Confirmed group B streptococcus infection: the tip of the iceberg

Case Report: Prolonged CSF PCR Positivity in a Neonate With GBS Meningitis

Bacterial meningitis is one of the critical diseases that needs to be diagnosed and treated promptly. Recent diagnostics of high sensitivity and specificity rates, such as PCR, helped with such presentation, especially in cases with prior antibiotics that led to culture negativity. However, the time window of PCR positivity is not well-studied, with scattered reports of different periods of positivity. Here, we report a case of neonatal GBS meningitis with positive PCR for more than 80 days from starting antibiotics.

The burden of infant group B streptococcal infections in Ontario: Analysis of administrative data to estimate the potential benefits of new vaccines

Group B streptococcus (GBS) is a leading bacterial cause of neonatal sepsis and meningitis in many countries as well as an important cause of disease in pregnant women. Currently, serotype-specific conjugate vaccines are being developed. We conducted an epidemiological analysis of health administrative data to estimate the burden of infant GBS disease in Ontario, Canada and combined these estimates with literature on serotype distribution to estimate the burden of disease likely to be vaccine-preventable. Between 1st January 2005 and 31st December 2015, 907 of 64320 health care encounters in Ontario in patients under 1 year old had codes specifically identifying GBS as the cause of the disease, of which 717 were under one month of age. In addition, application of epidemiological data to the remaining patients allowed us to estimate a further 2322 cases and among them 1822 were under one month of age. In the same period, 579 confirmed neonatal invasive GBS cases in patients up to one month of age were reported to public health. Depending on serotype distribution, vaccination coverage and early versus late onset disease (0-6 days and 7-90 days of age respectively), the preventable fraction ranged widely. With a vaccine that is 90% effective and 60% immunization coverage, up to 52% of early and late onset disease could be prevented by forthcoming vaccines. GBS is under-reported in Ontario. Uncertainty about the potential impact of vaccine indicates that further analysis and research may be needed to prepare for policy-decision making, including clinical validation studies and an economic evaluation of GBS vaccination in Ontario.

Emerging trends in invasive and noninvasive isolates of Streptococcus agalactiae in a Latin American hospital: a 17-year study

BACKGROUND

Streptococcus agalactiae or group B Streptococcus (GBS) has been recognized as a lethal pathogen in neonates worldwide. S. agalactiae infections also severely affect pregnant women and immunosuppressed adults with substantial attributable morbidity and mortality. However, in Latin America, studies on the epidemiology and behaviour of S. agalactiae infections remain limited.

METHODS

To better understand the behaviour of S. agalactiae infections in our region, we conducted a retrospective study to phenotypically describe S. agalactiae isolates collected in one of the largest hospitals in Colombia at two time periods: 1994-2001 and 2004-2012. The isolates were identified by biochemical analysis and tested for antimicrobial susceptibility.

RESULTS

In 1994-2001 a total of 201 S. agalactiae isolates were found in urine 38.3%, vaginal exudates 27.8%, soft tissue 12.9%, and blood 8.5%. Susceptibility to ampicillin or penicillin was 94% whereas resistance to erythromycin and clindamycin were 2.8% and 5.2% respectively. In total 46 culture-positive cases of invasive infections were reported, 11 (24%) in neonates and 35 (76%) in adults. In 2004-2012 a total of 671 isolates were found in urine 47.8%, vaginal exudates 32.6%, soft tissue 2.7% and blood 9%. Susceptibility rates to ampicillin and penicillin were 98% whereas resistance to erythromycin and clindamycin were 12.5% and 9.4%. A total of 95 severe infections were reported: 12 (12.6%) were in neonates, 5 (5.3%) in children and 78 (82.1%) in adults. Over the 17-year study period the averaged prevalence of invasive S. agalactiae isolates was 17.4%. The estimated incidence for neonatal infections was 1.34 per 1000 livebirths (0.99 × 1000 livebirths for early- onset disease and 0.35 × 1000 livebirths for late- onset disease) whereas for non-pregnant adults the estimated incidence was 0.75 × 1000 admissions.

CONCLUSIONS

A remarkable increase in bloodstream infections in immunosuppressed adults and a shift to early neonatal S. agalactiae infections were seen over time. We also found an increase in S. agalactiae resistance to erythromycin and clindamycin during the study period, and the emergence of penicillin-nonsusceptible isolates. Our findings are consistent with the global trends described elsewhere, reinforcing the need for S. agalactiae control measures in our region.

A three year descriptive study of early onset neonatal sepsis in a refugee population on the Thailand Myanmar border

BACKGROUND

Each year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur.

METHODS

We conducted a three year observational study of clinically diagnosed early onset (<7 days of age) neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology.

RESULTS

From April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1-2.1). No infants enrolled in study died as a direct result of EONS.

CONCLUSION

A low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use.

Changes in the body weight of term infants, born in the tropics, during the first seven days of life

BACKGROUND

Identifying unwell neonates, particularly in the first week of life, is often subjective. If normal values are known, calculating the weight lost or gained from birth weight can be a useful adjunct in the evaluation of the health of a neonate.

METHODS

Serial body weights of well, term, breast fed infants who were attending for routine follow up, were recorded at the Shoklo Malaria Research Unit clinic in Maela Camp for displaced persons on the Thailand Myanmar border. Newborn examination was routine. Weight loss, expressed as percent weight lost from birth weight, and weight gain, expressed as a velocity (g/kg/day), was calculated for the first seven days of life. The results from normal birth weight infants, low birth weight infants (<2.5 kg) and small for gestational age infants (SGA) were examined.

RESULTS

In the first week of life there were no significant differences in weight gained or lost across the three study groups. The maximum weight lost was 4.4% (95% CI 4.1 - 4.6%), which occurred on day three. Weight gain ranged from 13 g/kg/day [95% CI 10 - 16] on day four to 18 g/kg/day [95% CI 15 - 20] on days six and seven.

CONCLUSIONS

Use of these normal values for weight gain and loss, allows infants falling outside of the expected range (95% CI) to be easily identified and subsequently highlighted as needing further medical review.

Prevention of group B streptococcal neonatal disease revisited. The DEVANI European project

The purpose of this paper was to present the current knowledge on the prevention of group B streptococcus (GBS) neonatal infections and the status of prevention policies in European countries and to present the DEVANI pan-European program, launched in 2008. The aim of this program was to assess the GBS neonatal infection burden in Europe, to design a new vaccine to immunize neonates against GBS infections, to improve the laboratory performance for the diagnosis of GBS colonization and infection, and to improve the methods for the typing of GBS strains. The current guidelines for GBS prevention in different countries were ascertained and a picture of the burden before and after the instauration of prevention policies has been drawn. After the issue of the Centers for Disease Control and Prevention (CDC) guidelines, many European countries have adopted universal screening for the GBS colonization of pregnant women and intrapartum prophylaxis to colonized mothers. Nevertheless, some European countries continue advocating the risk factor approach to GBS prevention. Most European countries have implemented policies to prevent GBS neonatal infections and the burden of the disease has decreased during the last several years. Nevertheless, further steps are necessary in order to develop new strategies of prevention, to improve microbiological techniques to detect GBS colonization and infection, and to coordinate the prevention policies in the EU.