affiliation(s)
- Ginger Hilpipre
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Lucy L Furfaro
- Division of Obstetrics and Gynaecology, School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Michelle Porter
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
| | - Christopher C Blyth
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Daniel K Yeoh
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
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De Gaetano GV, Lentini G, Coppolino F, Famà A, Pietrocola G, Beninati C. Engagement of α 3β 1 and α 2β 1 integrins by hypervirulent Streptococcus agalactiae in invasion of polarized enterocytes. Front Microbiol 2024; 15:1367898. [PMID: 38511003 PMCID: PMC10951081 DOI: 10.3389/fmicb.2024.1367898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
The gut represents an important site of colonization of the commensal bacterium Streptococcus agalactiae (group B Streptococcus or GBS), which can also behave as a deadly pathogen in neonates and adults. Invasion of the intestinal epithelial barrier is likely a crucial step in the pathogenesis of neonatal infections caused by GBS belonging to clonal complex 17 (CC17). We have previously shown that the prototypical CC17 BM110 strain invades polarized enterocyte-like cells through their lateral surfaces using an endocytic pathway. By analyzing the cellular distribution of putative GBS receptors in human enterocyte-like Caco-2 cells, we find here that the alpha 3 (α3) and alpha 2 (α2) integrin subunits are selectively expressed on lateral enterocyte surfaces at equatorial and parabasal levels along the vertical axis of polarized cells, in an area corresponding to GBS entry sites. The α3β1 and α2β1 integrins were not readily accessible in fully differentiated Caco-2 monolayers but could be exposed to specific antibodies after weakening of intercellular junctions in calcium-free media. Under these conditions, anti-α3β1 and anti-α2β1 antibodies significantly reduced GBS adhesion to and invasion of enterocytes. After endocytosis, α3β1 and α2β1 integrins localized to areas of actin remodeling around GBS containing vacuoles. Taken together, these data indicate that GBS can invade enterocytes by binding to α3β1 and α2β1 integrins on the lateral membrane of polarized enterocytes, resulting in cytoskeletal remodeling and bacterial internalization. Blocking integrins might represent a viable strategy to prevent GBS invasion of gut epithelial tissues.
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Affiliation(s)
| | - Germana Lentini
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Francesco Coppolino
- Department of Biomedical, Dental and Imaging Sciences, University of Messina, Messina, Italy
| | - Agata Famà
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Giampiero Pietrocola
- Department of Molecular Medicine, Biochemistry Section, University of Pavia, Pavia, Italy
| | - Concetta Beninati
- Department of Human Pathology, University of Messina, Messina, Italy
- Scylla Biotech Srl, Messina, Italy
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Kasai Y, Komatsu M, Toyama Y, Nakano S, Hisata K, Yamada M, Shimizu T. Effect of probiotics on mother-to-neonate vertical transmission of group B streptococci: A prospective open-label randomized study. Pediatr Neonatol 2024; 65:145-151. [PMID: 37684161 DOI: 10.1016/j.pedneo.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/16/2023] [Accepted: 07/18/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Group B Streptococci (GBS) are common vaginal bacteria found in 20-30% of pregnant women and a significant cause of invasive infections in newborns. Recently, attention has been focused on the efficacy of probiotics during the perinatal period. However, the effect of probiotic intake on the mother-to-child transmission (MTCT) of GBS remains unknown. METHODS Pregnant women with positive GBS results from vaginal and rectal swab cultures at 35-37 weeks of gestation were randomly assigned to the probiotic group or the control group in an open-label manner at the Department of Obstetrics and Gynecology, San-ikukai Hospital, Tokyo, Japan. The probiotic group received Lactobacillus reuteri during antenatal checkups from 35 to 37-week gestation to 1 month after delivery. Rectal swabs were obtained from the newborns at 5 days and at 1 month of age. Whole-genome sequencing was performed to test for GBS strains in the mother, whose newborn carried GBS at the 1-month checkup. Multi-locus sequence typing and single nucleotide polymorphism analyses were performed to identify MTCT. RESULTS Overall, 67 mother-infant pairs were included, with 31 in the probiotic group and 36 in the control group. The positivity rate of GBS in newborns at 1 month of age was 10% (n = 3) in the probiotic group and 28% (n = 10) in the control group. In newborns carrying GBS at 1 month of age, genetic analysis revealed that the MTCT rate was 6% in the probiotic group and 22% in the control group, although the difference was not statistically significant (p = 0.0927). CONCLUSION No statistically significant difference was found; however, the consumption of L. reuteri by women with GBS-positive pregnancies may inhibit the MTCT of GBS.
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Affiliation(s)
- Yuriha Kasai
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mitsutaka Komatsu
- Department of Pediatrics, San-Ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo, 130-0012, Japan.
| | - Yudai Toyama
- Department of Pediatrics, Juntendo University Nerima Hospital, 3-1-10 Takanodai, Nerima-ku, Tokyo, 177-8521, Japan
| | - Saki Nakano
- Department of Pediatrics, Tokyo Rinkai Hospital, 1-4-2 Rinkai-cho, Edogawa-ku, Tokyo, 134-0086, Japan
| | - Ken Hisata
- Department of Pediatrics, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
| | - Mie Yamada
- Department of Obstetrics and Gynecology, San-Ikukai Hospital, 3-20-2 Taihei, Sumida-ku, Tokyo, 130-0012, Japan
| | - Toshiaki Shimizu
- Department of Pediatric and Adolescent Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8431, Japan
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Heston SM, Lim CSE, Ong C, Chua MC, Kelly MS, Yeo KT. Strain-resolved metagenomic analysis of the gut as a reservoir for bloodstream infection pathogens among premature infants in Singapore. Gut Pathog 2023; 15:55. [PMID: 37974294 PMCID: PMC10652614 DOI: 10.1186/s13099-023-00583-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Gut dysbiosis contributes to the high risk of bloodstream infection (BSI) among premature infants. Most prior studies of the premature infant gut microbiota were conducted in Western countries and prior to development of current tools for strain-resolved analysis. METHODS We performed metagenomic sequencing of weekly fecal samples from 75 premature infants at a single hospital in Singapore. We evaluated associations between clinical factors and gut microbiota composition using PERMANOVA and mixed effects linear regression. We used inStrain to perform strain-level analyses evaluating for gut colonization by BSI-causing strains. RESULTS Median (interquartile range) gestation was 27 (25, 29) weeks, and 63% of infants were born via Cesarean section. Antibiotic exposures (PERMANOVA; R2 = 0.017, p = 0.001) and postnatal age (R2 = 0.015, p = 0.001) accounted for the largest amount of variability in gut microbiota composition. Increasing postnatal age was associated with higher relative abundances of several common pathogens (Enterococcus faecalis: p < 0.0001; Escherichia coli: p < 0.0001; Klebsiella aerogenes: p < 0.0001; Klebsiella pneumoniae: p < 0.0001). Antibiotic exposures were generally associated with lower relative abundances of both frequently beneficial bacteria (e.g., Bifidobacterium species) and common enteric pathogens (e.g., Enterobacter, Klebsiella species). We identified strains identical to the blood culture isolate in fecal samples from 12 of 16 (75%) infants who developed BSI, including all infections caused by typical enteric bacteria. CONCLUSIONS Antibiotic exposures were the dominant modifiable factor affecting gut microbiota composition in a large cohort of premature infants from South-East Asia. Strain-resolved analyses indicate that the gut is an important reservoir for organisms causing BSI among premature infants.
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Affiliation(s)
- Sarah M Heston
- Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Charis Shu En Lim
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Chengsi Ong
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
- Department of Nutrition and Dietetics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Mei Chien Chua
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Matthew S Kelly
- Division of Pediatric Infectious Diseases, Duke University School of Medicine, Durham, NC, USA
| | - Kee Thai Yeo
- Department of Neonatology, KK Women's and Children's Hospital, Singapore, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
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Hsu JF, Lu JJ, Chu SM, Lee WJ, Huang HR, Chiang MC, Yang PH, Tsai MH. The Clinical and Genetic Characteristics of Streptococcus agalactiae Meningitis in Neonates. Int J Mol Sci 2023; 24:15387. [PMID: 37895067 PMCID: PMC10607198 DOI: 10.3390/ijms242015387] [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: 09/07/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is an important pathogen of bacterial meningitis in neonates. We aimed to investigate the clinical and genetic characteristics of neonatal GBS meningitis. All neonates with GBS meningitis at a tertiary level medical center in Taiwan between 2003 and 2020 were analyzed. Capsule serotyping, multilocus sequence typing, antimicrobial resistance, and whole-genome sequencing (WGS) were performed on the GBS isolates. We identified 48 neonates with GBS meningitis and 140 neonates with GBS sepsis. Neonates with GBS meningitis had significantly more severe clinical symptoms; thirty-seven neonates (77.8%) had neurological complications; seven (14.6%) neonates died; and 17 (41.5%) survivors had neurological sequelae at discharge. The most common serotypes that caused meningitis in neonates were type III (68.8%), Ia (20.8%), and Ib (8.3%). Sequence type (ST) is highly correlated with serotypes, and ST17/III GBS accounted for more than half of GBS meningitis cases (56.3%, n = 27), followed by ST19/Ia, ST23/Ia, and ST12/Ib. All GBS isolates were sensitive to ampicillin, but a high resistance rates of 72.3% and 70.7% to erythromycin and clindamycin, respectively, were noted in the cohort. The virulence and pilus genes varied greatly between different GBS serotypes. WGS analyses showed that the presence of PezT; BspC; and ICESag37 was likely associated with the occurrence of meningitis and was documented in 60.4%, 77.1%, and 52.1% of the GBS isolates that caused neonatal meningitis. We concluded that GBS meningitis can cause serious morbidity in neonates. Further experimental models are warranted to investigate the clinical and genetic relevance of GBS meningitis. Specific GBS strains that likely cause meningitis requires further investigation and clinical attention.
