Streptococcus Agalactiae Kristen Glasspoole Streptococcus Agalactiae

Objectives After the presentation, the audience should: Identify who is at risk for contracting Streptococcus agalactiae. Recognize the route of transmission of Streptococcus agalactiae. Define how the symptoms of Streptococcus agalactiae are diagnosed. Predict the prognosis of a person that has contacted Streptococcus agalactiae Be aware of what treatment options are available to patients with Streptococcus agalactiae. Evaluate ways in which to be proactive in preventing the disease.

Facts Emerged as pathogen in 1970, as sepsis in infants. 25% of women carry Group B Strep. Neonatal sepsis occurs 1.8-3.2 per 1000 live births. Before prevention – 20,000 cases annually Cost 300 million dollars

Morphology Aerobic gram positive Cocci, gray-white with narrow zone of beta hemolysis, encapsulated. Virulence is do to polysaccharide toxin it produces.

Gram Stain http://www.cdc.gov/groupbstrep/lab/lab-photos.html

Etiologic agents/ Causes Streptococcus agalactiae Mostly seen as normal vaginal flora of women Causes problem during pregnancy Adults – sepsis and soft tissue infections

Who is at Risk Infants born to mothers with Streptococcus agalactiae colonization. Prolonged rupture of the membrane Preterm birth Elderly people African Americans Adults with chronic illnesses Diabetes, heart disease, malignancy, cirrhosis, AIDS, steroids

Adults with Streptococcus agalactiae Increase chance of Group B strep with age. Bloodstream infections, pneumonia, skin and soft tissue infections, bone and joint infections. Blood or spinal fluid sampled. Treat with penicillin . Can be fatal.

Risk Factors Colonization of Streptococcus agalactiae during third trimester of pregnancy. Positive Group B Strep screening culture Delivery at less than 37 weeks of gestation Rupture of the amniotic membrane for more than 18 hours Intrapartum Fever of > 100.4 F Previous Infant with Streptococcus agalactiae infection.

Transmission Pregnant women Adults Asymptomatic – carried in genital tract and gastrointestinal tract Transmission to baby occurs vertically in utero or through the genital tract during delivery. Adults Transmission is unknown Possibility of endogenous isolates gaining access to sterile sites.

Symptoms in Neonates Meningitis, sepsis, pneumonia Early on set (<7 days old) Late on set (7-90 days old) Fever, difficulty breathing, difficulty feeding, bluish color of skin, lethargic, irregular heart rate

Neonates with Streptococcus agalactiae http://www.thirdage.com/hc/c/group-b-streptococcal-disease-causes

Neonate with Streptococcus agalactiae Tests: Complete blood count, blood gases, prothrombin time (PT), partial thromboplastin time (PTT), blood culture, CSF culture, urine culture, X-ray. Treatment: Antibiotics, fluids through a vein, breathing help, medication for shock

Collection Streptococcus agalactiae maybe seen in the urine Only a concern if woman is of child bearing age (15-45) Specimens are cultured at 35-37 weeks of pregnancy. A swab is collected from lower vagina and rectum.

Diagnosis Found in the blood, CSF, and urine. Test include: Latex agglutination CAMP Test Group B Strep Broth PCR

Detection–Latex agglutination http://www.cdc.gov/groupbstrep/lab/lab-photos.html

Detection – CAMP Test http://www.cdc.gov/groupbstrep/lab/labphotos.html

Group B Strep Broth Positive Negative http://www.cdc.gov/groupbstrep/lab/lab-photos.html

Streptococcus agalactiae Non-hemolytic Hemolytic http://www.cdc.gov/groupbstrep/lab/lab-photos.html

PCR * http://library.ncahec.net

Prognosis For women who are pregnant the prognosis is good. Neonates have a better prognosis than in previous years but the mortality rate is still significant. For adults (elderly) the prognosis is a high mortality rate.

Neonates with Streptococcus agalactiae http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w

Neonates with Streptococcus agalactiae http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w

Neonates with Streptococcus agalactiae www.cdc.gov/groupbstrep/downloads/Clinical_slideset.ppt

Treatment Penicillin or Ampicillin is the drug of choice Anaphylaxis Testing aminoglycosides Anaphylaxis Clindamycin, Erythromycin Antibiotic are only given DURING labor. Bacteria grows back very quickly

Drug Resistance www.cdc.gov/groupbstrep/downloads/Clinical_slideset.ppt

Prevention Working on a vaccine Problem with shifting serotypes Women not comfortable with vaccination during pregnancy

Prevention http://www.groupbstrepinternational.org/info_main.html

References (2010, November 18). Group b strep (gbs). Retrieved from Center for Disease Control and Prevention website: http://www.cdc.gov/groupbstrep/index.html (2011, November 14). Group b streptococcal septicemia of the newborn. Retrieved from Medline Plus website: http://www.nlm.nih.gov/medlineplus/ency/article/001366.htm (2011, September 13). Streptococcus group b infections clinical presentation. Retrieved from medscape website: http://emedicine.medscape.com/article/229091-overview (2009, ). Group b streptococcal disease causes. Retrieved from Thridage.com website: http://www.thirdage.com/hc/c/group-b-streptococcal-disease-causes (2011, ). Streptococcus agalactiae. Retrieved from Microbiology in Pictures website: http://www.microbiologyinpictures.com/streptococcus%20agalactiae.html (2010, November 19). Early-onset group b streptococcal disease prevention: for clinicians. Retrieved from Centers for Disease Control and Prevention website: www.cdc.gov/groupbstrep/downloads/Clinical_slideset.ppt

References (2010, November 19). Early-onset group b streptococcal disease prevention: procedures for laboratories. Retrieved from Centers for Disease Control and Prevention website: www.cdc.gov/groupbstrep/downloads/Lab_slideset.ppt Verani, J. R., McGee, L., & Schrag, S. J. (2010, November 19). Prevention of prenatal group b streptococcal disease. Retrieved from Morbidity and mortality weekly report website: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5910a1.htm?s_cid=rr5910a1_w Mahon, C. R., Lehman, D. C., & Manuselis, G. (2011). Diagnostic microbiology fourth edition. Missouri: Saunders Elsevier. Forbes, B. A., Sahm, D. F., & Weissfeld, A. S. (2007). Diagnostic microbiology 12th edition. Bailey And Scott's. Brooke, S., Whitworth, J., & Calabretta, N. (2009, January). How best to manage the patient in term labor whose group b strep status is unknown? website: http://library.ncahec.net * (2011, ). What is group b strep. Retrieved from Group B Strep International website: http://www.groupbstrepinternational.org/info_main.html