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Veronese P, Cella S, Giacometti A, Lapetina I, Maffini V, Pappalardo M, Rubini M, Ruozi MB, Dodi I. Invasive Streptococcus intermedius Infections in Children: Two Cases from a Pediatric Infectious Diseases Unit in Italy. Pathogens 2024; 13:1099. [PMID: 39770358 PMCID: PMC11728730 DOI: 10.3390/pathogens13121099] [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: 10/10/2024] [Revised: 11/26/2024] [Accepted: 12/05/2024] [Indexed: 01/16/2025] Open
Abstract
In recent years, an increasing number of reports have described invasive infections caused by bacteria from Streptococcus anginosus group (SAGs). S. intermedius seems to be more related with pleuropulmonary infections and abscess of the brain and deep soft tissues, and it is more likely to cause suppurative and non-bacteremic infections compared to other members of the same genus. We present two clinical cases of invasive S. intermedius infections in pediatric patients: a liver abscess case and a pansinusitis case associated with bilateral otomastoiditis and parapharyngeal abscess complicated by acute mediastinitis, thrombophlebitis of the cavernous sinus, and thrombosis of the cranial tract of the ipsilateral jugular vein. In both cases, prompt broad-spectrum antibiotic therapy and operative drainage of the collections resulted in a good clinical response with full recovery.
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Affiliation(s)
- Piero Veronese
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Simone Cella
- Pediatric Radiology Unit, Institute of Radiology, University of Parma, 43126 Parma, Italy;
| | - Alessandra Giacometti
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Irene Lapetina
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Valentina Maffini
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Marco Pappalardo
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Monica Rubini
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Maria Beatrice Ruozi
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
| | - Icilio Dodi
- Pediatric Infectious Disease Unit, Children’s Hospital of Parma, 43126 Parma, Italy; (A.G.); (I.L.); (V.M.); (M.P.); (M.R.); (M.B.R.); (I.D.)
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Furfaro LL, Chang BJ, Kahler CM, Payne MS. Genomic characterisation of perinatal Western Australian Streptococcus agalactiae isolates. PLoS One 2019; 14:e0223256. [PMID: 31577825 PMCID: PMC6774530 DOI: 10.1371/journal.pone.0223256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/17/2019] [Indexed: 11/18/2022] Open
Abstract
As a leading cause of neonatal sepsis, Streptococcus agalactiae, commonly known as Group B Streptococcus, is a major neonatal pathogen. Current global screening practices employ risk- or culture-based protocols for detection of these organisms. In Western Australia (WA), universal culture-based screening is provided, with subsequent intrapartum antibiotic prophylaxis for all S. agalactiae-positive women during labour. Widespread antibiotic exposure is not ideal and this is one of the factors driving development of vaccines against S. agalactiae. Vaccine candidates have focused on the capsule, surface proteins and pilus types, however, capsule serotypes are known to vary geographically. The aim of this study was to use genome sequencing to gain an understanding of the circulating genotypes in WA, and to assess variations in the associated gene pools. We sequenced 141 antenatal carriage (vaginal/rectal) isolates and 10 neonatal invasive disease isolates from WA. Based on the global PubMLST database, the 151 strains were characterised into 30 sequence types, with clustering of these mainly into clonal complexes 1, 12, 17, 19 and 23. Of the genes encoding eleven surface proteins that were analysed, the most prevalent were fbp, lmb and scpB which were present in ≥ 98% of isolates. A cluster of non-haemolytic isolates, one of which was a neonatal invasive disease isolate, appeared to lack the entire cyl locus. Admixture analysis of population structure revealed evidence of genetic transfer among the WA isolates across structural groups. When compared against the PubMLST S. agalactiae data, WA isolates showed high levels of strain diversity with minimal apparent clustering. This is the first whole genome sequence study of WA S. agalactiae isolates and also represents the first addition of Australian isolate data to PubMLST. This report provides insight into the distribution and diversity of vaccine targets of S. agalactiae within Western Australia, indicating that the most appropriate capsular vaccine for this population would be the proposed pentavalent (Cps Ia, Ib, II, III and V) preparation, whilst vaccines targeting surface proteins should ideally utilise Fbp, Lmb and/or ScpB.
