Group B Streptococcus infection in pregnant women and newborns: clinical case and current state of the problem
Group B streptococcus (GBS) is a significant cause of neonatal infections, particularly early-onset neonatal sepsis (EONS). This article presents a clinical case of an atypical course of systemic early neonatal infection caused by GBS in a preterm baby born at 36 weeks of gestation. The initial clinical manifestations, including pronounced hyperbilirubinemia and anemia, were more commonly associated with hemolytic disease of the newborn rather than GBS infection. A comprehensive analysis of the patient's course, clinical and laboratory data is provided, along with a comparison to current global findings. The publication also reviews the epidemiology, etiology, and diagnosis of GBS infections in pregnant women and newborns, with a specific focus on screening and timely diagnosis to reduce the severe outcomes associated with GBS infections in newborns.Nikitina I.V., Krogh-Jensen O.A., Budina A.Yu., Gordeev A.B., Zubkov V.V., Degtyarev D.N., Priputnevich T.V., Lenyushkina A.A.
Conclusion: Implementing prenatal screening measures, in conjunction with rapid microbiology and molecular genetic research methods, enables the prompt verification of premature newborn diagnoses. This approach facilitates the timely initiation of etiopathogenetic therapy and helps prevent the development of disabling complications.
Authors' contributions: Nikitina I.V., Krog-Jensen O.A. – conception of the study; Nikitina I.V., Krog-Jensen O.A.,
Budina A.Yu. – drafting of the manuscript; Nikitina I.V., Lenyushkina A.A., Gordeev A.B., Zubkov V.V., Priputnevich T.V., Degtyarev D.N. – manuscript editing.
Conflicts of interest: The authors have no conflicts of interest to declare.
Funding: The study was conducted within the framework of the state assignment of the V.I. Kulakov NMRC for OG&P, Ministry of Health of Russia for 2021–2023 "Early minimally invasive diagnosis and prediction of infectious and inflammatory diseases in newborns using modern echographic, microbiological, immunological and molecular genetic research methods", 121032500123-2.
Patient Consent for Publication: The mother of the newborn provided informed consent for the publication of the data.
For citation: Nikitina I.V., Krogh-Jensen, Budina A.Yu., Gordeev A.B., Zubkov V.V., Degtyarev D.N., Priputnevich T.V., Lenyushkina A.A. Group B Streptococcus infection
in pregnant women and newborns: clinical case and current state of the problem.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (9): 180-190 (in Russian)
https://dx.doi.org/10.18565/aig.2023.136
Keywords
Streptococcus agalactiae
newborn
group B streptococcus infection
pregnant women
hemolysis
References
- Prevention of Group B Streptococcal Early-Onsеet Disease in Newborns: ACOG Committee Opinion, Number 797. Obstet. Gynecol. 2020; 135(2): e51-e72. https://dx.doi.org/10.1097/AOG.0000000000003668.
- Seale A.C., Bianchi-Jassir F., Russell N.J., Kohli-Lynch M., Tann C.J., Hall J. et al. Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin. Infect. Dis. 2017; 65(Suppl. 2): S200-S219. https://dx.doi.org/10.1093/cid/cix664.
- Мелкумян А.Р., Припутневич Т.В., Кочетов А.Г., Стулёва Н.С. Перинатальная профилактика заболеваний, вызванных стрептококком группы В (клинический протокол). Акушерство и гинекология. 2017; 7: 161-5. [Melkumyan A.R., Priputnevich T.V., Kochetov A.G., Stuleva N.S. Perinatal prevention of diseases caused by group B streptococcus. Obstetrics and Gynecology. 2017; (7): 161-5. (in Russian)]. https://dx.doi.org/10.18565/aig.2017.7.161-165.
- Nanduri S.A., Petit S., Smelser C., Apostol M., Alden N.B., Harrison L.H. et al. Epidemiology of invasive early-onset and late-onset Group B streptococcal disease in the united states, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 2019; 173(3): 224-33.https://dx.doi.org/10.1001/jamapediatrics.2018.4826.
- Hasperhoven G.F., Al‐Nasiry S., Bekker V., Villamor E., Kramer B.W.W. Universal screening versus risk-based protocols for antibiotic prophylaxis during childbirth to prevent early-onset group B streptococcal disease: a systematic review and meta-analysis. BJOG. 2020; 127(6): 680-91. https://dx.doi.org/10.1111/1471-0528.16085.
- Le Doare K., Heath P.T., Plumb J., Owen N.A., Brocklehurst P., Chappell L.C. Uncertainties in screening and prevention of Group B streptococcus disease. Clin. Infect. Dis. 2019; 69(4): 720-5. https://dx.doi.org/10.1093/cid/ciy1069.
