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==Overview== | ==Overview== | ||
Group B Streptococcus (GBS) is the leading infectious cause of [[morbidity]] and mortality among infants in the United States, particularly among preterm neonates.<ref name="pmid4608888">{{cite journal| author=Baker CJ, Barrett FF| title=Group B streptococcal infections in infants. The importance of the various serotypes. | journal=JAMA | year= 1974 | volume= 230 | issue= 8 | pages= 1158-60 | pmid=4608888 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4608888 }} </ref><ref name="pmid18460666">{{cite journal| author=Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S et al.| title=Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. | journal=JAMA | year= 2008 | volume= 299 | issue= 17 | pages= 2056-65 | pmid=18460666 | doi=10.1001/jama.299.17.2056 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18460666 }} </ref><ref name="pmid10620644">{{cite journal| author=Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB et al.| title=Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 1 | pages= 15-20 | pmid=10620644 | doi=10.1056/NEJM200001063420103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10620644 }} </ref> Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of GBS disease after the first week of life. | |||
==Natural History== | ==Natural History, Complications and Prognosis== | ||
===GBS in Neonates=== | ===GBS in Neonates=== | ||
Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of group B strep disease after the first week of life. Infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24 | |||
====Natural History==== | |||
Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of group B strep disease after the first week of life. Infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24 to 48 hours of life.<ref name="pmid4572747">{{cite journal| author=Franciosi RA, Knostman JD, Zimmerman RA| title=Group B streptococcal neonatal and infant infections. | journal=J Pediatr | year= 1973 | volume= 82 | issue= 4 | pages= 707-18 | pmid=4572747 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4572747 }} </ref> The most common clinical syndromes of early-onset disease are [[sepsis]] and [[pneumonia]]; less frequently, early-onset infections can lead to [[meningitis]]. | |||
====Complications==== | |||
* [[Disseminated intravascular coagulation]] (DIC) | |||
* [[Hypoglycemia]] | |||
* [[Respiratory failure]] | |||
* Neurological complications of [[meningitis]] | |||
** Brain [[infarction]] | |||
** [[Cerebral edema]] | |||
** [[Cerebritis]] | |||
** Elevated [[intracranial pressure]] | |||
** [[Hydrocephalus]] | |||
** Subdural effusion | |||
** Subdural [[empyema]] | |||
** [[Ventriculitis]] | |||
* [[Death]] | |||
====Mortality==== | ====Mortality==== | ||
GBS is the leading infectious cause of [[morbidity]] and mortality among infants in the United States. The case-fatality ratio of early-onset disease has declined from as high as 50% in the 1970s<ref name="pmid4608888">{{cite journal| author=Baker CJ, Barrett FF| title=Group B streptococcal infections in infants. The importance of the various serotypes. | journal=JAMA | year= 1974 | volume= 230 | issue= 8 | pages= 1158-60 | pmid=4608888 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4608888 }} </ref> to 4% | GBS is the leading infectious cause of [[morbidity]] and mortality among infants in the United States. The case-fatality ratio of early-onset disease has declined from as high as 50% in the 1970s<ref name="pmid4608888">{{cite journal| author=Baker CJ, Barrett FF| title=Group B streptococcal infections in infants. The importance of the various serotypes. | journal=JAMA | year= 1974 | volume= 230 | issue= 8 | pages= 1158-60 | pmid=4608888 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4608888 }} </ref> to 4%-6% in recent years, primarily because of advances in neonatal care.<ref name="pmid18460666">{{cite journal| author=Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S et al.| title=Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. | journal=JAMA | year= 2008 | volume= 299 | issue= 17 | pages= 2056-65 | pmid=18460666 | doi=10.1001/jama.299.17.2056 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18460666 }} </ref><ref name="pmid10620644">{{cite journal| author=Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB et al.| title=Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 1 | pages= 15-20 | pmid=10620644 | doi=10.1056/NEJM200001063420103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10620644 }} </ref> | ||