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Affiliation(s)
- Lucy L. Furfaro
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Barbara J. Chang
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, Western Australia, Australia
| | - Charlene M. Kahler
- The School of Biomedical Sciences, The Marshall Centre for Infectious Diseases Research and Training, The University of Western Australia, Perth, Western Australia, Australia
| | - Matthew S. Payne
- The School of Medicine, Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, Australia
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Gendrin C, Vornhagen J, Armistead B, Singh P, Whidbey C, Merillat S, Knupp D, Parker R, Rogers LM, Quach P, Iyer LM, Aravind L, Manning SD, Aronoff DM, Rajagopal L. A Nonhemolytic Group B Streptococcus Strain Exhibits Hypervirulence. J Infect Dis 2019; 217:983-987. [PMID: 29244079 DOI: 10.1093/infdis/jix646] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/11/2017] [Indexed: 11/13/2022] Open
Abstract
Group B streptococci (GBS) are Gram-positive bacteria that are a leading cause of neonatal infections. Most invasive isolates are β-hemolytic, and hemolytic activity is critical for GBS virulence. Although nonhemolytic GBS strains are occasionally isolated, they are often thought to be virulence attenuated. In this study, we show that a nonhemolytic GBS strain (GB37) isolated from a septic neonate exhibits hypervirulence. Substitution of tryptophan to leucine (W297L) in the sensor histidine kinase CovS results in constitutive kinase signaling, leading to decreased hemolysis and increased activity of the GBS hyaluronidase, HylB. These results describe how nonpigmented and nonhemolytic GBS strains can exhibit hypervirulence.
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Affiliation(s)
- Claire Gendrin
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle
| | - Jay Vornhagen
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle.,Department of Global Health, University of Washington, Seattle
| | - Blair Armistead
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle.,Department of Global Health, University of Washington, Seattle
| | - Pallavi Singh
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing
| | - Christopher Whidbey
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle.,Department of Global Health, University of Washington, Seattle
| | - Sean Merillat
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle
| | - David Knupp
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing
| | - Robert Parker
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing
| | - Lisa M Rogers
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee.,Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Phoenicia Quach
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle
| | - Lakshminarayan M Iyer
- Computational Biology Branch, National Center for Biotechnology Information, National Institutes of Health, Bethesda, Maryland
| | - L Aravind
- Computational Biology Branch, National Center for Biotechnology Information, National Institutes of Health, Bethesda, Maryland
| | - Shannon D Manning
- Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing
| | - David M Aronoff
- Division of Infectious Diseases, Department of Medicine, Nashville, Tennessee.,Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Lakshmi Rajagopal
- Department of Pediatrics, University of Washington and Seattle Children's Research Institute, Seattle.,Department of Global Health, University of Washington, Seattle
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Khalil MR, Uldbjerg N, Thorsen PB, Møller JK. Risk-based approach versus culture-based screening for identification of group B streptococci among women in labor. Int J Gynaecol Obstet 2018; 144:187-191. [PMID: 30467848 DOI: 10.1002/ijgo.12721] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/24/2018] [Accepted: 11/21/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To compare a risk-based and culture-based screening approach for identification of group B streptococci (GBS) vaginal colonization using an intrapartum rectovaginal culture as the reference standard. METHODS Pregnant women attending the prenatal clinic at Lillebaelt Hospital, Kolding, Denmark, between April 1, 2013, and June 30, 2014, were invited to participate in a prospective observational study. For prepartum culture-based screening, vaginal and rectal culture samples were obtained and, for reference, standard, paired vaginal and rectal culture samples were collected during labor. Risk factors for risk-based screening were previous early-onset GBS, GBS bacteriuria during pregnancy, maternal temperature ≥38.0°C intrapartum, and rupture of membranes for more than 18 hours. RESULTS The intrapartum rectovaginal GBS colonization rate was 30% (32/108) among participants with risk factors and 15% (123/794) among participants without risk factors. Culture-based screening demonstrated a sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio in predicting intrapartum GBS carriage of 78% (95% confidence interval [CI] 71-84), 95% (94-97), 78% (70-84), 95% (94-97), and 17 (12-23), respectively; for risk-based screening, these values were 21% (15-28), 90% (87-92), 30% (22-38), 85% (83-86), and 2 (1-3), respectively. CONCLUSIONS Culture-based screening performed considerably better than a risk-based approach in identifying intrapartum GBS colonization.