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Affiliation(s)
- Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Jang-Jih Lu
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan 333, Taiwan
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wei-Ju Lee
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Peng-Hong Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (W.-J.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ming-Horng Tsai
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Neonatology and Pediatric Hematology-Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
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Vaz MJ, Dongas S, Ratner AJ. Capsule production promotes Group B Streptococcus intestinal colonization. Microbiol Spectr 2023; 11:e0234923. [PMID: 37732775 PMCID: PMC10655599 DOI: 10.1128/spectrum.02349-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/25/2023] [Indexed: 09/22/2023] Open
Abstract
Late-onset disease is the most common clinical presentation of Group B Streptococcus (GBS) infection during infancy, and gastrointestinal (GI) colonization is an important precursor. Previously, we described a murine model of postnatal GBS GI colonization that resulted in sustained colonization and progression to invasive disease. Capsular polysaccharide is an important GBS virulence factor. Vaccines based on a subset of capsular serotypes are in clinical trials. However, little is known regarding the role of specific GBS capsular serotypes in GI colonization. We examined the role of GBS capsule in GI colonization using capsule-producing and acapsular strains derived from GBS strain A909 (serotype Ia) in a murine model. Using isogenic GBS strains differing only in capsular serotypes, we explored the role of specific serotypes in GI colonization by determining competitive indices during cocolonization. We found that GBS A909 colonizes the murine GI tract without causing invasive disease. In monocolonization experiments, there was colonization persistence with the capsule-producing strain (100%) compared to the acapsular mutant strain (13%). In cocolonization experiments, the capsule-producing strain outcompeted its isogenic acapsular mutant, with a geometric mean competitive index of 8, 95% confidence interval (CI) [1.7, 38.9] in the colon at 7 days post-colonization. A909 expressing its native serotype Ia capsule outcompeted an isogenic mutant that expresses serotype III capsule, with a geometric mean competitive index of 2.5, 95% CI [1.2, 5.1] in the colon at 7 days post-colonization. Thus, polysaccharide capsule production enhances GBS GI colonization in vivo. In an A909 genetic background, the production of a serotype Ia capsule provides a competitive advantage over an isogenic strain producing type III capsule. The murine model is a valuable tool to understand the role of GBS capsule types in GI colonization. IMPORTANCE The establishment of GBS intestinal colonization is believed to be a critical precursor to late-onset disease in neonates, which has a significant impact on neurodevelopment outcomes in this population. Our prior work described a murine model of postnatal Group B Streptococcus (GBS) acquisition and invasive disease. Using this model, we explored the importance of GBS polysaccharide capsule production on gastrointestinal colonization. We found that the expression of capsule (compared to isogenic acapsular strains) provides an advantage in intestinal colonization and, importantly, that capsule type Ia has an advantage over capsule type III in a GBS A909 strain background. We speculate that specific serotypes may differ in colonization fitness, which may play a role in serotype distribution in neonatal disease.
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Affiliation(s)
- Michelle J. Vaz
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Sophia Dongas
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
| | - Adam J. Ratner
- Department of Pediatrics, NYU School of Medicine, New York, New York, USA
- Department of Microbiology, NYU School of Medicine, New York, New York, USA
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10
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Schim van der Loeff I, Tsilifis C, Abdelhafiz K, Williams EJ. Recurrent group B stretococcus infection in an extremely premature infant: as a preterm neonate, infant and toddler. BMJ Case Rep 2023; 16:e255216. [PMID: 37507127 PMCID: PMC10387633 DOI: 10.1136/bcr-2023-255216] [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] [Indexed: 07/30/2023] Open
Abstract
We report five discrete episodes of group B streptococcus (GBS) bacteraemia in an extremely premature infant, extending into early childhood. The first four episodes occurred during infancy despite appropriate treatment. Breastmilk was positive for group B streptococcal 16S DNA by polymerase chain reaction. The fifth episode occurred at 17 months of age, shortly after stopping antimicrobial prophylaxis.Radiological investigations did not identify a focus for recurrence of GBS bacteraemia, and immunological investigations and targeted whole genome sequencing yielded only transient hypogammaglobulinaemia of infancy, which resolved.This case highlights invasive GBS infection as a cause of infant morbidity. Premature infants are at particular risk of invasive as well as recurrent disease. GBS is typically a sensitive organism and each episode of GBS in our patient was effectively treated with penicillin. The role of breastmilk in recurrent GBS is controversial; in this case infant and mother isolated identical GBS serotypes and were concurrently treated with rifampicin.
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Affiliation(s)
- Ina Schim van der Loeff
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christo Tsilifis
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Khalid Abdelhafiz
- Neonatalogy, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eleri J Williams
- Paediatric Immunology and Infectious Diseases, Great North Children's Hospital, Newcastle upon Tyne, UK
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11
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Yue L, Liu H. Neonatal Late-Onset Meningitis Caused by Serotype III CC17 Group B Streptococci Aggregating in Two Families from Southern China. Infect Drug Resist 2023; 16:3417-3424. [PMID: 37283938 PMCID: PMC10239641 DOI: 10.2147/idr.s401545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/29/2023] [Indexed: 06/08/2023] Open
Abstract
Background Late-onset meningitis infected by group B Streptococcus (GBS) continues to be a major cause of perinatal mortality, morbidity and long-term neurodevelopmental sequelae despite the implementation of universal screening, but its risk factors are not fully understood. Case Presentation We reported a set of dizygotic twins and a pair of compatriot siblings diagnosed with late-onset GBS meningitis aggregating in two Chinese families. All of GBS strains were identified as serotype III CC17 with high homology between the strains within the same family, and the isolates from the compatriots identical to their mother's carriage. The siblings in the two families presented clinical signs several days after close contact with their index cases having a fever at home, and obtained prompt diagnosis and anti-infective therapy. The two index patients had obvious brain damage before effective treatment and severe sequelae compared to their siblings with complete healing. Conclusion The dramatic difference in outcomes between the index cases and their siblings brings attention to prevent and control familial aggregation of neonatal late-onset GBS infection which never reported in China.
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Affiliation(s)
- Lei Yue
- Clinical Laboratory, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Haiying Liu
- Clinical Laboratory, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China
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12
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Clonal Complex 12 Serotype Ib Streptococcus agalactiae Strain Causing Complicated Sepsis in Neonates: Clinical Features and Genetic Characteristics. Microbiol Spectr 2023; 11:e0377822. [PMID: 36475780 PMCID: PMC9927456 DOI: 10.1128/spectrum.03778-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Streptococcus agalactiae (group B Streptococcus [GBS]) is well known to cause serious diseases in infants. A serotype Ib GBS strain has recently emerged and become prevalent in Southeast Asia. We aimed to investigate the clinical and genetic characteristics of this strain. All neonates with invasive GBS diseases from a tertiary-level medical center in Taiwan between 2003 and 2020 were analyzed. The capsule serotyping, multilocus sequence typing, and antimicrobial resistance analyses were performed on all the invasive GBS isolates, and whole-genome sequencing (WGS) was performed specifically on the type Ib GBS strain. A total of 188 neonates with invasive GBS disease during the study period were identified. The type Ib GBS strain accounted for 7.4% (n = 14) of neonatal GBS invasive diseases. Almost all type Ib GBS isolates belonged to sequence type 12 (13/14, 92.9%) and clonal complex 12. Neonates with type Ib GBS disease had a significantly higher rate of complicated sepsis (10/14, 71.4%; P < 0.05) and sepsis-attributable mortality (6/14, 42.9%; P < 0.05). Additionally, type Ib GBS isolates had significantly higher rates of resistance to erythromycin and clindamycin (both 100%; P < 0.05) than other GBS serotypes. WGS revealed the presence of an ~75-kb integrative and conjugative element, ICESag37, comprising multiple antibiotic resistance and virulence genes, and PI-1 plus PI-2a were noted in all type Ib serotype 12 (ST12) GBS isolates; these isolates may be responsible for its high invasiveness and antimicrobial resistance rates. The genomic characteristics of the type Ib clonal complex 12 (CC12) GBS strain may account for the high illness severity associated with this strain and its antibiotic resistance. Continuous monitoring and advanced strategies to control the spread of type Ib CC12 GBS should be considered. IMPORTANCE A type Ib ST12 GBS strain is not a common isolate in neonatal invasive diseases and has been ignored for a long time. However, the recent literature and our data showed that such a GBS strain is associated with a significantly higher risk of severe sepsis, higher illness severity, and a significantly higher rate of sepsis-attributable mortality. This study found a novel gene cluster, including the presence of ICESag37 and specific pilus genes, carrying multiple antimicrobial resistance and virulence genes, which may be responsible for the clinical characteristics. Because of the higher mortality and severity of illness, we concluded that continuous monitoring of the type Ib ST12 GBS strain is warranted in the future.
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13
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Lohrmann F, Hufnagel M, Kunze M, Afshar B, Creti R, Detcheva A, Kozakova J, Rodriguez-Granger J, Sørensen UBS, Margarit I, Maione D, Rinaudo D, Orefici G, Telford J, de la Rosa Fraile M, Kilian M, Efstratiou A, Berner R, Melin P. Neonatal invasive disease caused by Streptococcus agalactiae in Europe: the DEVANI multi-center study. Infection 2022:10.1007/s15010-022-01965-x. [PMID: 36547864 PMCID: PMC9773664 DOI: 10.1007/s15010-022-01965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Group B streptococcus (GBS) remains a leading cause of invasive disease, mainly sepsis and meningitis, in infants < 3 months of age and of mortality among neonates. This study, a major component of the European DEVANI project (Design of a Vaccine Against Neonatal Infections) describes clinical and important microbiological characteristics of neonatal GBS diseases. It quantifies the rate of antenatal screening and intrapartum antibiotic prophylaxis among cases and identifies risk factors associated with an adverse outcome. METHODS Clinical and microbiological data from 153 invasive neonatal cases (82 early-onset [EOD], 71 late-onset disease [LOD] cases) were collected in eight European countries from mid-2008 to end-2010. RESULTS Respiratory distress was the most frequent clinical sign at onset of EOD, while meningitis is found in > 30% of LOD. The study revealed that 59% of mothers of EOD cases had not received antenatal screening, whilst GBS was detected in 48.5% of screened cases. Meningitis was associated with an adverse outcome in LOD cases, while prematurity and the presence of cardiocirculatory symptoms were associated with an adverse outcome in EOD cases. Capsular-polysaccharide type III was the most frequent in both EOD and LOD cases with regional differences in the clonal complex distribution. CONCLUSIONS Standardizing recommendations related to neonatal GBS disease and increasing compliance might improve clinical care and the prevention of GBS EOD. But even full adherence to antenatal screening would miss a relevant number of EOD cases, thus, the most promising prophylactic approach against GBS EOD and LOD would be a vaccine for maternal immunization.
