Disease: Group B Strep Infection

    Group B strep facts

    • Group B strep are bacteria found normally in the intestine, vagina, and rectal area in about 25% of all healthy women.
    • Group B strep infections can affect neonates and adults.
    • Most pregnant women who are colonized by the bacteria have no symptoms.
    • The infection can be spread to infants before or during delivery.
    • Signs and symptoms in babies may include fever, breathing problems, lethargy, and poor feeding.
    • Diagnosis of GBS infection is made by isolating the organism from body fluids.
    • The treatment for GBS infection is antibiotics.
    • Complications of GBS infection include sepsis, pneumonia, meningitis, or occasionally death.
    • In pregnant women, routine screening for colonization with GBS is recommended.

    What is group B strep?

    Group B strep (GBS) is a type of gram-positive streptococcal bacteria also known as Streptococcus agalactiae. This type of bacteria (not to be confused with group A strep which causes "strep throat") is commonly found in the human body, and it usually does not cause any symptoms. However, in certain cases, it can be a dangerous cause of various infections that can affect nonpregnant adults, pregnant women, and their newborn infants. In the United States, approximately 19,800 cases of GBS infection occur annually across all age groups. Group B strep infection is the most common cause of sepsis and meningitis in the United States during a newborn's first week of life.

    Group B strep infection can also afflict nonpregnant adults with certain chronic medical conditions, such as diabetes, cardiovascular disease, obesity, and cancer. The incidence of GBS infection in adults increases with age, with the highest rate in adults 65 years of age and older (20-25 cases per 100,000). Although the incidence of neonatal group B strep infection has been decreasing, the incidence of group B strep infection in nonpregnant adults has been increasing.

    What causes group B strep infection?

    Group B strep can normally be found in about 25% of all healthy adult women. It can commonly be found in the intestine, vagina, and rectal area. Most women who are carriers of the bacteria (colonized) will not have any symptoms; however, under certain circumstances, infection of both the mother and/or the newborn can develop. In newborns, if the group B strep infection develops in the first week of life, it is termed early onset disease. If the group B strep infection develops from 1 week to 3 months of age, it is referred to as late-onset disease. Approximately 1,200 babies in the United States develop early onset disease each year, with similar rates for late-onset disease.

    How is group B strep transmitted?

    In newborns, GBS infection is acquired through direct contact with the bacteria while in the uterus or during delivery; thus, the infection is transmitted from the colonized mother to her newborn. Approximately 50% of colonized mothers will pass the bacteria to their babies during pregnancy and vaginal delivery. However, not all babies will be affected by the bacteria, and statistics show that about only one of every 100-200 babies born to a GBS-colonized mother will actually go on to develop GBS infection.

    Group B strep infection is more common in African Americans than in whites. There are also maternal risk factors that increase the chance of transmitting group B strep to the newborn leading to early onset disease:

    • Labor or membrane rupture before 37 weeks gestation
    • Membrane rupture more than 18 hours before delivery
    • Urinary tract infection with GBS during pregnancy
    • Previous baby with GBS infection
    • Fever during labor
    • Positive culture for GBS colonization at 35-37 weeks

    Late-onset GBS infection occurs more commonly in babies who are born prematurely (<37 weeks) and in those babies whose mother tested positive for GBS during pregnancy.

    Group B strep infection is not a sexually transmitted disease (STD).

    What are group B strep infection symptoms and signs?

    In newborns with early onset group B strep infection, the signs and symptoms usually develop within the first 24 hours of life. Those babies who develop late-onset group B strep infection are often healthy and thriving, with the signs and symptoms of the disease developing after the first week of life. Signs and symptoms that may be observed with GBS infection in babies include

    • fever,
    • breathing problems/grunting sounds,
    • bluish-colored skin (cyanosis),
    • seizures,
    • limpness or stiffness,
    • heart rate and blood pressure abnormalities,
    • poor feeding,
    • fussiness.

    Adults who develop invasive GBS infection may develop

    • bloodstream infection (sepsis),
    • skin and soft-tissue infection,
    • bone and joint infection,
    • lung infection (pneumonia),
    • urinary tract infection,
    • rarely, an infection of the fluid and lining tissues surrounding the brain (meningitis).

    The exact source of the infection in nonpregnant adults is often not determined.

    How is group B strep infection diagnosed?

