Group B Streptococcus Meningitis Research Articles

Increased risk of group B Streptococcus causing meningitis in infants with mannose-binding lectin deficiency

ObjectivesTo evaluate the association of mannose-binding lectin (MBL) deficiency with susceptibility and clinical features of group B Streptococcus (GBS) causing meningitis in Chinese infants. MethodsDuring 2014–2017, 33 infants with laboratory-confirmed GBS meningitis were included. Six polymorphisms (H/L, Y/X, P/Q, A/D, A/B and A/C) of MBL were sought for in these patients and in 330 healthy controls by PCR-based sequencing. Serum MBL concentration was determined. ResultsSignificantly higher frequency of MBL variant genotype A/B was found in patients than controls (15/33, 45%, vs. 79/330, 24%, p=0.011). Patients with variant genotype A/B had significantly lower serum MBL than those with wild-type genotype A/A (median, 482.87 vs. 1455.13 ng/mL, p=0.002). Moreover, patients with genotype A/B had significantly higher level of C-reactive protein (median, 146 vs. 41 mg/L, p=0.007), neutrophil (median, 58.1% vs. 45.7%, p=0.033) and neutrophil-to-lymphocyte ratio in blood (median, 2.32 vs. 1.03, p=0.018) compared to those with genotype A/A. No significant differences were observed in clinical features of patients with different genotypes. ConclusionsOur result suggested that infants with MBL deficiency are at higher risk of meningitis caused by GBS. Further studies in different populations with larger number of subjects are needed.

Patterns of ischemic injury on brain images in neonatal group B Streptococcal meningitis.

Purpose This study investigated patterns of ischemic injury observed in brain images from patients with neonatal group B Streptococcal (GBS) meningitis.Methods Clinical findings and brain images from eight term or near-term newborn infants with GBS meningitis were reviewed.Results GBS meningitis was confirmed in all 8 infants via cerebrospinal fluid (CSF) analysis, and patients tested positive for GBS in both blood and CSF cultures. Six infants (75.0%) showed early onset manifestation of the disease (<7 days); the remaining 2 (25.0%) showed late onset manifestation. In 6 infants (75%), cranial ultrasonography showed focal or diffuse echogenicity, suggesting hypoxic-ischemic injury in the basal ganglia, cerebral hemispheres, and periventricular or subcortical white matter; these findings are compatible with meningitis. Findings from magnetic resonance imaging (MRI) were compatible with bacterial meningitis, showing prominent leptomeningeal enhancement, a widening echogenic interhemisphere, and ventricular wall thickening in all infants. Restrictive ischemic lesions observed through diffusion-weighted imaging were evident in all eight infants. Patterns of ischemic injury as detected through MRI were subdivided into 3 groups: 3 infants (37.5%) predominantly showed multiple punctuate lesions in the basal ganglia, 2 infants (25.0%) showed focal or diffuse cerebral infarcts, and 3 infants (37.5%) predominantly showed focal subcortical or periventricular white matter lesions. Four infants (50%) showed significant developmental delay or cerebral palsy.Conclusion Certain patterns of ischemic injury are commonly recognized in brain images from patients with neonatal GBS meningitis, and this ischemic complication may modify disease processes and contribute to poor neurologic outcomes.

Clinical analysis of 2 siblings with late-onset meningitis caused by group B streptococcus which were homogenous to the colonization bacteria of their mother

Objective To raise awareness of the late-onset meningitis caused by group B streptococcus (GBS) which was homogenous to the maternal colonization. Methods The clinical data of late-onset GBS meningitis in neonates twins whose pathogens were homogenous to their maternal colonization were collected from Department of Neonatology, Guangzhou Women and Children′s Medical Center.The general conditions, clinical symptoms, laboratory tests and drug treatment of the twins and their mother were retrospectively analyzed, and the GBS homology during inpatient care was tested.And the progress of the twins′ condition was investigated by telephone follow-up. Results The mother had two pregnancies without prenatal GBS screening or intrapartum antimicrobial intervention for GBS, everything was normal during pregnancy and delivery.Twins were born through cesarean section.The elder sister was discharged with Linezolid taken orally after 167 days in hospital without convulsions, shaking or other discomfort.The elder sister was followed up for every 2 weeks, and in the last time of follow-up, cerebrospinal fluid white blood cell counts were 45×106/L, protein level was 1.52 g/L and Linezolid was withdrawn.The younger brother was discharged after 58 days in hospital with follow-up for every 2 weeks, and in the last time of follow-up, cerebrospinal fluid white blood cell counts were 30×106/L, protein level was 0.66 g/L.During the hospitalization and follow-up without convulsions and irritation, and the cranial magnetic resonance imaging of the twin brother was normal.Test results showed that the GBS bacteria strain for twins and their mother were all serotype Ⅲ.The possibility of the GBS homology was more than 90%. Conclusions The toxicity of serotype Ⅲ GBS strain was strong.More proactive precautions should be considered to apply for the mother whose first birth already had GBS infection.Early identification and intervention of infection risk factors would help optimize the anti-infection treatment program and reduce nerve system damage and other adverse outcomes caused by invasive GBS infection. Key words: Group B streptococcus; Infant, newborn; Meningitis

