Molecular pathogenesis of neonatal group B streptococcal infection: no longer in its infancy

The process of human infection by group B Streptococcus (GBS) is complex and multifactorial. While this bacterium has adapted well to asymptomatic colonization of adult humans, it remains a potentially devastating pathogen to susceptible infants. Advances in molecular techniques and refinement of in vitro and in vivo model systems have elucidated key elements of the pathogenic process, from initial attachment to the maternal vaginal epithelium to penetration of the newborn blood-brain barrier. Sequencing of two complete GBS genomes has provided additional context for interpretation of experimental data and comparison to other well-studied pathogens. Here we review recent discoveries regarding GBS virulence mechanisms, many of which are revealed or magnified by the unique circumstances of the birthing process and the deficiencies of neonatal immune defence. Appreciation of the formidable array of GBS virulence factors underscores why this bacterium remains at the forefront of neonatal pathogens.