    In newborns and in adults, isolation of the group B strep bacteria is necessary for a definitive diagnosis. Laboratory studies that isolate the organism from certain body fluids, such as blood, cerebrospinal fluid (CSF), and urine help establish the diagnosis. Results of these tests can take a few days. A lumbar puncture (spinal tap) may need to be performed when meningitis is suspected. Imaging studies such as a chest X-ray may be ordered to evaluate whether pneumonia is present.

    What is the treatment for group B strep?

    For women who test positive for GBS during pregnancy and for those with certain risk factors for developing or transmitting GBS infection during pregnancy, intravenous antibiotics are recommended at the time of labor. The administration of antibiotics to women before labor who are known to be colonized with GBS is not effective in preventing early onset disease, as it has been found that the GBS bacteria can grow back quickly. Pregnant women who are not aware of their group B strep status should be given antibiotics during labor if they develop preterm labor (less than 37 weeks gestation), if they have membrane rupture for 18 hours or longer, or if they develop fever during labor. Penicillin or ampicillin are the recommended antibiotics. The administration of antibiotics has been shown to significantly decrease GBS early onset infection in newborns; however, it does not prevent late-onset GBS infection. If a pregnant carrier of GBS receives intravenous antibiotics during delivery, her baby has a one in 4,000 chance of developing GBS infection. Without antibiotics, her baby has a one in 200 chance of developing GBS infection.

    In neonates and nonpregnant adults who develop invasive GBS infection, intravenous antibiotics are also the mainstay of treatment. There are certain conditions associated with invasive GBS infection that may require surgical intervention, for example surgical debridement in certain patients with soft tissue/skin infections.

    What are the complications of group B strep infection?

    Invasive infection with GBS in babies may result in sepsis, pneumonia, meningitis, or occasionally death. In some babies who survive, meningitis, deafness, blindness. or developmental disabilities may occur. In the United States, the mortality (death) rate for group B strep infection in babies is about 5%.

    In pregnant women, infection with GBS may cause urinary tract infection, infection of the uterus and placenta, as well as preterm delivery, stillbirth, or miscarriage. Mortality rates in these patients are low because they tend to be healthy young or middle-aged individuals.

    In nonpregnant adults with chronic medical conditions who develop invasive GBS infection, complications may include pneumonia, urinary tract infection, sepsis, skin and soft-tissue infection, bone and joint infection, and rarely meningitis. This group of patients tends to have higher mortality rates, ranging from 8%-47% depending on the published report.

    What causes group B strep infection?

    Group B strep can normally be found in about 25% of all healthy adult women. It can commonly be found in the intestine, vagina, and rectal area. Most women who are carriers of the bacteria (colonized) will not have any symptoms; however, under certain circumstances, infection of both the mother and/or the newborn can develop. In newborns, if the group B strep infection develops in the first week of life, it is termed early onset disease. If the group B strep infection develops from 1 week to 3 months of age, it is referred to as late-onset disease. Approximately 1,200 babies in the United States develop early onset disease each year, with similar rates for late-onset disease.

    How is group B strep transmitted?

    In newborns, GBS infection is acquired through direct contact with the bacteria while in the uterus or during delivery; thus, the infection is transmitted from the colonized mother to her newborn. Approximately 50% of colonized mothers will pass the bacteria to their babies during pregnancy and vaginal delivery. However, not all babies will be affected by the bacteria, and statistics show that about only one of every 100-200 babies born to a GBS-colonized mother will actually go on to develop GBS infection.

    Group B strep infection is more common in African Americans than in whites. There are also maternal risk factors that increase the chance of transmitting group B strep to the newborn leading to early onset disease:

    • Labor or membrane rupture before 37 weeks gestation
    • Membrane rupture more than 18 hours before delivery
    • Urinary tract infection with GBS during pregnancy
    • Previous baby with GBS infection
    • Fever during labor
    • Positive culture for GBS colonization at 35-37 weeks

    Late-onset GBS infection occurs more commonly in babies who are born prematurely (<37 weeks) and in those babies whose mother tested positive for GBS during pregnancy.

    Group B strep infection is not a sexually transmitted disease (STD).

    What are group B strep infection symptoms and signs?

    In newborns with early onset group B strep infection, the signs and symptoms usually develop within the first 24 hours of life. Those babies who develop late-onset group B strep infection are often healthy and thriving, with the signs and symptoms of the disease developing after the first week of life. Signs and symptoms that may be observed with GBS infection in babies include

    • fever,
    • breathing problems/grunting sounds,
    • bluish-colored skin (cyanosis),
    • seizures,
    • limpness or stiffness,
    • heart rate and blood pressure abnormalities,
    • poor feeding,
    • fussiness.