- Schrag S.J., Farley M.M., Petit S., Reingold A., Weston E.J., Pondo T. et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014. Pediatrics. 2016; 138(6). https://dx.doi.org/10.1542/peds.2016-2013.
- Анкирская А.С., Припутневич Т.В., Муравьева В.В., Любасовская Л.А., Карапетян Т.Э., Мелкумян А.Р., Чубаров В.В., Калакуцкая А.Н. Дискуссионные вопросы профилактики внутриутробных инфекций, вызванных стрептококками группы В: какую стратегию выбираем? Акушерство и гинекология. 2015; 7: 9-14. [Ankirskaya A.S., Priputnevich T.V., Muravyeva V.V., Lyubasovskaya L.A., Karapetyan T.E., Melkumyan A.R., Chubarov V.V., Kalakutskaya A.N. Debatable problems in the prevention of intrauterine infections caused by group B streptococci: What strategy do we choose? Obstetrics. and Gynegology. 2015; (7): 9-14. (in Russian)].
- Capraro G.A., Lala S., Khaled K., Gosciniak E., Saadat B., Alvarez S.M. et al. Association of sexually-transmitted infection and African–American race with Streptococcus agalactiae colonization in pregnancy. Antimicrob. Resist. Infect. Control. 2020; 9(1): 174. https://dx.doi.org/10.1186/s13756-020-00827-1.
- Francois Watkins L.K., McGee L., Schr S.J., Beall B., Jain J.H., Pondo T. et al. Epidemiology of invasive group B streptococcal infections among nonpregnant adults in the United States, 2008-2016. JAMA Intern. Med. 2019; 179(4):479-88. https://dx.doi.org/10.1001/jamainternmed.2018.7269.
- Рищук С.В. Инфекционно-воспалительные заболевания женских половых органов: этиология, принципиальные подходы к диагностике и лечению. Охрана материнства и детства. 2016; 1: 69-79. [Rishchuk S.V. Infectious and inflammatory diseases of female genitals: etiology, fundamental approaches to diagnostics and treatment. Maternal and Child Safety. 2016; (1): 69-79. (in Russian)].
- Gizachew M., Tiruneh M., Moges F., Adefris M.., Tigabu Z, Tessema B. Proportion of Streptococcus agalactiae vertical transmission and associated risk factors among Ethiopian mother-newborn dyads, Northwest Ethiopia. Sci. Rep. 2020; 10: 3477. https://dx.doi.org/10.1038/s41598-020-60447-y.
- Хван В.О., Шпицына Е.В., Зациорская С.Л., Гриненко Г.В., Шалепо К.В., Савичева А.М. Частота и факторы риска колонизации беременных женщин стрептококками группы В. Журнал акушерства и женских болезней. 2017; 66(6): 44-58. [Khvan V.O., Shipitsyna E.V., Zatsiorskaya S.L., Grinenko G.V., Shalepo K.V., Savicheva A.M. Frequency and risk factors of colonization of pregnant women with group B streptococci. Journal of Obstetrics and Women’s Diseases. 2017; 66(6): 44-58. (in Russian)].https://dx.doi.org/10.17816/JOWD66644-58.
- Rick A.M., Aguilar A., Cortes R., Gordillo R., Melgar M., Samayoa-Reyes G. et al. Group B streptococci colonization in pregnant guatemalan women: prevalence, risk factors, and vaginal microbiome. Open Forum Infect. Dis. 2017; 4(1): ofx020. https://dx.doi.org/10.1093/ofid/ofx020.
- Kleweis S.M., Cahill A.G., Odibo A.O., Tuuli M.G. Maternal obesity and rectovaginal group B streptococcus colonization at term. Infect. Dis. Obstet. Gynecol. 2015; 2015: 586767. https://dx.doi.org/10.1155/2015/586767.
- Liébana-Martos M.D.C., Cabrera-Alavargonzalez J., Rodríguez-Granger J., Miranda-Casas C., Sampedro-Martínez A., Gutiérrez-Fernández J. et al. Serotypes and antibiotic resistance patterns in beta-hemolytic streptococcus agalactiae isolates in colonized mothers and newborns with invasive disease. Enferm. Infecc. Microbiol. Clin. 2015; 33(2): 84-8. https://dx.doi.org/10.1016/j.eimc.2014.02.023.
- Vieira L.L., Perez A.V., Machado M.M., Kayser M.L., Vettori D.V., Alegretti A.P. et al. Group B streptococcus detection in pregnant women: comparison of qPCR assay, culture, and the Xpert GBS rapid test. BMC Pregnancy Childbirth. 2019; 19(1): 532. https://dx.doi.org/10.1186/s12884-019-2681-0.
- Colicchia L.C., Lauderdale D.S., Du H., Adams M., Hirsch E. Recurrence of group B streptococcus colonization in successive pregnancies. J Perinatol. 2015; 35(3): 173-6. https://dx.doi.org/10.1038/jp.2014.185.