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Affiliation(s)
- Florens Lohrmann
- grid.5963.9Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany ,grid.5963.9Spemann Graduate School of Biology and Medicine (SGBM), Faculty of Biology, University of Freiburg and IMM-PACT Clinician Scientist Program, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Markus Hufnagel
- grid.5963.9Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- grid.5963.9Department for Gynecology and Obstetrics, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Baharak Afshar
- grid.515304.60000 0005 0421 4601UK Health Security Agency GB, London, UK
| | - Roberta Creti
- grid.416651.10000 0000 9120 6856Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | - Antoaneta Detcheva
- grid.419273.a0000 0004 0469 0184National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Jana Kozakova
- grid.425485.a0000 0001 2184 1595National Institute of Public Health, Prague, Czech Republic
| | - Javier Rodriguez-Granger
- grid.411380.f0000 0000 8771 3783Servicio Andaluz de Salud, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Uffe B. Skov Sørensen
- grid.7048.b0000 0001 1956 2722Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | | | | | | | - Graziella Orefici
- grid.416651.10000 0000 9120 6856Department of Infectious Diseases, Istituto Superiore Di Sanità, Rome, Italy
| | | | - Manuel de la Rosa Fraile
- grid.411380.f0000 0000 8771 3783Servicio Andaluz de Salud, Hospital Universitario Virgen de Las Nieves, Granada, Spain
| | - Mogens Kilian
- grid.7048.b0000 0001 1956 2722Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Reinhard Berner
- grid.4488.00000 0001 2111 7257Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Pierrette Melin
- grid.411374.40000 0000 8607 6858Department of Clinical Microbiology, National Reference Center Streptococcus agalactiae, University Hospital Center of Liege, Avenue de L’Hôpital, 1, 4000 Liège 1, Belgique
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14
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Miselli F, Frabboni I, Di Martino M, Zinani I, Buttera M, Insalaco A, Stefanelli F, Lugli L, Berardi A. Transmission of Group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence. Ther Adv Infect Dis 2022; 9:20499361221142732. [PMID: 36569815 PMCID: PMC9780763 DOI: 10.1177/20499361221142732] [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: 07/06/2022] [Accepted: 11/16/2022] [Indexed: 12/24/2022] Open
Abstract
Group B streptococcus (GBS) late-onset disease (LOD, occurring from 7 through 89 days of life) is an important cause of sepsis and meningitis in infants. The pathogenesis and modes of transmission of LOD to neonates are yet to be elucidated. Established risk factors for the incidence of LOD include maternal GBS colonisation, young maternal age, preterm birth, HIV exposure and African ethnicity. The mucosal colonisation by GBS may be acquired perinatally or in the postpartum period from maternal or other sources. Growing evidence has demonstrated the predominant role of maternal sources in the transmission of LOD. Intrapartum antibiotic prophylaxis (IAP) to prevent early-onset disease reduces neonatal GBS colonisation during delivery; however, a significant proportion of IAP-exposed neonates born to GBS-carrier mothers acquire the pathogen at mucosal sites in the first weeks of life. GBS-infected breast milk, with or without presence of mastitis, is considered a potential vehicle for transmitting GBS. Furthermore, horizontal transmission is possible from nosocomial and other community sources. Although unfrequently reported, nosocomial transmission of GBS in the neonatal intensive care unit is probably less rare than is usually believed. GBS disease can sometime recur and is usually caused by the same GBS serotype that caused the primary infection. This review aims to discuss the dynamics of transmission of GBS in the neonatal LOD.
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Affiliation(s)
- Francesca Miselli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Ilaria Frabboni
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Marianna Di Martino
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Isotta Zinani
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Martina Buttera
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Anna Insalaco
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Francesca Stefanelli
- Pediatric Post-Graduate School, University of Modena e Reggio Emilia, Modena, Italy
| | - Licia Lugli
- Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
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15
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Li A, Fang M, Hao D, Wu Q, Qian Y, Xu H, Zhu B. Late-Onset Sepsis in a Premature Infant Mediated by Breast Milk: Mother-to-Infant Transmission of Group B Streptococcus Detected by Whole-Genome Sequencing. Infect Drug Resist 2022; 15:5345-5352. [PMID: 36110126 PMCID: PMC9469938 DOI: 10.2147/idr.s381466] [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: 07/15/2022] [Accepted: 09/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Late-onset group B Streptococcus (LOGBS) sepsis is a cause of infection and death in infants. Infected breast milk has been considered a source of neonatal GBS infection and invasive infection. However, mother-to-infant transmission of GBS detected by the high-resolution diagnostic method is rarely reported. Methods This study describes a low-weight premature infant who developed late-onset GBS septicemia 21 days after birth. GBS strains isolated from the mother’s cervical secretion, the mother’s milk, and the baby’s blood were cultured to identify the source of GBS infection. We further confirmed the GBS isolates through matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF-MS). Finally, we performed whole-genome sequencing (WGS) and phylogenetic analyses on the GBS strains recovered. Results GBS isolates were cultured from the bloodstream of the premature infant and the mother’s milk, respectively. Subsequently, WGS and phylogenetic analyses on three GBS isolates demonstrated that the GBS strain from the infant’s bloodstream was 100% homologous to that from the mother’s breast milk, which had some different gene fragments from the GBS strain from the mother’s cervical secretion. It provided evidence that this infant’s late-onset GBS septicemia originated from his mother’s breast milk instead of the vertical mother-to-infant transmission. Conclusion Through WGS and phylogenetic analysis of the GBS strains, we proved in this study that the late-onset GBS sepsis in a premature infant was derived from his mother’s breast milk. It indicated that WGS diagnosis is an effective tool for infection tracing. Furthermore, this report provides direction for preventing late-onset GBS infection.
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Affiliation(s)
- Aiyun Li
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Ming Fang
- Institute of Infection Disease Control, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China
| | - Dongjie Hao
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Qiaoai Wu
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Yaqi Qian
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
| | - Hao Xu
- State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China.,Department of Structure and Morphology, Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China
| | - Bo Zhu
- Department of Clinical Medicine, The Women's Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People's Republic of China
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16
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Chaguza C, Jamrozy D, Bijlsma MW, Kuijpers TW, van de Beek D, van der Ende A, Bentley SD. Population genomics of Group B Streptococcus reveals the genetics of neonatal disease onset and meningeal invasion. Nat Commun 2022; 13:4215. [PMID: 35864107 PMCID: PMC9304382 DOI: 10.1038/s41467-022-31858-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Group B Streptococcus (GBS), or Streptococcus agalactiae, is a pathogen that causes preterm births, stillbirths, and acute invasive neonatal disease burden and mortality. Here, we investigate bacterial genetic signatures associated with disease onset time and meningeal tissue infection in acute invasive neonatal GBS disease. We carry out a genome-wide association study (GWAS) of 1,338 GBS isolates from newborns with acute invasive disease; the isolates had been collected annually, for 30 years, through a national bacterial surveillance program in the Netherlands. After controlling for the population structure, we identify genetic variation within noncoding and coding regions, particularly the capsule biosynthesis locus, statistically associated with neonatal GBS disease onset time and meningeal invasion. Our findings highlight the impact of integrating microbial population genomics and clinical pathogen surveillance, and demonstrate the effect of GBS genetics on disease pathogenesis in neonates and infants. Group B Streptococcus (GBS) causes neonatal disease and mortality worldwide. Here, the authors use genome-wide association analyses to identify bacterial genetic signatures associated with disease onset time and meningeal tissue infection in acute invasive neonatal GBS disease.
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Affiliation(s)
- Chrispin Chaguza
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK. .,Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA.
| | - Dorota Jamrozy
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory of the Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Amsterdam Infection and Immunity, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Netherlands Reference Laboratory for Bacterial Meningitis, Center of Infection and Immunity Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Stephen D Bentley
- Parasites and Microbes Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridge, UK.