    Adults who develop invasive GBS infection may develop

    • bloodstream infection (sepsis),
    • skin and soft-tissue infection,
    • bone and joint infection,
    • lung infection (pneumonia),
    • urinary tract infection,
    • rarely, an infection of the fluid and lining tissues surrounding the brain (meningitis).

    The exact source of the infection in nonpregnant adults is often not determined.

    How is group B strep infection diagnosed?

    In newborns and in adults, isolation of the group B strep bacteria is necessary for a definitive diagnosis. Laboratory studies that isolate the organism from certain body fluids, such as blood, cerebrospinal fluid (CSF), and urine help establish the diagnosis. Results of these tests can take a few days. A lumbar puncture (spinal tap) may need to be performed when meningitis is suspected. Imaging studies such as a chest X-ray may be ordered to evaluate whether pneumonia is present.

    What is the treatment for group B strep?

    For women who test positive for GBS during pregnancy and for those with certain risk factors for developing or transmitting GBS infection during pregnancy, intravenous antibiotics are recommended at the time of labor. The administration of antibiotics to women before labor who are known to be colonized with GBS is not effective in preventing early onset disease, as it has been found that the GBS bacteria can grow back quickly. Pregnant women who are not aware of their group B strep status should be given antibiotics during labor if they develop preterm labor (less than 37 weeks gestation), if they have membrane rupture for 18 hours or longer, or if they develop fever during labor. Penicillin or ampicillin are the recommended antibiotics. The administration of antibiotics has been shown to significantly decrease GBS early onset infection in newborns; however, it does not prevent late-onset GBS infection. If a pregnant carrier of GBS receives intravenous antibiotics during delivery, her baby has a one in 4,000 chance of developing GBS infection. Without antibiotics, her baby has a one in 200 chance of developing GBS infection.

    In neonates and nonpregnant adults who develop invasive GBS infection, intravenous antibiotics are also the mainstay of treatment. There are certain conditions associated with invasive GBS infection that may require surgical intervention, for example surgical debridement in certain patients with soft tissue/skin infections.

    What are the complications of group B strep infection?

    Invasive infection with GBS in babies may result in sepsis, pneumonia, meningitis, or occasionally death. In some babies who survive, meningitis, deafness, blindness. or developmental disabilities may occur. In the United States, the mortality (death) rate for group B strep infection in babies is about 5%.

    In pregnant women, infection with GBS may cause urinary tract infection, infection of the uterus and placenta, as well as preterm delivery, stillbirth, or miscarriage. Mortality rates in these patients are low because they tend to be healthy young or middle-aged individuals.

    In nonpregnant adults with chronic medical conditions who develop invasive GBS infection, complications may include pneumonia, urinary tract infection, sepsis, skin and soft-tissue infection, bone and joint infection, and rarely meningitis. This group of patients tends to have higher mortality rates, ranging from 8%-47% depending on the published report.

    Source: http://www.rxlist.com

    For women who test positive for GBS during pregnancy and for those with certain risk factors for developing or transmitting GBS infection during pregnancy, intravenous antibiotics are recommended at the time of labor. The administration of antibiotics to women before labor who are known to be colonized with GBS is not effective in preventing early onset disease, as it has been found that the GBS bacteria can grow back quickly. Pregnant women who are not aware of their group B strep status should be given antibiotics during labor if they develop preterm labor (less than 37 weeks gestation), if they have membrane rupture for 18 hours or longer, or if they develop fever during labor. Penicillin or ampicillin are the recommended antibiotics. The administration of antibiotics has been shown to significantly decrease GBS early onset infection in newborns; however, it does not prevent late-onset GBS infection. If a pregnant carrier of GBS receives intravenous antibiotics during delivery, her baby has a one in 4,000 chance of developing GBS infection. Without antibiotics, her baby has a one in 200 chance of developing GBS infection.

    In neonates and nonpregnant adults who develop invasive GBS infection, intravenous antibiotics are also the mainstay of treatment. There are certain conditions associated with invasive GBS infection that may require surgical intervention, for example surgical debridement in certain patients with soft tissue/skin infections.

    Source: http://www.rxlist.com

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