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A Unique Case of Purulent Malignant Otitis Externa Causing Community-Acquired Klebsiella Pneumonia Meningitis in a Marshallese Male. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Sirimanapong W, Phước NN, Crestani C, Chen S, Zadoks RN. Geographical, Temporal and Host-Species Distribution of Potentially Human-Pathogenic Group B Streptococcus in Aquaculture Species in Southeast Asia. Pathogens 2023; 12:pathogens12040525. [PMID: 37111411 PMCID: PMC10146238 DOI: 10.3390/pathogens12040525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023] Open
Abstract
Group B Streptococcus (GBS) is a major pathogen of humans and aquatic species. Fish have recently been recognized as the source of severe invasive foodborne GBS disease, caused by sequence type (ST) 283, in otherwise healthy adults in Southeast Asia. Thailand and Vietnam are among the major aquaculture producers in Southeast Asia, with GBS disease reported in fish as well as frogs in both countries. Still, the distribution of potentially human-pathogenic GBS in aquaculture species is poorly known. Using 35 GBS isolates from aquatic species in Thailand collected from 2007 to 2019 and 43 isolates from tilapia collected in Vietnam in 2018 and 2019, we have demonstrated that the temporal, geographical, and host-species distribution of GBS ST283 is broader than previously known, whereas the distribution of ST7 and the poikilothermic lineage of GBS are geographically restricted. The gene encoding the human GBS virulence factor C5a peptidase, scpB, was detected in aquatic ST283 from Thailand but not in ST283 from Vietnam or in ST7 from either country, mirroring current reports of GBS strains associated with human sepsis. The observed distribution of strains and virulence genes is likely to reflect a combination of spill-over, host adaptation through the gain and loss of mobile genetic elements, and current biosecurity practices. The plastic nature of the GBS genome and its importance as a human, aquatic, and potentially foodborne pathogen suggests that active surveillance of GBS presence and its evolution in aquaculture systems may be justified.
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Aiewsakun P, Ruangchai W, Thawornwattana Y, Jaemsai B, Mahasirimongkol S, Homkaew A, Suksomchit P, Dubbs P, Palittapongarnpim P. Genomic epidemiology of Streptococcus agalactiae ST283 in Southeast Asia. Sci Rep 2022; 12:4185. [PMID: 35264716 PMCID: PMC8907273 DOI: 10.1038/s41598-022-08097-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 02/28/2022] [Indexed: 01/12/2023] Open
Abstract
Streptococcus agalactiae, also known as Lancefield Group B Streptococcus (GBS), is typically regarded as a neonatal pathogen; however, several studies have shown that the bacteria are capable of causing invasive diseases in non-pregnant adults as well. The majority of documented cases were from Southeast Asian countries, and the most common genotype found was ST283, which is also known to be able to infect fish. This study sequenced 12 GBS ST283 samples collected from adult patients in Thailand. Together with publicly available sequences, we performed temporo-spatial analysis and estimated population dynamics of the bacteria. Putative drug resistance genes were also identified and characterized, and the drug resistance phenotypes were validated experimentally. The results, together with historical records, draw a detailed picture of the past transmission history of GBS ST283 in Southeast Asia.
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Affiliation(s)
- Pakorn Aiewsakun
- Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,Pornchai Matangkasombut Center for Microbial Genomics, Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Wuthiwat Ruangchai
- Pornchai Matangkasombut Center for Microbial Genomics, Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Yuttapong Thawornwattana
- Pornchai Matangkasombut Center for Microbial Genomics, Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Bharkbhoom Jaemsai
- Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Surakameth Mahasirimongkol
- Department of Medical Sciences, Ministry of Public Health, 88/7, Tiwanon Road, Amphoe Muang, Nonthaburi, 11000, Thailand
| | - Anchalee Homkaew
- Microbiological Unit, Central Laboratory and Blood Bank, Faculty of Medicine, Vajira Hospital, Navamindraraj University, Bangkok, Thailand
| | - Paveesuda Suksomchit
- Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand
| | - Padungsri Dubbs
- Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
| | - Prasit Palittapongarnpim
- Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,Pornchai Matangkasombut Center for Microbial Genomics, Department of Microbiology, Faculty of Science, Mahidol University, 272, Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.,National Science and Technology Development Agency, Pathumthani, Thailand
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Cahill JA, Li C, Wong PHP. Group B streptococcal leptomeningitis, ventriculitis, right cerebellitis, and cerebritis in an immunocompetent patient. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:75-80. [PMID: 36340851 PMCID: PMC9603013 DOI: 10.3138/jammi-2021-0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 10/19/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Group B streptococcal (GBS) meningitis is uncommon in non-puerperal adults outside of significant immunocompromise or structural abnormalities. CASE PRESENTATION We describe a relatively healthy 62-year-old man with GBS bacteremia, abnormal lumbar puncture, and MRI-confirmed leptomeningitis, ventriculitis, right cerebellitis, and cerebritis who presented without overt symptoms of meningitis. DIAGNOSIS The suspected source of infection was a high-inoculum genitourinary infection in the setting of hydronephrosis and recent cystoscopy. We performed a literature review of previous cases and clusters of GBS meningitis. DISCUSSION With increasing recognition of invasive GBS infection among adult patients, and in light of our patient's atypical presentation, we propose that an index of suspicion for GBS meningitis be maintained, even for patients who would traditionally have been considered at lower risk.