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Affiliation(s)
- Mohammed R Khalil
- Department of Obstetrics and Gynecology, Lillebaelt Hospital, Kolding, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Poul B Thorsen
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Lillebaelt Hospital, Vejle, Denmark
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Multicenter Diagnostic Accuracy Evaluation of the Luminex Aries Real-Time PCR Assay for Group B Streptococcus Detection in Lim Broth-Enriched Samples. J Clin Microbiol 2018; 56:JCM.01768-17. [PMID: 29848562 PMCID: PMC6062795 DOI: 10.1128/jcm.01768-17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/06/2018] [Indexed: 12/28/2022] Open
Abstract
The vertical transmission of group B Streptococcus (GBS) strains causing neonatal sepsis is one of the leading reasons for neonatal mortality worldwide. The gold standard for GBS detection is enriched culture with or without the aid of chromogenic agars. Given the high risk for morbidity and mortality in this population, high assay sensitivity is required to prevent the personal and economic costs of GBS disease. Nucleic acid amplification tests (NAATs) allow for objective determination of GBS colonization with a sensitivity and a specificity higher than those of traditional culture methods. In this study, we determined the analytical and clinical performance of the Aries GBS assay compared to those of the enrichment culture method, biochemical identification, and the NAATs used at the study sites. Remnant Lim broth samples were used to perform the Aries assay and reference testing. Upon first testing using enriched culture as the reference standard, the Aries GBS assay identified GBS with a 96.1% sensitivity (95% confidence interval [CI], 91.2 to 98.7%) and a 91.4% specificity (95% CI, 88.8 to 93.6%). The test performed with 100% positive agreement (95% CI, 83.2 to 100%) compared to the results of the BD Max GBS assay and 98.0% positive agreement (95% CI, 89.2 to 99.9%) compared to the results of the Cepheid Xpert GBS LB test. Repeatability and reproducibility were maintained in intra- and interlaboratory testing, regardless of the instrument, module, or user who performed the test. The Aries GBS assay can be set up in less than 5 min and produces results in 2 h. The easy setup, with minimal hands-on time, and high assay sensitivity and specificity make this a useful testing option for GBS screening in prepartum women.
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Intrapartum PCR assay versus antepartum culture for assessment of vaginal carriage of group B streptococci in a Danish cohort at birth. PLoS One 2017; 12:e0180262. [PMID: 28678829 PMCID: PMC5497980 DOI: 10.1371/journal.pone.0180262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/13/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this study was to compare the performances of two strategies for predicting intrapartum vaginal carriage of group B streptococci (GBS). One strategy was based on an antepartum culture and the other on an intrapartum polymerase chain reaction (PCR). We conducted a prospective observational study enrolling 902 pregnant women offered GBS screening before delivery by two strategies. The Culture-strategy was based on vaginal and rectal cultures at 35–37 weeks’ gestation, whereas the PCR-strategy was based on PCR assay on intrapartum vaginal swab samples. An intrapartum vaginal culture for GBS was used as the reference standard from which the performances of the 2 strategies were evaluated. The reference standard showed a GBS-prevalence of 12%. The culture-strategy performed with a sensitivity of 82%, specificity of 91%, positive predictive value (PPV) of 55%, negative predictive value (NPV) of 98%, and Likelihood ratio (LH+) of 9.2. The PCR-strategy showed corresponding values as sensitivity of 83%, specificity of 97%, PPV of 78%, NPV of 98%, and LH+ of 27.5. We conclude that in a Danish population with a low rate of early-onset neonatal infection with GBS, the intrapartum PCR assay performs better than the antepartum culture for identification of GBS vaginal carriers during labor.
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Abstract
Group B streptococcus (GBS) is a leading cause of invasive neonatal infections and a significant pathogen in immunocompromised adults. Screening to detect GBS colonization in pregnant women determines the need for antibiotic prophylaxis in that pregnancy. Efficient determination of the GBS colonization status of pregnant women is crucial. Methods that maximize the probability of GBS recovery are needed. The availability of technologies such as matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), molecular techniques, and chromogenic culture media, including Granada-type media, have changed the scenario for GBS detection and identification. This review presents and evaluates novel diagnostic tools, as well as classic identification techniques, for GBS species determination.
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