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Published on: November 16, 2016
Invasive Group B Streptococcus Disease With Recurrence and in Multiples: Towards a Better Understanding of GBS
Mirjam Freudenhammer1,2,3, Konstantinos Karampatsas4, Kirsty Le Doare4
1Institute for Immunodeficiency, Center for Chronic Immunodeficiency, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Insights
Group B Streptococcus (GBS) can cause late-onset invasive disease (iGBS) in infants. Recurrent or multiple births increase iGBS risk, suggesting microbiome disturbances and host immunity factors play a role.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Microbiology
Background:
- Group B Streptococcus (GBS) commonly colonizes the gut in newborns.
- While often asymptomatic, GBS can lead to late-onset invasive GBS disease (iGBS), including sepsis or meningitis, in a small percentage of infants.
- The transmission routes and specific risk factors for iGBS, particularly in recurrent cases and multiple births, remain incompletely understood.
Purpose of the Study:
- To investigate shared and fixed risk factors for invasive Group B Streptococcus disease (iGBS).
- To analyze cases of recurrent iGBS and iGBS occurring in twins/triplets to understand disease dynamics and contributing factors.
Main Methods:
- Analysis of iGBS cases with recurrence (n=25) and in twins/triplets (n=32).
- Data sourced from a UK/Ireland national surveillance study (2014/15) and a retrospective case collection from Germany and Switzerland.
- Statistical analysis to identify risk factors and disease onset intervals.
Main Results:
- Infants from multiple births faced a high risk (17%) of iGBS if a sibling was already affected.
- The onset interval for iGBS between siblings was 4.5 days, and for recurrent cases, it was 12.5 days.
- Increased risk of recurrence was associated with short-term antibiotic use (aOR 4.2, P=0.02), suggesting microbiome disruption.
Conclusions:
- High iGBS risk in multiples and recurrent cases points to disturbed individual microbiomes and potential failures in GBS strain integration.
- Identical GBS serotypes in recurrent/multiple infections suggest a common source or failed colonization resistance.
- Fluctuations in host immunity and individual exposure patterns likely contribute to the failure of natural niche occupation by GBS.
Abstract:
Group B Streptococcus (GBS) is a common intestinal colonizer during the neonatal period, but also may cause late-onset sepsis or meningitis in up to 0.5% of otherwise healthy colonized infants after day 3 of life. Transmission routes and risk factors of this late-onset form of invasive GBS disease (iGBS) are not fully understood. Cases of iGBS with recurrence (n=25) and those occurring in parallel in twins/triplets (n=32) from the UK and Ireland (national surveillance study 2014/15) and from Germany and Switzerland (retrospective case collection) were analyzed to unravel shared (in affected multiples) or fixed (in recurrent disease) risk factors for GBS disease. The risk of iGBS among infants from multiple births was high (17%), if one infant had already developed GBS disease. The interval of onset of iGBS between siblings was 4.5 days and in recurrent cases 12.5 days. Disturbances of the individual microbiome, including persistence of infectious foci are suggested e.g. by high usage of perinatal antibiotics in mothers of affected multiples, and by the association of an increased risk of recurrence with a short term of antibiotics [aOR 4.2 (1.3-14.2), P=0.02]. Identical GBS serotypes in both recurrent infections and concurrently infected multiples might indicate a failed microbiome integration of GBS strains that are generally regarded as commensals in healthy infants. The dynamics of recurrent GBS infections or concurrent infections in multiples suggest individual patterns of exposure and fluctuations in host immunity, causing failure of natural niche occupation.
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