[[Mortality]] is higher among preterm infants, with case-fatality rates of approximately 20% and as high as 30% among those ≤33 weeks | [[Mortality]] is higher among preterm infants, with case-fatality rates of approximately 20% and as high as 30% among those ≤33 weeks of gestation, compared with 2%--3% among full-term infants.<ref name="pmid18460666">{{cite journal| author=Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S et al.| title=Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. | journal=JAMA | year= 2008 | volume= 299 | issue= 17 | pages= 2056-65 | pmid=18460666 | doi=10.1001/jama.299.17.2056 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18460666 }} </ref><ref name="pmid10620644">{{cite journal| author=Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB et al.| title=Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. | journal=N Engl J Med | year= 2000 | volume= 342 | issue= 1 | pages= 15-20 | pmid=10620644 | doi=10.1056/NEJM200001063420103 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10620644 }} </ref> | ||
===GBS in Pregnancy=== | ===GBS in Pregnancy=== | ||
GBS colonization during pregnancy can be transient, intermittent, or persistent. Although some women with GBS colonization during a pregnancy will be colonized during subsequent pregnancies, a substantial proportion will not.<ref name="pmid18310374">{{cite journal| author=Cheng PJ, Chueh HY, Liu CM, Hsu JJ, Hsieh TT, Soong YK| title=Risk factors for recurrence of group B streptococcus colonization in a subsequent pregnancy. | journal=Obstet Gynecol | year= 2008 | volume= 111 | issue= 3 | pages= 704-9 | pmid=18310374 | doi=10.1097/AOG.0b013e318163cd6b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18310374 }} </ref><ref name="pmid18669720">{{cite journal| author=Turrentine MA, Ramirez MM| title=Recurrence of group B streptococci colonization in subsequent pregnancy. | journal=Obstet Gynecol | year= 2008 | volume= 112 | issue= 2 Pt 1 | pages= 259-64 | pmid=18669720 | doi=10.1097/AOG.0b013e31817f5cb9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18669720 }} </ref> In the absence of any intervention, an estimated 1%-2% of infants born to colonized mothers develop early-onset GBS infections.<ref name=CDC2007>CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45(No. RR-7).[http://www.cdc.gov/mmwr/preview/mmwrhtml/00043277.htm]</ref><ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref> | ====Natural History==== | ||
GBS colonization during pregnancy can be transient, intermittent, or persistent. Although some women with GBS colonization during a [[pregnancy]] will be colonized during subsequent pregnancies, a substantial proportion will not.<ref name="pmid18310374">{{cite journal| author=Cheng PJ, Chueh HY, Liu CM, Hsu JJ, Hsieh TT, Soong YK| title=Risk factors for recurrence of group B streptococcus colonization in a subsequent pregnancy. | journal=Obstet Gynecol | year= 2008 | volume= 111 | issue= 3 | pages= 704-9 | pmid=18310374 | doi=10.1097/AOG.0b013e318163cd6b | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18310374 }} </ref><ref name="pmid18669720">{{cite journal| author=Turrentine MA, Ramirez MM| title=Recurrence of group B streptococci colonization in subsequent pregnancy. | journal=Obstet Gynecol | year= 2008 | volume= 112 | issue= 2 Pt 1 | pages= 259-64 | pmid=18669720 | doi=10.1097/AOG.0b013e31817f5cb9 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18669720 }} </ref> In the absence of any intervention, an estimated 1%-2% of infants born to colonized mothers develop early-onset GBS infections.<ref name=CDC2007>CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45(No. RR-7).[http://www.cdc.gov/mmwr/preview/mmwrhtml/00043277.htm]</ref><ref name="pmid3931544">{{cite journal| author=Boyer KM, Gotoff SP| title=Strategies for chemoprophylaxis of GBS early-onset infections. | journal=Antibiot Chemother (1971) | year= 1985 | volume= 35 | issue= | pages= 267-80 | pmid=3931544 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3931544 }} </ref> | |||
Pregnant women who are colonized by GBS are most commonly asymptomatic. Some pregnant women develop serious conditions as a result of the infection, such as [[endometritis]], [[chorioamnionitis]], [[urinary tract infection]]s, and preterm delivery. | |||
==References== | ==References== | ||
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[[Category:Streptococcaceae]] | [[Category:Streptococcaceae]] | ||
[[Category:Obstetrics]] | [[Category:Obstetrics]] | ||
[[Category:Mature chapter]] | [[Category:Mature chapter]] | ||
[[Category:Pediatrics]] | |||
[[Category:Neonatology]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [3]
Overview
Group B Streptococcus (GBS) is the leading infectious cause of morbidity and mortality among infants in the United States, particularly among preterm neonates.[1][2][3] Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of GBS disease after the first week of life.