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Affiliation(s)
- Julia A Cahill
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Calvin Li
- Department of Hospital Medicine, Fraser Health
| | - Patrick HP Wong
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Navarro-Torné A, Curcio D, Moïsi JC, Jodar L. Burden of invasive group B Streptococcus disease in non-pregnant adults: A systematic review and meta-analysis. PLoS One 2021; 16:e0258030. [PMID: 34591924 PMCID: PMC8483371 DOI: 10.1371/journal.pone.0258030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/17/2021] [Indexed: 11/26/2022] Open
Abstract
Background Streptococcus agalactiae or group B Streptococcus (GBS) has emerged as an important cause of invasive disease in adults, particularly among the elderly and those with underlying comorbidities. Traditionally, it was recognised as an opportunistic pathogen colonising and causing disease in pregnant women, neonates, and young infants. Reasons for the upsurge of invasive GBS (iGBS) among the elderly remain unclear, although it has been related to risk factors such as underlying chronic diseases, immunosenescence, impaired inflammatory response, and spread of virulent clones. Antibiotics are successfully as treatment or prophylaxis against iGBS. Several candidate vaccines against iGBS are under development. Objectives To conduct a systematic review of the current literature on invasive GBS in order to determine disease incidence and case fatality ratio (CFR) among non-pregnant adults. Additionally, information on risk factors, clinical presentation, serotype distribution, and antimicrobial resistance was also retrieved. Methods Between January and June 2020, electronic searches were conducted in relevant databases: MEDLINE, EMBASE, Global Health, and SCOPUS. Studies were included in the systematic review if they met the inclusion/exclusion criteria. The authors assessed the selected studies for relevance, risk of bias, outcome measures, and heterogeneity. Meta-analyses on incidence and CFR were conducted after evaluating the quality of methods for assessment of exposure and outcomes. Results Pooled estimates of iGBS incidence in non-pregnant adults 15 years and older were 2.86 cases per 100.000 population (95% CI, 1.68–4.34). Incidence rates in older adults were substantially higher, 9.13 (95%CI, 3.53–17.22) and 19.40 (95%CI, 16.26–22.81) per 100.000 population ≥50 and ≥ 65 years old, respectively. Incidence rates ranged from 0.40 (95% CI, 0.30–0.60) in Africa to 5.90 cases per 100.000 population (95% CI, 4.30–7.70) in North America. The overall CFR was and 9.98% (95% CI, 8.47–11.58). CFR was highest in Africa at 22.09% (95% CI, 12.31–33.57). Serotype V was the most prevalent serotype globally and in North America accounting for 43.48% (n = 12926) and 46,72% (n = 12184) of cases, respectively. Serotype Ia was the second and serotype III was more prevalent in Europe (25.0%) and Asia (29.5%). Comorbidities were frequent among non-pregnant adult iGBS cases. Antimicrobial resistance against different antibiotics (i.e., penicillin, erythromycin) is increasing over time. Conclusions This systematic review revealed that iGBS in non-pregnant adults has risen in the last few years and has become a serious public health threat especially in older adults with underlying conditions. Given the current serotype distribution, vaccines including serotypes predominant among non-pregnant adults (i.e., serotypes V, Ia, II, and III) in their formulation are needed to provide breadth of protection. Continued surveillance monitoring potential changes in serotype distribution and antimicrobial resistance patterns are warranted to inform public health interventions.
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Affiliation(s)
| | | | | | - Luis Jodar
- Pfizer Inc, Collegeville, PA, United States of America
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Pieranski M, Sitkiewicz I, Grinholc M. Increased photoinactivation stress tolerance of Streptococcus agalactiae upon consecutive sublethal phototreatments. Free Radic Biol Med 2020; 160:657-669. [PMID: 32916279 DOI: 10.1016/j.freeradbiomed.2020.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 09/02/2020] [Indexed: 02/08/2023]
Abstract
Streptococcus agalactiae (Group B Streptococcus, GBS) is a common commensal bacterium in adults but remains a leading source of invasive infections in newborns, pregnant women, and the elderly, and more recently, causes an increased incidence of invasive disease in nonpregnant adults. Reduced penicillin susceptibility and emerging resistance to non-β-lactams pose challenges for the development and implementation of novel, nonantimicrobial strategies to reduce the burden of GBS infections. Antimicrobial photodynamic inactivation (aPDI) via the production of singlet oxygen or other reactive oxygen species leads to the successful eradication of pathogenic bacteria, affecting numerous cellular targets of microbial pathogens and indicating a low risk of resistance development. Nevertheless, we have previously reported possible aPDI tolerance development upon repeated sublethal aPDI applications; thus, the current work was aimed at investigating whether aPDI tolerance could be observed for GBS and what mechanisms could cause it. To address this problem, 10 cycles of sublethal aPDI treatments employing rose bengal as a photosensitizer, were applied to the S. agalactiae ATCC 27956 reference strain and two clinical isolates (2306/02 and 2974/07, serotypes III and V, respectively). We demonstrated aPDI tolerance development and stability after 5 cycles of subculturing with no aPDI exposure. Though the treatment resulted in a stable phenotype, no increases in mutation rate or accumulated genetic alterations were observed (employing a RIF-, CIP-, STR-resistant mutant selection assay and cyl sequencing, respectively). qRT-PCR analysis demonstrated that 10 sublethal aPDI exposures led to increased expression of all tested major oxidative stress response elements; changes in sodA, ahpC, npx, cylE, tpx and recA expression indicate possible mechanisms of developed tolerance. Increased expression upon sublethal aPDI treatment was reported for all but two genes, namely, ahpC and cylE. aPDI targeting cylE was further supported by colony morphology changes induced with 10 cycles of aPDI (increased SCV population, increased hemolysis, increased numbers of dark- and unpigmented colonies). In oxidant killing assays, aPDI-tolerant strains demonstrated no increased tolerance to hypochlorite, superoxide (paraquat), singlet oxygen (new methylene blue) or oxidative stress induced by aPDI employing a structurally different photosensitizer, i.e., zinc phthalocyanine, indicating a lack of cross resistance. The results indicate that S. agalactiae may develop stable aPDI tolerance but not resistance when subjected to multiple sublethal phototreatments, and this risk should be considered significant when defining efficient anti-S. agalactiae aPDI protocols.