Early-Onset Meningitis with Group B Streptococcus: The Case of a Female Neonate with Brain Abscess in Iran

Introduction: Group B streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis. Although late-onset GBS meningitis is the most common form of the disease, it may happen earlier, like just a few hours after birth, known as the early-onset. GBS meningitis is associated with 30% mortality rate among infants. Of those who stay alive, 25% of them will develop adverse neurological conditions. Herein, we report a case of early-onset GBS meningitis in a female infant with brain abscess. Case Presentation: A 10-hour old female was admitted to the neonatal intensive care unit (of the University of Tehran) for poor feeding, irritability, lethargy, and seizure. Sepsis work-up and lumbar puncture were performed. The treatment was started with vancomycin, cefotaxime and phenobarbital. The GBS was isolated from both blood and CSF cultures. A cranial sonography revealed intraparenchymal hemorrhage. The infant’s hospital course was complicated by recurrent and intractable seizures. The brain MRI of the patient showed micro-abscess. After six weeks of medical therapy, the patient was discharged from the hospital in a good condition. Neurological evaluations of the patient, conducted two and five months after her birth, showed normal results. Conclusions: Neonates with GBS meningitis are prone to adverse neurological conditions, including brain abscess. Although GBS is a normal flora in the genitourinary tracts of 15 to 30% of women, routine screening and treatments of the GBS-positive women during their course of pregnancy could reduce such serious complications.

Neurodevelopmental Impairment in Children After Group B Streptococcal Disease Worldwide: Systematic Review and Meta-analyses.

Survivors of infant group B streptococcal (GBS) disease are at risk of neurodevelopmental impairment (NDI), a burden not previously systematically quantified. This is the 10th of 11 articles estimating the burden of GBS disease. Here we aimed to estimate NDI in survivors of infant GBS disease. We conducted systematic literature reviews (PubMed/Medline, Embase, Latin American and Caribbean Health Sciences Literature [LILACS], World Health Organization Library Information System [WHOLIS], and Scopus) and sought unpublished data on the risk of NDI after invasive GBS disease in infants <90 days of age. We did meta-analyses to derive pooled estimates of the percentage of infants with NDI following GBS meningitis. We identified 6127 studies, of which 18 met eligibility criteria, all from middle- or high-income contexts. All 18 studies followed up survivors of GBS meningitis; only 5 of these studies also followed up survivors of GBS sepsis and were too few to pool in a meta-analysis. Of meningitis survivors, 32% (95% CI, 25%-38%) had NDI at 18 months of follow-up, including 18% (95% CI, 13%-22%) with moderate to severe NDI. GBS meningitis is an important risk factor for moderate to severe NDI, affecting around 1 in 5 survivors. However, data are limited, and we were unable to estimate NDI after GBS sepsis. Comparability of studies is difficult due to methodological differences including variability in timing of clinical reviews and assessment tools. Follow-up of clinical cases and standardization of methods are essential to fully quantify the total burden of NDI associated with GBS disease, and inform program priorities.

Clinical and Laboratory Features of Group B Streptococcus Meningitis in Infants and Newborns: Study of 848 Cases in France, 2001-2014.

Group B Streptococcus (GBS) disease is the leading cause of neonatal bacterial meningitis despite women receiving an intravenous antibiotic prophylaxis during labor. We aimed to describe GBS meningitis in children <1 year old in France. Clinical and biological data of GBS meningitis gathered by the Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV) were analyzed. The cases were classified by age: 0-6 days old (early-onset disease [EOD]), newborns and infants 7-89 days old (late-onset disease [LOD]: LOD1, 7-26 days; LOD2, 27-89 days), and infants aged 3 months to 1 year (infant disease). Among 848 GBS meningitis cases from 2001 to 2014, the incidence of EOD decreased by 63.3% (95% confidence interval [CI], 43.9%-80.1%]; P < .001) and that of LOD increased by 58.1% (95% CI, 39.1%-75.5%); P < .001) (52.9% and 64.3% for LOD1 and LOD2, respectively). The mean gestational age (GA) decreased significantly for EOD, LOD1, LOD2, and infant disease cases (38.7, 38.6, 37.3, and 34 weeks, respectively). Serotype III accounted for 83.9% of cases, with no significant difference among the 4 groups or by GA. The frequency of GBS belonging to the clonal complex 17 did not differ among the 4 groups. Case mortality was 11.4%. In the era of intravenous antibiotic prophylaxis, we found decreased incidence of early-onset GBS meningitis but, unexpectedly, increased incidence of LOD. These data underline the interest in the development of effective GBS vaccines for pregnant women.

Epidemiology of Late and Very Late Onset Group B Streptococcal Disease: Fifteen-Year Experience From Two Australian Tertiary Pediatric Facilities.