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17
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Travier L, Lecuit M. [Neonatal susceptibility to meningitis results from the immaturity of epithelial barriers and gut microbiota]. Med Sci (Paris) 2022; 38:416-418. [PMID: 35608460 DOI: 10.1051/medsci/2022049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Laetitia Travier
- Institut Pasteur, Université Paris Cité, Inserm U1117, Biology of Infection Unit, 75015 Paris, France
| | - Marc Lecuit
- Institut Pasteur, Université Paris Cité, Inserm U1117, Biology of Infection Unit, 75015 Paris, France - Institut Pasteur, Centre national de référence des Listeria et Centre collaborateur de l'OMS sur les Listeria 75015 Paris, France - Hôpital Necker-Enfants malades AP-HP, Service des maladies infectieuses et tropicales, Institut Imagine, 75015 Paris, France
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18
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Pellegrini A, Lentini G, Famà A, Bonacorsi A, Scoffone VC, Buroni S, Trespidi G, Postiglione U, Sassera D, Manai F, Pietrocola G, Firon A, Biondo C, Teti G, Beninati C, Barbieri G. CodY Is a Global Transcriptional Regulator Required for Virulence in Group B Streptococcus. Front Microbiol 2022; 13:881549. [PMID: 35572655 PMCID: PMC9096947 DOI: 10.3389/fmicb.2022.881549] [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: 02/22/2022] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Group B Streptococcus (GBS) is a Gram-positive bacterium able to switch from a harmless commensal of healthy adults to a pathogen responsible for invasive infections in neonates. The signals and regulatory mechanisms governing this transition are still largely unknown. CodY is a highly conserved global transcriptional regulator that links nutrient availability to the regulation of major metabolic and virulence pathways in low-G+C Gram-positive bacteria. In this work, we investigated the role of CodY in BM110, a GBS strain representative of a hypervirulent lineage associated with the majority of neonatal meningitis. Deletion of codY resulted in a reduced ability of the mutant strain to cause infections in neonatal and adult animal models. The observed decreased in vivo lethality was associated with an impaired ability of the mutant to persist in the blood, spread to distant organs, and cross the blood-brain barrier. Notably, the codY null mutant showed reduced adhesion to monolayers of human epithelial cells in vitro and an increased ability to form biofilms, a phenotype associated with strains able to asymptomatically colonize the host. RNA-seq analysis showed that CodY controls about 13% of the genome of GBS, acting mainly as a repressor of genes involved in amino acid transport and metabolism and encoding surface anchored proteins, including the virulence factor Srr2. CodY activity was shown to be dependent on the availability of branched-chain amino acids, which are the universal cofactors of this regulator. These results highlight a key role for CodY in the control of GBS virulence.
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Affiliation(s)
- Angelica Pellegrini
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Germana Lentini
- Department of Human Pathology and Medicine, University of Messina, Messina, Italy
| | - Agata Famà
- Department of Human Pathology and Medicine, University of Messina, Messina, Italy
| | - Andrea Bonacorsi
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Viola Camilla Scoffone
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Silvia Buroni
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Gabriele Trespidi
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Umberto Postiglione
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Davide Sassera
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | - Federico Manai
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
| | | | - Arnaud Firon
- Institut Pasteur, Université de Paris, CNRS UMR 6047, Unité Biologie des Bactéries Pathogènes à Gram-positif, Paris, France
| | - Carmelo Biondo
- Department of Human Pathology and Medicine, University of Messina, Messina, Italy
| | | | - Concetta Beninati
- Department of Human Pathology and Medicine, University of Messina, Messina, Italy
| | - Giulia Barbieri
- Department of Biology and Biotechnology "Lazzaro Spallanzani," University of Pavia, Pavia, Italy
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19
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Epidemiology of group B streptococcal disease in infants younger than 1 year in Japan: a nationwide surveillance study 2016-2020. Eur J Clin Microbiol Infect Dis 2022; 41:559-571. [PMID: 35048277 DOI: 10.1007/s10096-021-04396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/10/2021] [Indexed: 11/03/2022]
Abstract
We aimed to define the burden and clinical features of invasive group B streptococcus (GBS) disease in infants younger than 1 year in Japan, to explore transmission route of late-onset disease (LOD), and to identify risk factors associated with recurrent GBS disease. We conducted a retrospective, questionnaire-based nationwide surveillance study between 2016 and 2020. A total of 875 GBS cases were identified, including 186 early-onset disease, 628 LOD, and 61 ultra-late-onset disease. Case fatality rate in each age category was 6.5%, 3.0%, and 3.3%, respectively. Patients with meningitis had neurodevelopmental sequelae in 21.5% (64/297). Annual incidence in infants younger than 1 year and in LOD significantly increased from 0.28 to 0.45/1000 livebirths (p = 0.021) and from 0.19 to 0.29/1000 livebirths (p = 0.046), respectively. Maternal colonization status at the LOD diagnosis was available for 148 mothers, of whom 21/58 (36.2%) had positive rectovaginal swabs and 42/117 (36.2%) had GBS in breastmilk culture. These two sites are potentially infectious routes in LOD. The four leading disease-causing serotypes III, Ia, Ib, and V represented 95% of the available serotypes. Thirty-one recurrent cases were identified, accounting for 3.7% of total patients. A multivariate regression analysis showed that prematurity (p = 0.029) and antepartum maternal GBS colonization (p = 0.032) were significantly associated with risk for the recurrence. Our findings indicated that GBS disease burden still remains with considerable mortality and morbidity in Japan, and provided important information for developing better strategies for the prevention of GBS disease, including maternal vaccination.
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20
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Furuta A, Brokaw A, Manuel G, Dacanay M, Marcell L, Seepersaud R, Rajagopal L, Adams Waldorf K. Bacterial and Host Determinants of Group B Streptococcal Infection of the Neonate and Infant. Front Microbiol 2022; 13:820365. [PMID: 35265059 PMCID: PMC8899651 DOI: 10.3389/fmicb.2022.820365] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 12/15/2022] Open
Abstract
Group B streptococci (GBS) are Gram-positive β-hemolytic bacteria that can cause serious and life-threatening infections in neonates manifesting as sepsis, pneumonia, meningitis, osteomyelitis, and/or septic arthritis. Invasive GBS infections in neonates in the first week of life are referred to as early-onset disease (EOD) and thought to be acquired by the fetus through exposure to GBS in utero or to vaginal fluids during birth. Late-onset disease (LOD) refers to invasive GBS infections between 7 and 89 days of life. LOD transmission routes are incompletely understood, but may include breast milk, household contacts, nosocomial, or community sources. Invasive GBS infections and particularly meningitis may result in significant neurodevelopmental injury and long-term disability that persists into childhood and adulthood. Globally, EOD and LOD occur in more than 300,000 neonates and infants annually, resulting in 90,000 infant deaths and leaving more than 10,000 infants with a lifelong disability. In this review, we discuss the clinical impact of invasive GBS neonatal infections and then summarize virulence and host factors that allow the bacteria to exploit the developing neonatal immune system and target organs. Specifically, we consider the mechanisms known to enable GBS invasion into the neonatal lung, blood vessels and brain. Understanding mechanisms of GBS invasion and pathogenesis relevant to infections in the neonate and infant may inform the development of therapeutics to prevent or mitigate injury, as well as improve risk stratification.
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Affiliation(s)
- Anna Furuta
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Alyssa Brokaw
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States
| | - Gygeria Manuel
- Morehouse School of Medicine, Atlanta, GA, United States
| | - Matthew Dacanay
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Lauren Marcell
- Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
| | - Ravin Seepersaud
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Lakshmi Rajagopal
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Kristina Adams Waldorf
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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21
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Maternal vaccination with a type-III glycoconjugate protects mouse neonates against Group B Streptococcus intranasal infection. Sci Rep 2021; 11:21384. [PMID: 34725414 PMCID: PMC8560876 DOI: 10.1038/s41598-021-00941-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/12/2021] [Indexed: 11/15/2022] Open
Abstract
Group B Streptococcus (GBS) is generally an asymptomatic colonizer of human mucosa but it occasionally infects pregnant women and neonates through vertical transmission, causing disease during the first weeks of life with frequent and severe complications. Preclinical studies have shown that maternal vaccination with polysaccharide-based vaccines protects mothers and offspring from GBS mucosal colonization and consecutive infection. In these models, bacteria were inoculated in mouse either intravaginally in the last trimester of pregnancy or systemically in pups. Here, we investigated whether maternal vaccination with glycoconjugate vaccines may also prevent GBS-mediated colonization and disease in neonates using an infection route that more closely mimics inhalation or ingestion of bacteria during human delivery. To address this point, mice aged less than two days were intranasally challenged with epidemiologically relevant GBS strains. Bacteria were found to colonize nose and intestine, reaching in some cases lungs and blood during the first days of life. Bacteria were also found in vagina of a fraction of colonized female mice within the first month of life. GBS-specific IgG induced by maternal vaccination with a glycoconjugate vaccine formulation were found in blood and mucosal tissues of newborns. Finally, when intranasally challenged with GBS serotype III strains, pups delivered by vaccinated mothers were partially protected against mucosal colonization and deeper infection.
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22
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Hsu JF, Tsai MH, Lin LC, Chu SM, Lai MY, Huang HR, Chiang MC, Yang PH, Lu JJ. Genomic Characterization of Serotype III/ST-17 Group B Streptococcus Strains with Antimicrobial Resistance Using Whole Genome Sequencing. Biomedicines 2021; 9:biomedicines9101477. [PMID: 34680594 PMCID: PMC8533585 DOI: 10.3390/biomedicines9101477] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Antibiotic-resistant type III/ST-17 Streptococcus agalactiae (group B Streptococcus, GBS) strain is predominant in neonatal invasive GBS diseases. We aimed to investigate the antibiotic resistance profiles and genetic characteristics of type III/ST-17 GBS strains. Methods: A total of 681 non-duplicate GBS isolates were typed (MLST, capsular types) and their antibiotic resistances were performed. Several molecular methods (WGS, PCR, sequencing and sequence analysis) were used to determine the genetic context of antibiotic resistant genes and pili genes. Results: The antibiotic resistant rates were significantly higher in type Ib (90.1%) and type III (71.1%) GBS isolates. WGS revealed that the loss of PI-1 genes and absence of ISSag5 was found in antibiotic-resistant III/ST-17 GBS isolates, which is replaced by a ~75-kb integrative and conjugative element, ICESag37, comprising multiple antibiotic resistance and virulence genes. Among 190 serotype III GBS isolates, the most common pilus island was PI-2b (58.4%) alone, which was found in 81.3% of the III/ST-17 GBS isolates. Loss of PI-1 and ISSag5 was significantly associated with antibiotic resistance (95.5% vs. 27.8%, p < 0.001). The presence of ICESag37 was found in 83.6% of all III/ST-17 GBS isolates and 99.1% (105/106) of the antibiotic-resistant III/ST-17 GBS isolates. Conclusions: Loss of PI-1 and ISSag5, which is replaced by ICESag37 carrying multiple antibiotic resistance genes, accounts for the high antibiotic resistance rate in III/ST-17 GBS isolates. The emerging clonal expansion of this hypervirulent strain with antibiotic resistance after acquisition of ICESag37 highlights the urgent need for continuous surveillance of GBS infections.