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Affiliation(s)
- Michal Pieranski
- Intercollegiate Faculty of Biotechnology, Laboratory of Molecular Diagnostics, University of Gdansk and Medical University of Gdansk, Abrahama 58, 80-307, Gdansk, Poland
| | - Izabela Sitkiewicz
- Department of Drug Biotechnology and Bioinformatics, National Medicines Institute, Chelmska 30/34, 00-725, Warszawa, Poland
| | - Mariusz Grinholc
- Intercollegiate Faculty of Biotechnology, Laboratory of Molecular Diagnostics, University of Gdansk and Medical University of Gdansk, Abrahama 58, 80-307, Gdansk, Poland.
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Aimbudlop K, Bruminhent J, Kiertiburanakul S. Infectious causes of acute meningitis among Thai adults in a university hospital. J Infect Chemother 2020; 27:198-204. [PMID: 32933857 DOI: 10.1016/j.jiac.2020.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/06/2020] [Accepted: 09/01/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Knowing the epidemiology of acute meningitis may guide physicians to promptly administer appropriate empirical therapy, thereby minimizing morbidity and mortality. We aimed to determine the etiology, clinical manifestations, cerebrospinal fluid (CSF) findings, and outcomes of patients with acute meningitis. METHODS We conducted a retrospective cohort study among a total 89 adult (age ≥15 years) patients with acute meningitis. RESULTS Among them, 48 (53.9%) patients were men; the median age (interquartile range; IQR) was 49 (32.1-63.8) years. The most common coexisting conditions were HIV infection (30%), prednisolone therapy (16.9%), and diabetes mellitus (15.7%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and viruses (4.5%). In multivariate logistic regression, predicting factors of acute bacterial meningitis were higher white blood cells (WBCs) in a complete blood count [odds ratio (OR) 1.01 per increase of 100 cells/mm3; 95% confidence interval (CI) 1.00-1.02, p = 0.031], no HIV infection (OR 0.08; 95% CI 0.01-0.72, p = 0.023), and higher serum sodium (OR 1.13; 95% CI 1.01-0.23, p = 0.029). Overall, the median (IQR) duration of hospitalization was 23 (11-29) days. A total 26 (29%) patients had complications, such as septic shock, hydrocephalus, seizure, and brain edema. The in-hospital mortality rate was 7.9%. CONCLUSIONS In this setting, the most common cause of acute meningitis in adults was cryptococcosis followed by tuberculosis. Awareness of local epidemiology and patients' risk factors are important to initiate appropriate antimicrobial therapy.
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Affiliation(s)
- Kittipat Aimbudlop
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Jackrapong Bruminhent
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sasisopin Kiertiburanakul
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Dance D, Zadoks RN, Luangraj M, Simpson A, Chen SL, Barkham T. Community-acquired Group B streptococcal meningitis in adults. J Infect 2020; 81:147-178. [PMID: 32171868 DOI: 10.1016/j.jinf.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/09/2020] [Accepted: 03/09/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Dab Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao Democratic People's Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | | | - M Luangraj
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao Democratic People's Republic
| | - A Simpson
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao Democratic People's Republic; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - S L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Infectious Diseases Group, Genome Institute of Singapore, Singapore
| | - T Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
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van Kassel MN, van Haeringen KJ, Brouwer MC, Bijlsma MW, van de Beek D. Community-acquired group B streptococcal meningitis in adults. J Infect 2019; 80:255-260. [PMID: 31830496 DOI: 10.1016/j.jinf.2019.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/23/2019] [Accepted: 12/04/2019] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Streptococcus agalactiae (group B streptococci; GBS) is an uncommon cause of bacterial meningitis in adults. METHODS We reviewed literature published between 1975 and 2018. Studies were included if they reported age, sex and outcome of patients above 16 years of age with cerebrospinal fluid culture (CSF) positive for GBS. RESULTS Sixty-seven articles describing 141 patients were included. Median age was 56 years (IQR 41-66); 52% were male. Fifty-three patients (38%) were immunocompromised and CSF leakage was reported in 9 (10%) of 88 immunocompetent patients. Sixty-two patients (44%) had extra-meningeal foci of infection, most commonly endocarditis, which occurred in 14 patients (12%). Twenty-eight patients (23%) were described as previously healthy. Forty-four (31%) of the 141 patients died, after a median duration of 5 days after admission. Death was associated with advanced age and an immunocompromised state. CONCLUSION GBS meningitis in adults mainly occurs in those with underlying conditions such as immunocompromised state, CSF leakage, and endocarditis. These conditions should be actively sought for in adults with GBS meningitis.
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Affiliation(s)
- Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, the Netherlands
| | - Koen J van Haeringen
- Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, the Netherlands
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, the Netherlands
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, the Netherlands
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, University of Amsterdam, Amsterdam University Medical Centers, Meibergdreef 9, the Netherlands.