- Kim E.J., Oh K.Y., Kim M.Y., Seo Y.S., Shin J.H., Song Y.R. et al. Risk factors for Group B Streptococcus colonization among pregnant women in Korea. Epidemiol. Health. 2011; 33: e2011010. https://dx.doi.org/10.4178/epih/e2011010.
- Verani J.R., McGee L., Schrag S.J. Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC). Prevention of perinatal group B streptococcal disease--revised guidelines from CDC, 2010. MMWR Recomm. Rep. 2010; 59(RR-10): 1-36.
- Zhang Y.H., He M., Wang Y., Liao A.H. Modulators of the Balance between M1 and M2 macrophages during pregnancy. Front. Immunol. 2017; 8.https://dx.doi.org/10.3389/fimmu.2017.00120.
- Money D., Allen V.M. Infectious Diseases Committee. The prevention of early-onset neonatal group B streptococcal disease. J. Obstet. Gynaecol. Can. 2013; 35(10): 939-48. https://dx.doi.org/10.1016/S1701-2163(15)30818-5.
- Whidbey C., Vornhagen J., Gendrin C., Boldenow E., Samson J.M., Doering K. et al. A streptococcal lipid toxin induces membrane permeabilization and pyroptosis leading to fetal injury. EMBO Mol. Med. 2015; 7(4): 488-505. https://dx.doi.org/10.15252/emmm.201404883.
- Zhu L., Beres S.B., Yerramilli P., Boldenow E., Samson J.M., Doering K. et al. Genetic basis underlying the hyperhemolytic phenotype of streptococcus agalactiae strain CNCTC10/84. J. Bacteriol. 2020; 202(23): e00504-20.https://dx.doi.org/10.1128/JB.00504-20.
- Министерство здравоохранения Российской Федерации. Нормальная беременность. Клинические рекомендации. М.; 2020. [Ministry of Health of the Russian Federation. Normal pregnancy. Clinical guidelines. Moscow; 2020. (in Russian)].
- Оленев А.С., Коноплянников А.Г., Сонголова Е.Н., Стецюк О.В. Колонизация беременных стрептококком группы В: современное представление проблемы. Акушерство, гинекология и репродукция. 2022; 16(2): 182-93. [Olenev A.S., Konopliannikov A.G., Songolova E.N., Stetsyuk O.V. Colonization of pregnant women with group B streptococcus: current view at the problem. Obstetrics, Gynecology and Reproduction. 2022; 16(2): 182-93.(in Russian)]. https://dx.doi.org/10.17749/2313-7347/ob.gyn.rep.2022.284.
- Mirsky R., Carpenter D.M., Postlethwaite D.A., Regenstein A.C. Preventing early-onset group B streptococcal sepsis: is there a role for rescreening near term? J. Matern. Fetal Neonatal Med. 2020; 33(22): 3791-7. https://dx.doi.org/10.108/14767058.2019.1586874.
- Virranniemi M.., Raudaskoski T., Haapsamo M., Kauppila J., Renko M., Peltola J. et al. The effect of screening-to-labor interval on the sensitivity of late-pregnancy culture in the prediction of group B streptococcus colonization at labor: A prospective multicenter cohort study. Acta Obstet. Gynecol. Scand. 2019; 98(4): 494-9. https://dx.doi.org/10.1111/aogs.13522.
- Tanaka K., Iwashita M., Matsushima M., Wachi Y., Izawa T., Sakai K., Kobayashi Y. Intrapartum group B Streptococcus screening using real-time polymerase chain reaction in Japanese population. J. Matern. Fetal Neonatal Med. 2016; 29(1): 130-4. https://dx.doi.org/10.3109/14767058.2014.989496.
- Corvaglia L., Tonti G., Martini S., Aceti A., Mazzola G., Aloisio I. et al. Influence of intrapartum antibiotic prophylaxis for group B streptococcus on gut microbiota in the first month of life. J. Pediatr. Gastroenterol. Nutr. 2016; 62(2): 304-8. https://dx.doi.org/10.1097/MPG.0000000000000928.
- Davies H.D., Miller M.A., Faro S., Gregson D., Kehl S.C., Jordan J.A. Multicenter study of a rapid molecular-based assay for the diagnosis of group B Streptococcus colonization in pregnant women. Clin. Infect. Dis. 2004; 39(8): 1129-35. https://dx.doi.org/10.1086/424518.
- Daniels J., Gray J., Pattison H., Roberts T., Edwards E., Milner P. et al. Rapid testing for group B streptococcus during labour: a test accuracy study with evaluation of acceptability and cost-effectiveness. Health Technol. Assess. 2009; 13(42): 1-154, iii-iv. https://dx.doi.org/10.3310/hta13420.