Natural History, Complications and Prognosis
GBS in Neonates
Natural History
Most newborns with early-onset disease have symptoms on the day of birth. Babies who develop late-onset disease may appear healthy at birth and develop symptoms of group B strep disease after the first week of life. Infants with early-onset GBS disease generally present with respiratory distress, apnea, or other signs of sepsis within the first 24 to 48 hours of life.[4] The most common clinical syndromes of early-onset disease are sepsis and pneumonia; less frequently, early-onset infections can lead to meningitis.
Complications
- Disseminated intravascular coagulation (DIC)
- Hypoglycemia
- Respiratory failure
- Neurological complications of meningitis
- Brain infarction
- Cerebral edema
- Cerebritis
- Elevated intracranial pressure
- Hydrocephalus
- Subdural effusion
- Subdural empyema
- Ventriculitis
- Death
Mortality
GBS is the leading infectious cause of morbidity and mortality among infants in the United States. The case-fatality ratio of early-onset disease has declined from as high as 50% in the 1970s[1] to 4%-6% in recent years, primarily because of advances in neonatal care.[2][3]
Mortality is higher among preterm infants, with case-fatality rates of approximately 20% and as high as 30% among those ≤33 weeks of gestation, compared with 2%--3% among full-term infants.[2][3]
GBS in Pregnancy
Natural History
GBS colonization during pregnancy can be transient, intermittent, or persistent. Although some women with GBS colonization during a pregnancy will be colonized during subsequent pregnancies, a substantial proportion will not.[5][6] In the absence of any intervention, an estimated 1%-2% of infants born to colonized mothers develop early-onset GBS infections.[7][8]
Pregnant women who are colonized by GBS are most commonly asymptomatic. Some pregnant women develop serious conditions as a result of the infection, such as endometritis, chorioamnionitis, urinary tract infections, and preterm delivery.
References
- ↑ 1.0 1.1 Baker CJ, Barrett FF (1974). "Group B streptococcal infections in infants. The importance of the various serotypes". JAMA. 230 (8): 1158–60. PMID 4608888.
- ↑ 2.0 2.1 2.2 Phares CR, Lynfield R, Farley MM, Mohle-Boetani J, Harrison LH, Petit S; et al. (2008). "Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005". JAMA. 299 (17): 2056–65. doi:10.1001/jama.299.17.2056. PMID 18460666.
- ↑ 3.0 3.1 3.2 Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB; et al. (2000). "Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis". N Engl J Med. 342 (1): 15–20. doi:10.1056/NEJM200001063420103. PMID 10620644.
- ↑ Franciosi RA, Knostman JD, Zimmerman RA (1973). "Group B streptococcal neonatal and infant infections". J Pediatr. 82 (4): 707–18. PMID 4572747.
- ↑ Cheng PJ, Chueh HY, Liu CM, Hsu JJ, Hsieh TT, Soong YK (2008). "Risk factors for recurrence of group B streptococcus colonization in a subsequent pregnancy". Obstet Gynecol. 111 (3): 704–9. doi:10.1097/AOG.0b013e318163cd6b. PMID 18310374.
- ↑ Turrentine MA, Ramirez MM (2008). "Recurrence of group B streptococci colonization in subsequent pregnancy". Obstet Gynecol. 112 (2 Pt 1): 259–64. doi:10.1097/AOG.0b013e31817f5cb9. PMID 18669720.
- ↑ CDC. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR 1996;45(No. RR-7).[1]
- ↑ Boyer KM, Gotoff SP (1985). "Strategies for chemoprophylaxis of GBS early-onset infections". Antibiot Chemother (1971). 35: 267–80. PMID 3931544.