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Chen SL. Genomic Insights Into the Distribution and Evolution of Group B Streptococcus. Front Microbiol 2019; 10:1447. [PMID: 31316488 PMCID: PMC6611187 DOI: 10.3389/fmicb.2019.01447] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023] Open
Abstract
Streptococcus agalactiae, also known as Group B Streptococcus (GBS), is a bacteria with truly protean biology. It infects a variety of hosts, among which the most commonly studied are humans, cattle, and fish. GBS holds a singular position in the history of bacterial genomics, as it was the substrate used to describe one of the first major conceptual advances of comparative genomics, the idea of the pan-genome. In this review, I describe a brief history of GBS and the major contributions of genomics to understanding its genome plasticity and evolution as well as its molecular epidemiology, focusing on the three hosts mentioned above. I also discuss one of the major recent paradigm shifts in our understanding of GBS evolution and disease burden: foodborne GBS can cause invasive infections in humans.
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Affiliation(s)
- Swaine L Chen
- Division of Infectious Diseases, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Infectious Diseases Group, Genome Institute of Singapore, Singapore, Singapore
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Barkham T, Zadoks RN, Azmai MNA, Baker S, Bich VTN, Chalker V, Chau ML, Dance D, Deepak RN, van Doorn HR, Gutierrez RA, Holmes MA, Huong LNP, Koh TH, Martins E, Mehershahi K, Newton P, Ng LC, Phuoc NN, Sangwichian O, Sawatwong P, Surin U, Tan TY, Tang WY, Thuy NV, Turner P, Vongsouvath M, Zhang D, Whistler T, Chen SL. One hypervirulent clone, sequence type 283, accounts for a large proportion of invasive Streptococcus agalactiae isolated from humans and diseased tilapia in Southeast Asia. PLoS Negl Trop Dis 2019; 13:e0007421. [PMID: 31246981 PMCID: PMC6597049 DOI: 10.1371/journal.pntd.0007421] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/29/2019] [Indexed: 12/11/2022] Open
Abstract
Background In 2015, Singapore had the first and only reported foodborne outbreak of invasive disease caused by the group B Streptococcus (GBS; Streptococcus agalactiae). Disease, predominantly septic arthritis and meningitis, was associated with sequence type (ST)283, acquired from eating raw farmed freshwater fish. Although GBS sepsis is well-described in neonates and older adults with co-morbidities, this outbreak affected non-pregnant and younger adults with fewer co-morbidities, suggesting greater virulence. Before 2015 ST283 had only been reported from twenty humans in Hong Kong and two in France, and from one fish in Thailand. We hypothesised that ST283 was causing region-wide infection in Southeast Asia. Methodology/Principal findings We performed a literature review, whole genome sequencing on 145 GBS isolates collected from six Southeast Asian countries, and phylogenetic analysis on 7,468 GBS sequences including 227 variants of ST283 from humans and animals. Although almost absent outside Asia, ST283 was found in all invasive Asian collections analysed, from 1995 to 2017. It accounted for 29/38 (76%) human isolates in Lao PDR, 102/139 (73%) in Thailand, 4/13 (31%) in Vietnam, and 167/739 (23%) in Singapore. ST283 and its variants were found in 62/62 (100%) tilapia from 14 outbreak sites in Malaysia and Vietnam, in seven fish species in Singapore markets, and a diseased frog in China. Conclusions GBS ST283 is widespread in Southeast Asia, where it accounts for a large proportion of bacteraemic GBS, and causes disease and economic loss in aquaculture. If human ST283 is fishborne, as in the Singapore outbreak, then GBS sepsis in Thailand and Lao PDR is predominantly a foodborne disease. However, whether transmission is from aquaculture to humans, or vice versa, or involves an unidentified reservoir remains unknown. Creation of cross-border collaborations in human and animal health are needed to complete the epidemiological picture. An outbreak due to a bacterium called Streptococccus agalactiae in Singapore in 2015 was caused by a clone called ST283, and was associated with consumption of raw freshwater-fish. It was considered unique as it was the only reported foodborne outbreak of this bacterium. Our new data show that invasive ST283 disease is far from unique. ST283 has been causing disease in humans and farmed fish in SE Asian countries for decades. Reports of ST283 are almost absent outside Asia. We suspect that human ST283 is fishborne in other Asian countries, as it was in Singapore, but we haven’t looked at this yet. We don’t know where ST283 originally came from; it may have been transmitted from humans to fish, or come from another animal. More studies are needed to determine ST283’s geographical extent and burden of disease, as well as its origin, how it is transmitted, and what enables it to be so aggressive. We may then be able to interrupt transmission, to the benefit of fish, farmers, and the general public.