- El Helali N., Nguyen J.C., Ly A., Giovangrandi Y., Trinquart L. Diagnostic accuracy of a rapid real-time polymerase chain reaction assay for universal intrapartum group B streptococcus screening. Clin. Infect. Dis. 2009; 49(3): 417-23. https://dx.doi.org/10.1086/600303.
- Крог-Йенсен О.А., Никитина И.В., Брагина О.Н., Исаева Е.Л., Припутневич Т.В., Зубков В.В., Дегтярев Д.Н., Ленюшкина А.А. Клиническая значимость микробиологического исследования отделяемого со слизистой верхних дыхательных путей и желудочно-кишечного тракта у недоношенных новорожденных в первые сутки жизни. Акушерство и гинекология. 2022; 8: 108-23. [Krogh-Jensen O.A., Nikitina I.V., Bragina O.N., Isaeva E.L., Priputnevich T.V., Zubkov V.V., Degtyarev D.N., Lenyushkina A.A. Body surface cultures in preterm neonates on the first day of life: clinical usefulness. Obstetrics and Gynecology.2022; (8): 108-23. (in Russian)].https://dx.doi.org/10.18565/aig.2022.8.108-123.
Received 24.05.2023
Accepted 03.07.2023
About the Authors
Irina V. Nikitina, Dr. Med. Sci., Leading Researcher at the Neonatal Intensive Care Unit №2 of the Institute of Neonatology and Pediatrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Professor at Neonatology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(495)531-44-44, ex. 2700, 2697, i_nikitina@oparina4.ru,https://orcid.org/0000-0002-1103-1908, Researcher ID: AAH-3465-2019, Scopus ID: 57189233499, 117997, Russia, Moscow, Oparina str., 4.
Olga A. Krogh-Jensen, Ph.D., Neonatologist at the Neonatal Intensive Care Unit №2 of the Institute of Neonatology and Pediatrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4; Associate Professor at the Neonatal Department, Pediatric Faculty, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, 119991, Russia, Moscow, Trubetskaya str., 8-2,
+7(926)014-01-35, o_krogh@oparina4.ru, olgaborisevich@gmail.com, https://orcid.org/0000-0002-5178-5659, Scopus Author ID: 57214220453.
Arina Yu. Budina, Medical resident at the Department of Pediatrics and Neonatology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, budinaarina@mail.ru, https://orcid.org/0000-0001-8893-7639, 117997, Russia, Moscow, Oparina str., 4.
Alexey B. Gordeev, Ph.D., Head of the Department of Molecular Microbiology and Bioinformatics, Institute of Microbiology, Antimicrobial Therapy and Epidemiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, +7(916)226-86-67,
a_gordeev@oparina4.ru, https://orcid.org/0000-0002-9171-5276, Researcher ID: T-4072-2018, Scopus ID: 24331513200, Elibrary: SPIN-код: 6479-1248, AuthorID: 614924, 117997, Russia, Moscow, Oparina str., 4.
Viktor V. Zubkov, Dr. Med. Sci., Director of the Institute of Neonatology and Pediatrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4; Professor at Neonatal Department at Pediatric Faculty,
I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, 119991, Russia, Moscow, Trubetskaya str., 8-2,
victor.zubkov@mail.ru, https://orcid.org/0000-0002-9697-9596
Dmitriy N. Degtyarev, Dr. Med. Sci., Vice Director, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia; Professor of Neonatology Department, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology,
Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4; Professor, Head of Neonatal Department at Pediatric Faculty, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, 119991, Russia, Moscow, Trubetskaya str., 8-2, +7(495)438-25-33, d_degtiarev@oparina4.ru,
https://orcid.org/0000-0001-8975-2425
Tatiana V. Priputnevich, Dr. Med. Sci., Corresponding Member of RAS, Head of the Institute of Microbiology, Clinical Pharmacology and Epidemiology, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, 117997, Russia, Moscow, Oparina str., 4;
Professor at the Department of Microbiology and Virology, Faculty of Pediatrics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia, 117997, Russia, Moscow, Ostrovityanova str., 1, +7(495)438-25-10, ex. 2770, priput1@gmail.com, https://orcid.org/0000-0002-4126-9730
Anna A. Lenyushkina, Ph.D., Head of the Neonatal Intensive Care Unit №2 of the Institute of Neonatology and Pediatrics, Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Ministry of Health of Russia, Associate Professor at Neonatology Department, +7(495)531-44-44, ex. 2700, 2697, a-lenushkina@yandex.ru, Scopus ID: 57202802436, WOS ID: AAJ-6896-2021, https://orcid.org/0000-0001-8929-2991, 117997, Russia, Moscow, Oparina str., 4.
Similar Articles