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Affiliation(s)
- Jen-Fu Hsu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 638, Taiwan
| | - Lee-Chung Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
| | - Shih-Ming Chu
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Mei-Yin Lai
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Hsuan-Rong Huang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Ming-Chou Chiang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Peng-Hong Yang
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (J.-F.H.); (S.-M.C.); (M.-Y.L.); (H.-R.H.); (M.-C.C.); (P.-H.Y.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Jang-Jih Lu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan;
- Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-3-328-1200 (ext. 2554); Fax: +886-3-397-1827
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23
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Deshayes de Cambronne R, Fouet A, Picart A, Bourrel AS, Anjou C, Bouvier G, Candeias C, Bouaboud A, Costa L, Boulay AC, Cohen-Salmon M, Plu I, Rambaud C, Faurobert E, Albigès-Rizo C, Tazi A, Poyart C, Guignot J. CC17 group B Streptococcus exploits integrins for neonatal meningitis development. J Clin Invest 2021; 131:136737. [PMID: 33465054 DOI: 10.1172/jci136737] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/13/2021] [Indexed: 12/28/2022] Open
Abstract
Group B Streptococcus (GBS) is the major cause of human neonatal infections. A single clone, designated CC17-GBS, accounts for more than 80% of meningitis cases, the most severe form of the infection. However, the events allowing blood-borne GBS to penetrate the brain remain largely elusive. In this study, we identified the host transmembrane receptors α5β1 and αvβ3 integrins as the ligands of Srr2, a major CC17-GBS-specific adhesin. Two motifs located in the binding region of Srr2 were responsible for the interaction between CC17-GBS and these integrins. We demonstrated in a blood-brain-barrier cellular model that both integrins contributed to the adhesion and internalization of CC17-GBS. Strikingly, both integrins were overexpressed during the postnatal period in the brain vessels of the blood-brain barrier and blood-cerebrospinal fluid barrier and contributed to juvenile susceptibility to CC17 meningitis. Finally, blocking these integrins decreased the ability of CC17-GBS to cross into the CNS of juvenile mice in an in vivo model of meningitis. Our study demonstrated that CC17-GBS exploits integrins in order to cross the brain vessels, leading to meningitis. Importantly, it provides host molecular insights into neonate's susceptibility to CC17-GBS meningitis, thereby opening new perspectives for therapeutic and prevention strategies of GBS-elicited meningitis.
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Affiliation(s)
| | - Agnès Fouet
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Amandine Picart
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Anne-Sophie Bourrel
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, France
| | - Cyril Anjou
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Guillaume Bouvier
- Structural Bioinformatics Unit, Department of Structural Biology and Chemistry, Institut Pasteur, CNRS UMR3528, C3BI, Paris, France
| | - Cristina Candeias
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Abdelouhab Bouaboud
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Lionel Costa
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
| | - Anne-Cécile Boulay
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS UMR7241, INSERM U1050, PSL Research University, Paris, France
| | - Martine Cohen-Salmon
- Center for Interdisciplinary Research in Biology (CIRB), Collège de France, CNRS UMR7241, INSERM U1050, PSL Research University, Paris, France
| | - Isabelle Plu
- Sorbonne Université/Département de Neuropathologie Raymond Escourolle - Hôpital Pitié-Salpêtrière - Assistance Publique-Hôpitaux de Paris, France
| | - Caroline Rambaud
- Université de Versailles Saint Quentin en Yvelines (Université Paris-Saclay)/Service d'anatomie-pathologique et médecine légale, Hôpital Raymond Poincaré, Garches, France
| | - Eva Faurobert
- INSERM U1209, CNRS UMR 5309, Institute for Advanced Biosciences, France/Université Grenoble Alpes, La Tronche, France
| | - Corinne Albigès-Rizo
- INSERM U1209, CNRS UMR 5309, Institute for Advanced Biosciences, France/Université Grenoble Alpes, La Tronche, France
| | - Asmaa Tazi
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, France.,Centre National de Référence des Streptocoques, France
| | - Claire Poyart
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France.,Hôpitaux Universitaires Paris Centre, Cochin, Assistance Publique Hôpitaux de Paris, France.,Centre National de Référence des Streptocoques, France
| | - Julie Guignot
- Université de Paris, Institut Cochin, INSERM, U1016, CNRS, UMR8104, Paris, France
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24
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Mazzuoli MV, Daunesse M, Varet H, Rosinski-Chupin I, Legendre R, Sismeiro O, Gominet M, Kaminski PA, Glaser P, Chica C, Trieu-Cuot P, Firon A. The CovR regulatory network drives the evolution of Group B Streptococcus virulence. PLoS Genet 2021; 17:e1009761. [PMID: 34491998 PMCID: PMC8448333 DOI: 10.1371/journal.pgen.1009761] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/17/2021] [Accepted: 08/09/2021] [Indexed: 01/31/2023] Open
Abstract
Virulence of the neonatal pathogen Group B Streptococcus is under the control of the master regulator CovR. Inactivation of CovR is associated with large-scale transcriptome remodeling and impairs almost every step of the interaction between the pathogen and the host. However, transcriptome analyses suggested a plasticity of the CovR signaling pathway in clinical isolates leading to phenotypic heterogeneity in the bacterial population. In this study, we characterized the CovR regulatory network in a strain representative of the CC-17 hypervirulent lineage responsible of the majority of neonatal meningitis. Transcriptome and genome-wide binding analysis reveal the architecture of the CovR network characterized by the direct repression of a large array of virulence-associated genes and the extent of co-regulation at specific loci. Comparative functional analysis of the signaling network links strain-specificities to the regulation of the pan-genome, including the two specific hypervirulent adhesins and horizontally acquired genes, to mutations in CovR-regulated promoters, and to variability in CovR activation by phosphorylation. This regulatory adaptation occurs at the level of genes, promoters, and of CovR itself, and allows to globally reshape the expression of virulence genes. Overall, our results reveal the direct, coordinated, and strain-specific regulation of virulence genes by the master regulator CovR and suggest that the intra-species evolution of the signaling network is as important as the expression of specific virulence factors in the emergence of clone associated with specific diseases. Streptococcus agalactiae, commonly known as the Group B Streptococcus (GBS), is a commensal bacterium of the intestinal and vaginal tracts found in approximately 30% of healthy adults. However, GBS is also an opportunistic pathogen and the leading cause of neonatal invasive infections. Epidemiologic data have identified a particular GBS clone, designated the CC-17 hypervirulent clonal complex, as responsible for the overwhelming majority of neonatal meningitis. The hypervirulence of CC-17 has been linked to the expression of two specific surface proteins increasing their abilities to cross epithelial and endothelial barriers. In this study, we characterized the role of the major regulator of virulence gene expression, the CovR response regulator, in a representative hypervirulent strain. Transcriptome and genome-wide binding analysis reveal the architecture of the CovR signaling network characterized by the direct repression of a large array of virulence-associated genes, including the specific hypervirulent adhesins. Comparative analysis in a non-CC-17 wild type strain demonstrates a high level of plasticity of the regulatory network, allowing to globally reshape pathogen-host interaction. Overall, our results suggest that the intra-species evolution of the regulatory network is an important factor in the emergence of GBS clones associated with specific pathologies.
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Affiliation(s)
- Maria-Vittoria Mazzuoli
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
- Sorbonne Paris Cité, Université de Paris, Paris, France
| | - Maëlle Daunesse
- Hub de Bioinformatique et Biostatistique—Département Biologie Computationnelle, Institut Pasteur, Paris, France
| | - Hugo Varet
- Hub de Bioinformatique et Biostatistique—Département Biologie Computationnelle, Institut Pasteur, Paris, France
- Plate-forme Technologique Biomics—Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, Paris, France
| | - Isabelle Rosinski-Chupin
- Unité Écologie et Évolution de la Résistance aux Antibiotiques, CNRS UMR3525, Institut Pasteur, Paris, France
| | - Rachel Legendre
- Hub de Bioinformatique et Biostatistique—Département Biologie Computationnelle, Institut Pasteur, Paris, France
- Plate-forme Technologique Biomics—Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, Paris, France
| | - Odile Sismeiro
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
- Plate-forme Technologique Biomics—Centre de Ressources et Recherches Technologiques (C2RT), Institut Pasteur, Paris, France
| | - Myriam Gominet
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
| | - Pierre Alexandre Kaminski
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
| | - Philippe Glaser
- Unité Écologie et Évolution de la Résistance aux Antibiotiques, CNRS UMR3525, Institut Pasteur, Paris, France
| | - Claudia Chica
- Hub de Bioinformatique et Biostatistique—Département Biologie Computationnelle, Institut Pasteur, Paris, France
| | - Patrick Trieu-Cuot
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
| | - Arnaud Firon
- Unité Biologie des Bactéries Pathogènes à Gram-positif, CNRS UMR2001 Microbiologie Intégrative et Moléculaire, Institut Pasteur, Paris, France
- * E-mail:
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25
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Berardi A, Trevisani V, Di Caprio A, Bua J, China M, Perrone B, Pagano R, Lucaccioni L, Fanaro S, Iughetti L, Lugli L, Creti R. Understanding Factors in Group B Streptococcus Late-Onset Disease. Infect Drug Resist 2021; 14:3207-3218. [PMID: 34429620 PMCID: PMC8380284 DOI: 10.2147/idr.s291511] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/14/2021] [Indexed: 12/22/2022] Open
Abstract
Group B streptococcus (GBS) infection remains a leading cause of sepsis, pneumonia, and meningitis in infants. Rates of GBS early onset disease have declined following the widcespread use of intrapartum antibiotic prophylaxis; hence, late-onset infections (LOGBS) are currently a common presentation of neonatal GBS dicsease. The pathogenesis, mode of transmission, and risk factors associated with LOGBS are unclear, which interfere with effective prevention efforts. GBS may be transmitted from the mother to the infant at the time of delivery or during the postpartum period via contaminated breast milk, or as nosocomial or community-acquired infection. Maternal GBS colonization, prematurity, young maternal age, HIV exposure, and ethnicity (Black) are identified as risk factors for LOGBS disease; however, further studies are necessary to confirm additional risk factors, if any, for the implementation of effective prevention strategies. This narrative review discusses current and previous studies that have reported LOGBS. Few well-designed studies have described this condition; therefore, reliable assessment of maternal GBS colonization, breastfeeding, and twin delivery as risk factors for LOGBS remains limited.