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Affiliation(s)
- Timothy Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore
- * E-mail: (TB); (SLC)
| | - Ruth N. Zadoks
- Institute of Biodiversity Animal Health and Comparative Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Mohammad Noor Amal Azmai
- Department of Biology, Faculty of Science, and Laboratory of Marine Biotechnology, Institute of Bioscience, Universiti Putra Malaysia, Selangor, Malaysia
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ngoc Bich
- Centre for Tropical Medicine, Oxford University Clinical Research Unit, Hanoi, Vietnam
| | | | - Man Ling Chau
- Environmental Health Institute, National Environment Agency, Singapore
- National Centre for Food Science, Singapore Food Agency, Singapore
| | - David Dance
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Vietnam
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
| | - Ramona A. Gutierrez
- Environmental Health Institute, National Environment Agency, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Mark A. Holmes
- Department of Veterinary Medicine, University of Cambridge, Cambridge, United Kingdom
| | | | - Tse Hsien Koh
- Department of Microbiology, Singapore General Hospital, Singapore
| | - Elisabete Martins
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Kurosh Mehershahi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Paul Newton
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency, Singapore
| | - Nguyen Ngoc Phuoc
- Faculty of Fisheries, University of Agriculture and Forestry, Hue University, Hue City, Vietnam
| | - Ornuma Sangwichian
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Pongpun Sawatwong
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
| | - Uraiwan Surin
- Nakhon Phanom General Hospital, Nakhon Phanom Provincial Health Office, Nakhon Phanom, Thailand
| | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Wen Ying Tang
- Molecular Biology Laboratory, Tan Tock Seng Hospital, Singapore
| | - Nguyen Vu Thuy
- National Hospital for Obstetrics & Gynaecology, Hanoi, Vietnam
| | - Paul Turner
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, United Kingdom
- Cambodia-Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
| | - Manivanh Vongsouvath
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit, Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Defeng Zhang
- Key Laboratory of Tropical & Subtropical Fishery Resource Application & Cultivation, Ministry of Agriculture and Rural Affairs, Pearl River Fisheries Research Institute, Chinese Academy of Fishery Sciences, Guangzhou, People’s Republic of China
| | - Toni Whistler
- Thailand Ministry of Public Health (MOPH)-US Centers for Disease Control and Prevention Collaboration (TUC), Nonthaburi, Thailand
- Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Swaine L. Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Infectious Diseases Group, Genome Institute of Singapore, Singapore
- * E-mail: (TB); (SLC)
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Yang Y, Luo M, Zhou H, Li C, Luk A, Zhao G, Fung K, Ip M. Role of Two-Component System Response Regulator bceR in the Antimicrobial Resistance, Virulence, Biofilm Formation, and Stress Response of Group B Streptococcus. Front Microbiol 2019; 10:10. [PMID: 30728810 PMCID: PMC6351488 DOI: 10.3389/fmicb.2019.00010] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/07/2019] [Indexed: 01/31/2023] Open
Abstract
Group B Streptococcus (GBS; Streptococcus agalactiae) is a leading cause of sepsis in neonates and pregnant mothers worldwide. Whereas the hyper-virulent serogroup III clonal cluster 17 has been associated with neonatal disease and meningitis, serogroup III ST283 was recently implicated in invasive disease among non-pregnant adults in Asia. Here, through comparative genome analyses of invasive and non-invasive ST283 strains, we identified a truncated DNA-binding regulator of a two-component system in a non-invasive strain that was homologous to Bacillus subtilis bceR, encoding the bceRSAB response regulator, which was conserved among GBS strains. Using isogenic knockout and complementation mutants of the ST283 strain, we demonstrated that resistance to bacitracin and the human antimicrobial peptide cathelicidin LL-37 was reduced in the ΔbceR strain with MICs changing from 64 and 256 μg/ml to 0.25 and 64 μg/ml, respectively. Further, the ATP-binding cassette transporter was upregulated by sub-inhibitory concentrations of bacitracin in the wild-type strain. Upregulation of dltA in the wild-type strain was also observed and thought to explain the increased resistance to antimicrobial peptides. DltA, an enzyme involved in D-alanylation during the synthesis of wall teichoic acids, which mediates reduced antimicrobial susceptibility, was previously shown to be regulated by the bceR-type regulator in Staphylococcus aureus. In a murine infection model, we found that the ΔbceR mutation significantly reduced the mortality rate compared to that with the wild-type strain (p < 0.01). Moreover, this mutant was more susceptible to oxidative stress compared to the wild-type strain (p < 0.001) and was associated with reduced biofilm formation (p < 0.0001). Based on 2-DGE and mass spectrometry, we showed that downregulation of alkyl hydroperoxide reductase (AhpC), a Gls24 family stress protein, and alcohol dehydrogenase (Adh) in the ΔbceR strain might explain the attenuated virulence and compromised stress response. Together, we showed for the first time that the bceR regulator in GBS plays an important role in bacitracin and antimicrobial peptide resistance, virulence, survival under oxidative stress, and biofilm formation.
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Affiliation(s)
- Ying Yang
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Mingjing Luo
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Haokui Zhou
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Carmen Li
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alison Luk
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - GuoPing Zhao
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kitty Fung
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
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14
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Rizvi SMD, Hussain T, Ahmed ABF, Alshammari TM, Moin A, Ahmed MQ, Barreto GE, Kamal MA, Ashraf GM. Gold nanoparticles: A plausible tool to combat neurological bacterial infections in humans. Biomed Pharmacother 2018; 107:7-18. [PMID: 30075371 DOI: 10.1016/j.biopha.2018.07.130] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/16/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Management of bacterial infections of central nervous system is a major challenge for the scientists all over the world. Despite the development of various potential drugs, the issue of central nervous system infections persists in the society. The main constraint is the delivery of drugs across the blood brain barrier and only a few drugs after meeting the stringent criteria could cross the blood brain barrier. On the other hand, certain bacterial pathogens could easily enter the brain by using several factors and mechanisms by crossing the blood brain barriers. Interestingly, in the recent past, gold nanoparticles have shown immense potential to overcome the issues associated with the treatment of central nervous system infections, especially due to their inherent ability to cross the blood brain barrier. Initially, the present review summarized the recent updates on the pathogenesis and factors involved in neurological bacterial infections, including the mechanism used by bacterial pathogens to cross the blood brain barriers. Thereafter, the emphasis of the review was on providing current information on gold nanoparticles pertinent to their applicability for the treatment of neurological infections. After discussing the background of neurological bacterial infections, the characteristic features, antibacterial properties, mechanisms of antibacterial action and ability to cross the blood brain barrier of gold nanoparticles have been summarized. Some of the features of gold nanoparticles that make them an ideal candidate for brain delivery are biocompatibity, stability, ability to get synthesized in different sizes with facile methods, surface affinity towards various functional groups, spontaneous crossing of blood brain barrier without applying any external field and most importantly, easy non-invasive tracing by CT imaging. The current updates on the development of gold nanoparticles based therapeutic strategies for the prevention and treatment of central nervous system infections have been discussed in the present study. However, further investigation would be required to translate these preclinical outcomes into clinical applications. Nevertheless, we could safely state that the information gathered and discussed in the present review would benefit the scientists working in the field of neuro-nanotechnology.
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Affiliation(s)
- Syed Mohd Danish Rizvi
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia.
| | - Talib Hussain
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Abo Bakr Fathy Ahmed
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Thamir M Alshammari
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Afrasim Moin
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Mohammed Qumani Ahmed
- Department of Pharmacology, College of Medicine,University of Hail, Hail, Saudi Arabia
| | - George E Barreto
- Departamento de Nutrición y Bioquímica, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá D.C, Colombia; Instituto de Ciencias Biomédicas, Universidad Autónoma de Chile, Santiago, Chile
| | - Mohammad Ajmal Kamal
- Enzymoics, 7 Peterlee Place, Hebersham, NSW 2770, Sydney, Australia; Novel Global Community Educational Foundation, Australia; King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ghulam Md Ashraf
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
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15
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Barkham T, Sheppard A, Jones N, Chen SL. Streptococcus agalactiae that caused meningitis in healthy adults in 1998 are ST283, the same type that caused a food-borne outbreak of invasive sepsis in 2015: an observational molecular epidemiology study. Clin Microbiol Infect 2018; 24:923-925. [PMID: 29655956 DOI: 10.1016/j.cmi.2018.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Affiliation(s)
- T Barkham
- Department of Laboratory Medicine, Tan Tock Seng Hospital, Singapore.
| | - A Sheppard
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - N Jones
- Department of Infectious Diseases, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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16
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Ip M, Ang I, Fung K, Liyanapathirana V, Luo MJ, Lai R. Hypervirulent Clone of Group B Streptococcus Serotype III Sequence Type 283, Hong Kong, 1993-2012. Emerg Infect Dis 2018; 22:1800-3. [PMID: 27648702 PMCID: PMC5038432 DOI: 10.3201/eid2210.151436] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We describe a hypervirulent clone of group B Streptococcus serotype III, subtype 4, sequence type 283, that caused invasive disease with a predilection for meningitis in Hong Kong during 1993–2012. The organism is associated with high mortality and increased summer prevalence and is linked to diseased fish from freshwater fish farms.
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17
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Kalimuddin S, Chen SL, Lim CTK, Koh TH, Tan TY, Kam M, Wong CW, Mehershahi KS, Chau ML, Ng LC, Tang WY, Badaruddin H, Teo J, Apisarnthanarak A, Suwantarat N, Ip M, Holden MTG, Hsu LY, Barkham T. 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data. Clin Infect Dis 2018; 64:S145-S152. [PMID: 28475781 DOI: 10.1093/cid/cix021] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Streptococcus agalactiae (group B Streptococcus [GBS]) has not been described as a foodborne pathogen. However, in 2015, a large outbreak of severe invasive sequence type (ST) 283 GBS infections in adults epidemiologically linked to the consumption of raw freshwater fish occurred in Singapore. We attempted to determine the scale of the outbreak, define the clinical spectrum of disease, and link the outbreak to contaminated fish. Methods Time-series analysis was performed on microbiology laboratory data. Food handlers and fishmongers were screened for enteric carriage of GBS. A retrospective cohort study was conducted to assess differences in demographic and clinical characteristics of patients with invasive ST283 and non-ST283 infections. Whole-genome sequencing was performed on human and fish ST283 isolates from Singapore, Thailand, and Hong Kong. Results The outbreak was estimated to have started in late January 2015. Within the study cohort of 408 patients, ST283 accounted for 35.8% of cases. Patients with ST283 infection were younger and had fewer comorbidities but were more likely to develop meningoencephalitis, septic arthritis, and spinal infection. Of 82 food handlers and fishmongers screened, none carried ST283. Culture of 43 fish samples yielded 13 ST283-positive samples. Phylogenomic analysis of 161 ST283 isolates from humans and fish revealed they formed a tight clade distinguished by 93 single-nucleotide polymorphisms. Conclusions ST283 is a zoonotic GBS clone associated with farmed freshwater fish, capable of causing severe disease in humans. It caused a large foodborne outbreak in Singapore and poses both a regional and potentially more widespread threat.