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Affiliation(s)
- Alberto Berardi
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Viola Trevisani
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Antonella Di Caprio
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy
| | - Jenny Bua
- Terapia Intensiva Neonatale, IRCCS Azienda Ospedaliero Universitaria "Burlo Garofalo", Trieste, Italy
| | | | - Barbara Perrone
- Terapia Intensiva Neonatale, Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Rossella Pagano
- Unità Operativa di Pediatria, Civile Sassuolo, Sassuolo, Italy
| | - Laura Lucaccioni
- Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Silvia Fanaro
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Lorenzo Iughetti
- Scuola di Specializzazione in Pediatria, Università di Modena & Reggio Emilia, Modena, Italy.,Unità Operativa di Pediatria, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Licia Lugli
- Terapia Intensiva Neonatale, Azienda Ospedaliero-Universitaria Policlinico, Modena, Italy
| | - Roberta Creti
- Reparto di Antibiotico Resistenza e Patogeni Speciali (AR-PS), Dipartimento di Malattie Infettive, Istituto Superiore di Sanità, Rome, Italy
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26
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Berardi A, Spada C, Creti R, Auriti C, Gambini L, Rizzo V, Capretti M, Laforgia N, Papa I, Tarocco A, Lanzoni A, Biasucci G, Piccinini G, Nardella G, Latorre G, Merazzi D, Travan L, Reggiani MLB, Baroni L, Ciccia M, Lucaccioni L, Iughetti L, Lugli L. Maternal Carriage in Late-Onset Group B Streptococcus Disease, Italy. Emerg Infect Dis 2021; 27:2279-2287. [PMID: 34423765 PMCID: PMC8386770 DOI: 10.3201/eid2709.210049] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
At the time of late-onset disease, mothers often have positive breast milk culture or group B Streptococcus bacteriuria, suggesting heavy maternal colonization. We retrospectively investigated mother-to-infant transmission of group B Streptococcus (GBS) in 98 cases of late-onset disease reported during 2007–2018 by a network in Italy. Mothers with full assessment of vaginal/rectal carriage tested at prenatal screening and at time of late onset (ATLO) were included. Thirty-three mothers (33.7%) were never GBS colonized; 65 (66.3%) were vaginal/rectal colonized, of which 36 (36.7%) were persistently colonized. Mothers with vaginal/rectal colonization ATLO had high rates of GBS bacteriuria (33.9%) and positive breast milk culture (27.5%). GBS strains from mother–infant pairs were serotype III and possessed the surface protein antigen Rib. All but 1 strain belonged to clonal complex 17. GBS strains from 4 mother–infant pairs were indistinguishable through pulsed-field gel electrophoresis. At least two thirds of late-onset cases are transmitted from mothers, who often have vaginal/rectal carriage, positive breast milk culture, or GBS bacteriuria, which suggests heavy maternal colonization.
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27
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Shibata M, Morozumi M, Maeda N, Komiyama O, Shiro H, Iwata S, Ubukata K. Relationship between intrapartum antibiotic prophylaxis and group B streptococcal colonization dynamics in Japanese mother-neonate pairs. J Infect Chemother 2021; 27:977-983. [PMID: 33610482 DOI: 10.1016/j.jiac.2021.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 02/08/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION In Japan, universal screening for group B streptococcal (GBS) colonization in pregnant women and intrapartum antibiotic prophylaxis (IAP) are recommended to prevent neonatal GBS infection. However, the dynamics of GBS colonization in Japanese mother/neonate pairs have not been adequately studied. METHODS A prospective cohort study was conducted from July 2018 to March 2019. Rectovaginal samples were collected from pregnant women (33-37 gestation weeks) once. In neonates, nasopharyngeal and rectal samples were collected at three time points: after birth, 1 week after birth, and 1 month after birth. All samples were analyzed for GBS using real-time PCR testing and culture methods. Capsular typing was performed for all GBS isolates and GBS-positive samples using real-time PCR testing. RESULTS The overall maternal and neonatal GBS-positivity rates were 22.7% (57/251) and 8.8% (22/251), respectively. IAP for GBS-positive mothers (96.5%) was highly administered. Eleven (19.3%) neonates born to GBS-positive mothers were GBS-positive, which was significantly higher than the 11 (5.7%) neonates born to GBS-negative mothers. The rate of GBS-positivity in neonates increased with an increased number of GBS colonies in mothers. More neonates were GBS-positive 1 month after birth than 1 week after birth, and there was a higher rate of GBS-positive rectal swabs than nasopharyngeal swabs. Capsular types of GBS that were isolated from each mother and neonate pair were the same, namely, Ib, III, V, and VI. CONCLUSIONS These findings indicate that the efficacy of IAP in preventing GBS transmission to neonates might be limited to within a few weeks after birth.
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Affiliation(s)
- Meiwa Shibata
- Department of Pediatrics, Yokohama Rosai Hospital, Japan; Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Miyuki Morozumi
- Department of Infectious Diseases, Keio University School of Medicine, Japan
| | - Naonori Maeda
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Osamu Komiyama
- Department of Pediatrics, National Hospital Organization Tokyo Medical Center, Japan
| | - Hiroyuki Shiro
- Department of Pediatrics, Yokohama Rosai Hospital, Japan
| | - Satoshi Iwata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of Infectious Diseases, National Cancer Center Hospital, Japan
| | - Kimiko Ubukata
- Department of Infectious Diseases, Keio University School of Medicine, Japan; Department of General Medicine, Keio University School of Medicine, Japan.
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Travier L, Alonso M, Andronico A, Hafner L, Disson O, Lledo PM, Cauchemez S, Lecuit M. Neonatal susceptibility to meningitis results from the immaturity of epithelial barriers and gut microbiota. Cell Rep 2021; 35:109319. [PMID: 34192531 DOI: 10.1016/j.celrep.2021.109319] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/25/2021] [Accepted: 06/07/2021] [Indexed: 01/06/2023] Open
Abstract
Neonates are highly susceptible to bacterial meningitis as compared to children and adults. Group B streptococcus (GBS) is a major cause of neonatal meningitis. Neonatal meningitis can result from GBS intestinal colonization and translocation across the intestinal barrier (IB). Here, we show that the immaturity of the neonatal intestinal microbiota leads to low resistance to GBS intestinal colonization and permissiveness of the gut-vascular barrier. Moreover, the age-dependent but microbiota-independent Wnt activity in intestinal and choroid plexus (CP) epithelia results in a lower degree of cell-cell junctions' polarization, which favors bacterial translocation. This study thus reveals that neonatal susceptibility to GBS meningitis results from the age-dependent immaturity of the intestinal microbiota and developmental pathways associated with neonatal tissue growth, which both concur to GBS gut colonization, systemic dissemination, and neuroinvasion. Whereas the activation of developmental pathways is intrinsic to neonates, interventions aimed at maturing the microbiota may help prevent neonatal meningitis.
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Affiliation(s)
- Laetitia Travier
- Institut Pasteur, Biology of Infection Unit, Paris, France; Institut National de la Santé et de la Recherche Médicale U1117, Paris, France
| | - Mariana Alonso
- Laboratory for Perception and Memory, Institut Pasteur, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France
| | - Alessio Andronico
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 2000, Paris, France
| | - Lukas Hafner
- Institut Pasteur, Biology of Infection Unit, Paris, France; Institut National de la Santé et de la Recherche Médicale U1117, Paris, France; Université de Paris, Paris, France
| | - Olivier Disson
- Institut Pasteur, Biology of Infection Unit, Paris, France; Institut National de la Santé et de la Recherche Médicale U1117, Paris, France
| | - Pierre-Marie Lledo
- Laboratory for Perception and Memory, Institut Pasteur, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 3571, Paris, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France; Centre National de la Recherche Scientifique, Unité Mixte de Recherche 2000, Paris, France
| | - Marc Lecuit
- Institut Pasteur, Biology of Infection Unit, Paris, France; Institut National de la Santé et de la Recherche Médicale U1117, Paris, France; Université de Paris, Paris, France; National Reference Centre and WHO Collaborating Centre Listeria, Institut Pasteur, Paris, France; Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, APHP, Institut Imagine, Paris, France.
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29
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De Gaetano GV, Lentini G, Galbo R, Coppolino F, Famà A, Teti G, Beninati C. Invasion and trafficking of hypervirulent group B streptococci in polarized enterocytes. PLoS One 2021; 16:e0253242. [PMID: 34129624 PMCID: PMC8205152 DOI: 10.1371/journal.pone.0253242] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/01/2021] [Indexed: 11/29/2022] Open
Abstract
Streptococcus agalactiae (group B streptococcus or GBS) is a commensal bacterium that can frequently behave as a pathogen, particularly in the neonatal period and in the elderly. The gut is a primary site of GBS colonization and a potential port of entry during neonatal infections caused by hypervirulent clonal complex 17 (CC17) strains. Here we studied the interactions between the prototypical CC17 BM110 strain and polarized enterocytes using the Caco-2 cell line. GBS could adhere to and invade these cells through their apical or basolateral surfaces. Basolateral invasion was considerably more efficient than apical invasion and predominated under conditions resulting in weakening of cell-to-cell junctions. Bacterial internalization occurred by a mechanism involving caveolae- and lipid raft-dependent endocytosis and actin re-organization, but not clathrin-dependent endocytosis. In the first steps of Caco-2 invasion, GBS colocalized with the early endocytic marker EEA-1, to later reside in acidic vacuoles. Taken together, these data suggest that CC17 GBS selectively adheres to the lateral surface of enterocytes from which it enters through caveolar lipid rafts using a classical, actin-dependent endocytic pathway. These data may be useful to develop alternative preventive strategies aimed at blocking GBS invasion of the intestinal barrier.