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Affiliation(s)
| | - Swaine L Chen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Genome Institute of Singapore
| | - Cindy T K Lim
- Saw Swee Hock School of Public Health, National University Singapore
| | | | - Thean Yen Tan
- Department of Laboratory Medicine, Changi General Hospital, Singapore
| | - Michelle Kam
- Department of Internal Medicine, Singapore General Hospital
| | | | - Kurosh S Mehershahi
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Man Ling Chau
- Environmental Health Institute, National Environment Agency
| | - Lee Ching Ng
- Environmental Health Institute, National Environment Agency
| | - Wen Ying Tang
- Department of Laboratory Medicine, Tan Tock Seng Hospital
| | | | - Jeanette Teo
- Department of Laboratory Medicine, Microbiology Unit, National University Hospital, Singapore
| | | | - Nuntra Suwantarat
- Infectious Disease Division, Thammasat University Hospital, and.,Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand
| | - Margaret Ip
- Department of Microbiology, Chinese University of Hong Kong, Shatin; and
| | | | - Li Yang Hsu
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.,Saw Swee Hock School of Public Health, National University Singapore
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18
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Tan K, Wijaya L, Chiew HJ, Sitoh YY, Shafi H, Chen RC, Goh CK, Lim CCT. Diffusion-weighted MRI abnormalities in an outbreak of Streptococcus agalactiae Serotype III, multilocus sequence type 283 meningitis. J Magn Reson Imaging 2016; 45:507-514. [PMID: 27469307 PMCID: PMC7166531 DOI: 10.1002/jmri.25373] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/21/2016] [Indexed: 11/05/2022] Open
Abstract
PURPOSE In 2015, an outbreak of group B streptococcal (GBS) infection caused by Streptococcus agalactiae Serotype III, multilocus sequence type 283, related to consuming infected raw freshwater fish, affected more than 200 patients in Singapore. We describe the clinical, laboratory, and neuroimaging features of a subgroup of adults with central nervous system (CNS) infections caused by GBS. MATERIALS AND METHODS The database of the Singapore Neurologic Infections Program (SNIP), a national multicenter study for surveillance of infectious neurologic disease, was reviewed to select patients with GBS CNS infection during the outbreak. Cases were diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) findings and identification or isolation of Streptococcus agalactiae in the blood or CSF. Demographic, clinical and neuroradiological information was obtained prospectively and retrospectively abstracted. RESULTS Fourteen patients (6 male, 8 female; median age, 58 years) presented with fever, meningism, headache, encephalopathy, focal neurological deficits, and/or seizures. All except two were previously healthy. Diffusion-weighted imaging (DWI) on admission was abnormal in 13 patients, showing tiny hyperintensities in the subarachnoid space (7 patients), ventricles (6 patients) and brain parenchyma (8 patients); 5 patients had cerebellar abnormalities. CONCLUSION Among healthy non-pregnant adults infected with Serotype III, multilocus sequence type 283 GBS meningitis linked to eating infected raw freshwater fish, DWI detected small pus collections and unusual cerebellar involvement. A collaborative national surveillance system that includes MRI can be helpful during unusual food-borne zoonotic infectious disease outbreaks. LEVEL OF EVIDENCE 4 J. Magn. Reson. Imaging 2017;45:507-514.
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Affiliation(s)
- Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.,Duke-NUS Graduate Medical School, Singapore
| | - Limin Wijaya
- Department of Infectious Disease, Singapore General Hospital, Singapore
| | - Hui-Jin Chiew
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore
| | - Yih-Yian Sitoh
- Duke-NUS Graduate Medical School, Singapore.,Department of Neuroradiology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore
| | - Humaira Shafi
- Department of Medicine, Division of Infectious Diseases, Changi General Hospital, Singapore
| | - Robert C Chen
- Duke-NUS Graduate Medical School, Singapore.,Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Chin Kong Goh
- Department of Radiology, Changi General Hospital, Singapore
| | - C C Tchoyoson Lim
- Duke-NUS Graduate Medical School, Singapore.,Department of Neuroradiology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore
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BACTERIOLOGICAL PROFILE OF COMMUNITY ACQUIRED ACUTE BACTERIAL MENINGITIS: A TEN-YEAR RETROSPECTIVE STUDY IN A TERTIARY NEUROCARE CENTRE IN SOUTH INDIA. Indian J Med Microbiol 2007. [DOI: 10.1016/s0255-0857(21)02167-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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20
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Ip M, Cheuk ESC, Tsui MHY, Kong F, Leung TN, Gilbert GL. Identification of a Streptococcus agalactiae serotype III subtype 4 clone in association with adult invasive disease in Hong Kong. J Clin Microbiol 2006; 44:4252-4. [PMID: 17005749 PMCID: PMC1698356 DOI: 10.1128/jcm.01533-06] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Characterization of Streptococcus agalactiae serotype III isolates revealed a subtype 4 clone that has an indistinguishable pulsed-field gel electrophoresis pattern and possesses a C-alpha protein, IS1381, and a novel sequence type (ST), ST 283, by multilocus sequence tagging. This clone was significantly associated with diseases caused by invasive strains from nonpregnant adults (P <or= 0.01, chi-square test) and was not present in the genital tracts of pregnant mothers.
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Affiliation(s)
- Margaret Ip
- Dept of Microbiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
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21
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Caínzos M, Hindi EY, Fernandez F, Rodriguez-Segade F, Ferandez A, Potel J. Wound erysipelas following appendectomy caused by group B beta-hemolytic Streptococcus (Streptococcus agalactiae). Surg Infect (Larchmt) 2005; 2:37-40. [PMID: 12594879 DOI: 10.1089/109629601750185343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Case description of a patient who developed erysipelas of the surgical wound following appendectomy for acute appendicitis, and literature review of invasive group B streptococcal infections. METHODS A 65-year-old man with perforated appendicitis underwent urgent appendectomy and drainage. Antibiotic prophylaxis with tobramycin (100 mg) and metronidazole (500 mg) was administered. At surgery, a phlegmon was identified with free perforation of the appendix and purulent peritoneal fluid. Appendectomy, irrigation with 0.9% NaCl solution, and drainage with a Silastic closed-suction drain was performed. A literature search in all languages was performed using MEDLINE, using the search terms surgical site infection, wound infection, group B streptococcus, Streptococcus agalactiae, necrotizing fasciitis, and postoperative infection. RESULTS Erysipelas of the surgical wound developed on the fourth postoperative day. Intravenous penicillin and amoxicillin/clavulanic acid were administered empirically. Culture of the wound drainage identified Streptococcus agalactiae and a few colonies of Escherichia coli. The broad-spectrum antibiotic was discontinued, and a 10-day course of penicillin was completed. CONCLUSIONS Erysipelas of the surgical wound is unusual, and infection with group B streptococci is rare compared with infection by group A streptococci. Streptococcus agalactiae is recognized to be increasingly virulent, with an increasing predilection for bacteremic infections in healthy hosts. Although Streptococcus agalactiae remains highly susceptible to antimicrobial agents effective against gram-positive cocci, the changing epidemiology and potentially invasive nature of these infections should have clinicians alert to the possibility of infection caused by group B streptococci.
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Affiliation(s)
- M Caínzos
- Department of Surgery, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain.
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22
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Ko WC, Yan JJ, Lee NY, Wu HM, Wu JJ. Polyclonal Spread of Erythromycin-ResistantStreptococcus agalactiaein Southern Taiwan. Microb Drug Resist 2004; 10:306-12. [PMID: 15650375 DOI: 10.1089/mdr.2004.10.306] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Resistance to erythromycin is common among Streptococcus agalactiae in Taiwan, however the genetic relatedness of erythromycin-resistant isolates has not yet been reported. From 1991 to 2001, 629 clinical isolates of S. agalactiae were collected in a medical center at Tainan in southern Taiwan, of which 189 (30.0%) were resistant to erythromycin. The isolation rate of erythromycin-resistant group B streptococcus (GBS) was stable, irrespective of the clinical sources or study period. Among them, 145 (76.7%) isolates showed the macrolide-lincosamide-streptogramin B (MLS)-resistant phenotype, and 44 (23.3%) had the macrolide (M)- resistant phenotype. Of the isolates with MLS phenotype, 141 (97.2%) isolates harbored the ermB gene alone and only three (2.1%) the ermTR gene, whereas 41 (93.2%) of 44 isolates with M phenotype harbored the mefA/E gene. Of 177 typeable isolates, there were 26 unrelated pulsed-field gel electrophoresis (PFGE) patterns. PFGE type 1 accounted for 17.8% (24/135) of MLS phenotype isolates with the ermB gene and 48.7% (18/37) of M phenotype isolates with the mefA/E gene. During the study period, the proportion of PFGE type 6 decreased significantly, whereas that of type 8 increased. Our results suggest that erythromycin resistance is not uncommon among clinical isolates of S. agalactiae and is, at least, partially related to polyclonal spread in southern Taiwan.
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Affiliation(s)
- Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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23
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Abstract
Group B Streptococcus (Streptococcus agalactiae) is a well-known cause of early and late onset infections in neonates and very young infants. Recently attention has focused on the changing spectrum of invasive Group B Streptococcus (GBS) disease, including children beyond early infancy and non-pregnant adults. There is very little information available on invasive GBS infection especially meningitis in pediatric population older than three months of age. We report a case of uncomplicated meningitis due to GBS in a previously healthy 5-year-old boy. The literature on infection especially meningitis caused by Group B Streptococcus beyond infancy is reviewed.
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Affiliation(s)
- Sanjeev Managoli
- Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
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24
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Jones N, Bohnsack JF, Takahashi S, Oliver KA, Chan MS, Kunst F, Glaser P, Rusniok C, Crook DWM, Harding RM, Bisharat N, Spratt BG. Multilocus sequence typing system for group B streptococcus. J Clin Microbiol 2003; 41:2530-6. [PMID: 12791877 PMCID: PMC156480 DOI: 10.1128/jcm.41.6.2530-2536.2003] [Citation(s) in RCA: 436] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A multilocus sequence typing (MLST) system was developed for group B streptococcus (GBS). The system was used to characterize a collection (n = 152) of globally and ecologically diverse human strains of GBS that included representatives of capsular serotypes Ia, Ib, II, III, V, VI, and VIII. Fragments (459 to 519 bp) of seven housekeeping genes were amplified by PCR for each strain and sequenced. The combination of alleles at the seven loci provided an allelic profile or sequence type (ST) for each strain. A subset of the strains were characterized by restriction digest patterning, and these results were highly congruent with those obtained with MLST. There were 29 STs, but 66% of isolates were assigned to four major STs. ST-1 and ST-19 were significantly associated with asymptomatic carriage, whereas ST-23 included both carried and invasive strains. All 44 isolates of ST-17 were serotype III clones, and this ST appeared to define a homogeneous clone that was strongly associated with neonatal invasive infections. The finding that isolates with different capsular serotypes had the same ST suggests that recombination occurs at the capsular locus. A web site for GBS MLST was set up and can be accessed at http://sagalactiae.mlst.net. The GBS MLST system offers investigators a valuable typing tool that will promote further investigation of the population biology of this organism.
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Affiliation(s)
- Nicola Jones
- Nuffield Department of Clinical Laboratory Sciences, Institute for Molecular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom.
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