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Affiliation(s)
| | - Germana Lentini
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Roberta Galbo
- Department of Chemical, Biological and Pharmaceutical Sciences, University of Messina, Messina, Italy
| | | | - Agata Famà
- Department of Human Pathology, University of Messina, Messina, Italy
| | | | - Concetta Beninati
- Department of Human Pathology, University of Messina, Messina, Italy
- Scylla Biotech Srl, Messina, Italy
- * E-mail:
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30
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Freudenhammer M, Karampatsas K, Le Doare K, Lander F, Armann J, Acero Moreno D, Boyle M, Buxmann H, Campbell R, Chalker V, Cunney R, Doherty L, Davies E, Efstratiou A, Elling R, Endmann M, Essers J, Hentschel R, Jones CE, Kallsen S, Kapatai G, Krüger M, Ladhani S, Lamagni T, Lindsay D, Meehan M, O'Sullivan CP, Patel D, Reynolds AJ, Roll C, Schulzke S, Smith A, Stein A, von der Wense A, Voss E, Wieg C, Härtel C, Heath PT, Henneke P. Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS Late-Onset Sepsis. Front Immunol 2021; 12:617925. [PMID: 34149682 PMCID: PMC8208644 DOI: 10.3389/fimmu.2021.617925] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 05/04/2021] [Indexed: 01/30/2023] Open
Abstract
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
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Affiliation(s)
- Mirjam Freudenhammer
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,IMM-PACT Clinician Scientist Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Konstantinos Karampatsas
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Kirsty Le Doare
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Fabian Lander
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Jakob Armann
- Department of Pediatrics, University Hospital and Medical Faculty Carl Gustav Carus, Technische Universität (TU) Dresden, Dresden, Germany
| | - Daniel Acero Moreno
- Department of Neonatology, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | - Margaret Boyle
- Department of Health Northern Ireland, Belfast, United Kingdom
| | - Horst Buxmann
- Department of Pediatric and Adolescent Medicine, Division for Neonatology at the University Hospital Frankfurt, Frankfurt/Main, Germany
| | - Ruth Campbell
- Public Health Agency Northern Ireland, Belfast, United Kingdom
| | - Victoria Chalker
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Robert Cunney
- Health Service Executive, Health Protection Surveillance Centre, Dublin, Ireland.,Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | | | | | | | - Roland Elling
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Matthias Endmann
- Department of Pediatric and Adolescent Medicine, St. Franziskus Hospital Ahlen, Ahlen, Germany
| | - Jochen Essers
- Department of Pediatrics, University of Ulm, Ulm, Germany
| | - Roland Hentschel
- Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christine E Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Steffen Kallsen
- Department of Paediatrics and Youth Medicine, Klinikum Friedrichshafen, Friedrichshafen, Germany
| | - Georgia Kapatai
- Immunisation, Hepatitis and Blood Safety Department, Public Health England, London, United Kingdom
| | - Marcus Krüger
- Department of Neonatology, München Klinik Harlaching and Schwabing, Munich, Germany
| | - Shamez Ladhani
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom.,Immunisation and Countermeasures Division, Public Health England, London, United Kingdom
| | - Theresa Lamagni
- National Infection Service, Public Health England, London, United Kingdom
| | - Diane Lindsay
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Mary Meehan
- Irish Meningitis and Sepsis Reference Laboratory, Temple Street Children's University Hospital, Dublin, Ireland
| | - Catherine P O'Sullivan
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Darshana Patel
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | | | - Claudia Roll
- Department of Neonatology, Vest Children's Hospital Datteln, University Witten-Herdecke, Witten-Herdecke, Germany
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Andrew Smith
- Scottish Microbiology Reference Laboratory, Glasgow Royal Infirmary, Glasgow, United Kingdom.,Glasgow Dental Hospital and School, University of Glasgow, Glasgow, United Kingdom
| | - Anja Stein
- Department of Pediatrics, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Axel von der Wense
- Neonatology and Pediatric Intensive Care, Altonaer Children's Hospital, Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Egbert Voss
- Klinik Hallerwiese-Cnopfsche Kinderklinik, Nürnberg, Germany
| | - Christian Wieg
- Department of Neonatology, Klinikum Aschaffenburg, Aschaffenburg, Germany
| | - Christoph Härtel
- Department of Pediatrics, University of Würzburg, Würzburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St. George's, University of London, London, United Kingdom
| | - Philipp Henneke
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Center for Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,PRIMAL (Priming Immunity at the Beginning of Life) Consortium, Freiburg/Lübeck, Germany
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31
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Zhang L, Kang WJ, Zhu L, Xu LJ, Guo C, Zhang XH, Liu QH, Ma L. Emergence of Invasive Serotype Ib Sequence Type 10 Group B Streptococcus Disease in Chinese Infants Is Driven by a Tetracycline-Sensitive Clone. Front Cell Infect Microbiol 2021; 11:642455. [PMID: 34055663 PMCID: PMC8162377 DOI: 10.3389/fcimb.2021.642455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/26/2021] [Indexed: 01/31/2023] Open
Abstract
Background Group B streptococcus (GBS) is a leading cause of serious infections in infants. The extensive use of tetracycline has led to the selection of specific resistant and infectious GBS clones. The sequence type (ST) 10 GBS strain, causing invasive infections in infants, is becoming prevalent in China. We aimed to understand the clinical and microbiological characteristics of this GBS strain. Methods We conducted a retrospective study on infants with invasive GBS disease from the largest women’s and children’s medical center in Shanxi and collected data between January 2017 and October 2020. GBS isolates were analyzed by capsule serotyping, genotyping, antibiotic resistance, and surface protein genes. Results All ST10 isolates belonged to serotype Ib; type Ib/ST10 strains were responsible for 66.7% (14/21, P < 0.05) of infant invasive GBS infections during the period and all resulted in late-onset (LOD) and late LOD disease (14/14). Infants with type Ib/ST10 GBS disease had significantly higher rates of meningitis (9/14, 64.3%, p < 0.05) and clinical complications (5/14, 35.7%, p < 0.05). The Ib/ST10 GBS isolates had limited genetic diversity, clustered in the CC10/bca/PI-1 + PI-2a genetic lineage, showed resistance to erythromycin, lincomycin, and fluoroquinolones and sensitivity to tetracycline, and possessed genes ermT, ermB, and amino acid changes in gyrA and parC. Conclusions The probable clonal expansion can result in severe infections in infants and ongoing emergence of multi-drug resistant isolates. Continued monitoring for type Ib/ST10 GBS infections is warranted.
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Affiliation(s)
- Li Zhang
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Wen-Juan Kang
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Lei Zhu
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Li-Jun Xu
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Chao Guo
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Xin-Hua Zhang
- Department of Neonatology Department, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
| | - Qing-Hua Liu
- Department of Pathophysiology, Shanxi Medical University, Taiyuan, China
| | - Lan Ma
- Department of Clinical Laboratory, Shanxi Children's Hospital Shanxi Maternal and Child Health Hospital, Taiyuan, China
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32
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Gilbert NM, Foster LR, Cao B, Yin Y, Mysorekar IU, Lewis AL. Gardnerella vaginalis promotes group B Streptococcus vaginal colonization, enabling ascending uteroplacental infection in pregnant mice. Am J Obstet Gynecol 2021; 224:530.e1-530.e17. [PMID: 33248136 DOI: 10.1016/j.ajog.2020.11.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Group B Streptococcus is a common vaginal bacterium and the leading cause of invasive fetoplacental infections. Group B Streptococcus in the vagina can invade through the cervix to cause ascending uteroplacental infections or can be transmitted to the neonate during vaginal delivery. Some studies have found that women with a "dysbiotic" polymicrobial or Lactobacillus-depleted vaginal microbiota are more likely to harbor group B Streptococcus. Gardnerella vaginalis is often the most abundant bacteria in the vaginas of women with dysbiosis, while being detected at lower levels in most other women, and has been linked with several adverse pregnancy outcomes. Mouse models of group B Streptococcus and Gardnerella vaginalis colonization have been reported but, to the best of our knowledge, the two have not been studied together. The overarching idea driving this study is that certain members of the dysbiotic vaginal microbiota, such as Gardnerella vaginalis, may directly contribute to the increased rate of group B Streptococcus vaginal colonization observed in women with vaginal dysbiosis. OBJECTIVE We used a mouse model to test the hypothesis that vaginal exposure to Gardnerella vaginalis may facilitate colonization and/or invasive infection of the upper reproductive tract by group B Streptococcus during pregnancy. STUDY DESIGN Timed-pregnant mice were generated using an allogeneic mating strategy with BALB/c males and C57Bl/6 females. Dams were vaginally inoculated at gestational day 14 with group B Streptococcus alone (using a 10-fold lower dose than previously reported models) or coinoculated with group B Streptococcus and Gardnerella vaginalis. Bacterial titers were enumerated in vaginal, uterine horn, and placental tissues at gestational day 17. The presence (Fisher exact tests) and levels (Mann-Whitney U tests) of bacterial titers were compared between mono- and coinoculated dams in each compartment. Relative risks were calculated for outcomes that occurred in both groups. Tissue samples were also examined for evidence of pathophysiology. RESULTS Inoculation of pregnant mice with 107 group B Streptococcus alone did not result in vaginal colonization or ascending infection. In contrast, coinoculation of group B Streptococcus with Gardnerella vaginalis in pregnant mice resulted in a 10-fold higher risk of group B Streptococcus vaginal colonization (relative risk, 10.31; 95% confidence interval, 2.710-59.04; P=.0006 [Fisher exact test]). Ascending group B Streptococcus infection of the uterus and placenta occurred in approximately 40% of coinoculated animals, whereas none of those receiving group B Streptococcus alone developed uterine or placental infections. Immunofluorescence microscopy revealed group B Streptococcus in both the maternal and fetal sides of the placenta. Histologic inflammation and increased proinflammatory cytokines were evident in the setting of group B Streptococcus placental infection. Interestingly, placentas from dams exposed to group B Streptococcus and Gardnerella vaginalis, but without recoverable vaginal or placental bacteria, displayed distinct histopathologic features and cytokine signatures. CONCLUSION These data suggest that Gardnerella vaginalis vaginal exposure can promote group B Streptococcus vaginal colonization, resulting in a greater likelihood of invasive perinatal group B Streptococcus infections. These findings suggest that future clinical studies should examine whether the presence of Gardnerella vaginalis is a risk factor for group B Streptococcus vaginal colonization in women. Because Gardnerella vaginalis can also be present in women without bacterial vaginosis, these findings may be relevant both inside and outside of the context of vaginal dysbiosis.
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Prevalence of group B streptococcal colonization in the healthy non-pregnant population: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:968-980. [PMID: 33813109 DOI: 10.1016/j.cmi.2021.03.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/17/2021] [Accepted: 03/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Colonization and transmission precede invasive group B streptococcal (GBS) disease. Data on GBS colonization prevalence, detection methods and risk factors for carriage are relevant for vaccine development and to understand GBS pathogenesis. OBJECTIVES To evaluate GBS colonization prevalence after the first week of life in the healthy non-pregnant population. DATA SOURCES Pubmed/Medline, Embase, Latin American and Caribbean Health Sciences Literature, World Health Organization Library Information System, and Scopus. Search performed 12 January 2021 with search terms related to 'GBS' and 'colonization, epidemiology, prevalence or screening' without restrictions. STUDY ELIGIBILITY CRITERIA All studies that reported prevalence of GBS colonization (any site) in the healthy population. PARTICIPANTS All individuals (>6 days of age), with no indication of pregnancy, invasive disease or severe underlying immunological co-morbidities. METHODS Logit transformation and a random effects model (DerSimonian and Laird) were used to pool colonization estimates. Subgroup analysis and meta-regression on a priori determined subgroups were performed. RESULTS We included 98 studies with 43 112 participants. Our search identified 9309 studies of which 8831 were excluded based on title and abstract and 380 after reading the full text. Colonization rates varied considerably between studies (I2 = 97%), which could be partly explained by differences in culture methods (R2 = 27%), culture sites (R2 = 24%), continent (R2 = 10%) and participant's age (R2 = 6%). Higher prevalence was found with selective culture methods (19%, 95% CI 16%-23% versus non-selective methods 8%, 95% CI 6%-9%; p < 0.0001). Colonization rates were highest in rectum (19%, 95% CI 15%-24%), vagina (14%, 95% CI 12%-17%) and urethra (9%, 95% CI 5%-18%). In participants with negative rectal cultures, 7% (95% CI 5%-9%) had GBS cultured from another niche. Colonization prevalence was lower in children (6 months to 16 years; 3%, 95% CI 2%-5%) compared with adults (16%, 95% CI 14%-20%; p < 0.0001). Using selective culture methods in adults resulted in a prevalence of 26% (95% CI 19%-33%) rectal, 21% (95% CI 17%-25%) vaginal and 9% (95% CI 6%-14%) urethral colonization. CONCLUSION The rectum is the most common body site colonized by GBS. The best approach to screen for any GBS colonization is to screen multiple body sites using selective culture methods.
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Plainvert C, Anselem O, Joubrel C, Marcou V, Falloukh A, Frigo A, Magdoud El Alaoui F, Ancel PY, Jarreau PH, Mandelbrot L, Goffinet F, Poyart C, Tazi A. Persistence of group B Streptococcus vaginal colonization and prevalence of hypervirulent CC-17 clone correlate with the country of birth: a prospective 3-month follow-up cohort study. Eur J Clin Microbiol Infect Dis 2020; 40:133-140. [PMID: 32812077 DOI: 10.1007/s10096-020-04011-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023]
Abstract
To identify factors associated with vaginal colonization and persistence by group B Streptococcus (GBS) and by the hypervirulent neonatal CC-17 clone in late pregnancy and after delivery, a multicentre prospective observational cohort with 3-month follow-up was established in two university hospitals, Paris area, France. Pregnant women were recruited when antenatal screening for GBS vaginal colonization at 34-38 weeks of gestational age was positive. Vaginal samples were analysed by conventional culture methods at antenatal screening, delivery, and 21 and 60 days following delivery. Identification of the hypervirulent neonatal GBS CC-17 was performed. Colonization was defined as persistent when all vaginal samples were positive for GBS. A total of 754 women were included. GBS vaginal colonization was persistent in 63% of the cases (95% CI 59%-67%). Persistent colonization was more likely in women born in Sub-Saharan Africa compared with women born in France (OR = 1.88, 95% CI 1.05-3.52), and GBS CC-17 was overrepresented in women born in Sub-Saharan Africa (OR = 2.09, 95% CI 1.20-3.57). Women born in Sub-Saharan Africa are at higher risk for GBS vaginal persistence than women born in France. This observation correlates with an increased prevalence of the hypervirulent GBS CC-17 in the former group, which likely reflect variations linked to ethnicity and vaginal community-state types and might account for the increased susceptibility of black neonates to GBS infections.
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Affiliation(s)
- Céline Plainvert
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Olivia Anselem
- FHU Prema, Paris, France
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Caroline Joubrel
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Valérie Marcou
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Amiel Falloukh
- Department of Neonatal Medicine, Louis Mourier Hospital, AP-HP, Colombes, France
| | - Amandine Frigo
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
| | - Fatma Magdoud El Alaoui
- Department of Microbiology, Louis Mourier Hospital, AP-HP, Colombes, France
- Université de Paris, Paris, France
| | - Pierre-Yves Ancel
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
- URC-CIC P1419, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
| | - Pierre Henri Jarreau
- FHU Prema, Paris, France
- Department of Neonatal Medicine, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
| | - Laurent Mandelbrot
- FHU Prema, Paris, France
- Université de Paris, Paris, France
- Department of Obstetrics and Gynaecology, Louis Mourier Hospital, AP-HP, Colombes, France
| | - François Goffinet
- Department of Obstetrics and Gynaecology, Port-Royal Maternity, University Hospitals Paris Centre Cochin Port Royal, AP-HP, Paris, France
- Université de Paris, Paris, France
- Obstetrical, Perinatal and Paediatric Epidemiology Research Team (EPOPé), INSERM UMR 1153, Paris, France
| | - Claire Poyart
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France
- FHU Prema, Paris, France
- Université de Paris, Paris, France
| | - Asmaa Tazi
- Department of Bacteriology, University Hospitals Paris Centre Cochin Port Royal, French National Reference Centre for Streptococci, AP-HP, Paris, France.
- FHU Prema, Paris, France.
- Université de Paris, Paris, France.
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35
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Hays C, Touak G, Bouaboud A, Fouet A, Guignot J, Poyart C, Tazi A. Perinatal hormones favor CC17 group B Streptococcus intestinal translocation through M cells and hypervirulence in neonates. eLife 2019; 8:48772. [PMID: 31710290 PMCID: PMC6867712 DOI: 10.7554/elife.48772] [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] [Received: 05/24/2019] [Accepted: 11/09/2019] [Indexed: 01/01/2023] Open
Abstract
Group B Streptococcus (GBS) is the leading cause of invasive bacterial neonatal infections. Late-onset diseases (LOD) occur between 7 and 89 days of life and are largely due to the CC17 GBS hypervirulent clone. We studied the impact of estradiol (E2) and progesterone (P4), which impregnate the fetus during pregnancy, on GBS neonatal infection in cellular and mouse models of hormonal exposure corresponding to concentrations found at birth (E2-P4 C0) and over 7 days old (E2-P4 C7). Using representative GBS isolates, we show that E2-P4 C7 concentrations specifically favor CC17 GBS meningitis following mice oral infection. CC17 GBS crosses the intestinal barrier through M cells. This process mediated by the CC17-specific surface protein Srr2 is enhanced by E2-P4 C7 concentrations which promote M cell differentiation and CC17 GBS invasiveness. Our findings provide an explanation for CC17 GBS responsibility in LOD in link with neonatal gastrointestinal tract maturation and hormonal imprint.
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Affiliation(s)
- Constantin Hays
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France.,Department of Bacteriology, University Hospitals Paris Centre-Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Gérald Touak
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France
| | - Abdelouhab Bouaboud
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France
| | - Agnès Fouet
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France
| | - Julie Guignot
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France
| | - Claire Poyart
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France.,Department of Bacteriology, University Hospitals Paris Centre-Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.,National Reference Center for Streptococci, Paris, France
| | - Asmaa Tazi
- Institut Cochin, Team Bacteria and Perinatality, INSERM U1016, Paris, France.,CNRS UMR 8104, Paris, France.,Paris Descartes University, Paris, France.,Department of Bacteriology, University Hospitals Paris Centre-Cochin, Assistance Publique - Hôpitaux de Paris, Paris, France.,National Reference Center for Streptococci, Paris, France
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36
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Ratner AJ. Enhanced Postnatal Acquisition of Hypervirulent Group B Streptococcus. Clin Infect Dis 2019; 69:1749-1751. [PMID: 30945730 PMCID: PMC6821193 DOI: 10.1093/cid/ciz035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/10/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Adam J Ratner
- Departments of Pediatrics and Microbiology, New York University School of Medicine, New York
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