Group B Streptococcus (GBS) is a recognized cause of sepsis and meningitis, particularly in infants. Early onset (<7 days) GBS disease has been well characterized, whereas the epidemiology of late onset disease (LOD, 7-89 days) and very late onset disease (VLOD, ≥90 days) is less well understood. The aims of this study were to assess risk factors, presentation, management and outcome for GBS LOD and VLOD. Microbiology laboratory databases and hospital diagnostic coding for Sydney Children's Hospital and the Children's Hospital at Westmead were investigated for patients ≥7 days of age diagnosed with GBS bloodstream infection or meningitis from January 1, 2000 to December 31, 2014 (15 years). Subjects' medical records were reviewed to confirm diagnosis and analyze risk factors, presentation, management and outcome. Eighty-seven cases of LOD and 28 cases of VLOD were identified, including 49 cases of bloodstream infection and 66 cases of meningitis. No significant differences in risk factors or presentation were identified between LOD and VLOD. Patients with LOD were more likely to develop sequelae compared with VLOD [odds ratio (OR): 3, 95% confidence interval (CI): 1.03-8.77]. Female sex was the only significant risk factor identified for GBS meningitis (OR: 3.5, 95% CI: 1.5-8.1). GBS meningitis was significantly associated with neurodevelopmental impairment or death compared with bloodstream infection (OR: 30, 95% CI: 6.4-140.6). GBS LOD and VLOD are encountered in similar at-risk populations, with LOD associated with higher morbidity. Infants presenting with meningitis are at significantly higher risk of sequelae compared with bloodstream infection.

Late Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?

We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.

Diffusion-weighted MRI abnormalities in an outbreak of Streptococcus agalactiae Serotype III, multilocus sequence type 283 meningitis.

PurposeIn 2015, an outbreak of group B streptococcal (GBS) infection caused by Streptococcus agalactiae Serotype III, multilocus sequence type 283, related to consuming infected raw freshwater fish, affected more than 200 patients in Singapore. We describe the clinical, laboratory, and neuroimaging features of a subgroup of adults with central nervous system (CNS) infections caused by GBS.Materials and MethodsThe database of the Singapore Neurologic Infections Program (SNIP), a national multicenter study for surveillance of infectious neurologic disease, was reviewed to select patients with GBS CNS infection during the outbreak. Cases were diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) findings and identification or isolation of Streptococcus agalactiae in the blood or CSF. Demographic, clinical and neuroradiological information was obtained prospectively and retrospectively abstracted.ResultsFourteen patients (6 male, 8 female; median age, 58 years) presented with fever, meningism, headache, encephalopathy, focal neurological deficits, and/or seizures. All except two were previously healthy. Diffusion‐weighted imaging (DWI) on admission was abnormal in 13 patients, showing tiny hyperintensities in the subarachnoid space (7 patients), ventricles (6 patients) and brain parenchyma (8 patients); 5 patients had cerebellar abnormalities.ConclusionAmong healthy non‐pregnant adults infected with Serotype III, multilocus sequence type 283 GBS meningitis linked to eating infected raw freshwater fish, DWI detected small pus collections and unusual cerebellar involvement. A collaborative national surveillance system that includes MRI can be helpful during unusual food‐borne zoonotic infectious disease outbreaks.Level of Evidence: 4J. Magn. Reson. Imaging 2017;45:507–514.

Ongoing Cases of Early-Onset Group B Streptococcal Disease in the Era of Screening and Prophylaxis.

We reviewed cases of group B Streptococcus (GBS) sepsis in term infants at our institution to identify areas for potential prevention. We identified cases by searching our institution's microbiology databases for all positive GBS blood and cerebrospinal fluid cultures taken from infants between 2008 and 2013. Patients were included if the timing of the positive culture met the criteria for early-onset GBS disease (age 7 days or under). Charts that met inclusion criteria were abstracted for details related to antepartum screening, intrapartum care, and postpartum outcome. There are an average of 10 000 deliveries per year in our institution. During the five-year period (2008-2013), we identified 13 cases representing early-onset GBS disease in term infants. Of the 13 cases, nine mothers screened negative for GBS, two screened positive, and two were screened unknown. Four cases qualified for intrapartum prophylaxis; of these, two did not receive appropriate prophylaxis, one because of parental refusal and one for unspecified reasons after the membranes had been ruptured for > 18 hours. All 13 infants had confirmed GBS bacteremia, and four had concurrent GBS meningitis. One infant died and one infant had neurologic sequelae. Early-onset GBS disease in term infants continues to occur at our institution, and consequences for the infant can be severe. The majority of cases identified were screened and managed in accordance with current guidelines. Most cases were GBS negative when screened in the antepartum period, raising the question of whether a more sensitive test or a test closer to delivery could prevent further cases of early-onset GBS disease.

Late-Onset Group B Streptococcal Meningitis Has Cerebrovascular Complications

To describe cerebrovascular diseases related to late-onset group B Streptococcus (GBS) meningitis. Retrospective case series. Patients treated for cerebrovascular complication of late-onset GBS meningitis over 5years were identified through neuroradiology and microbiology databases. Patient charts were reviewed with regard to clinical presentation, laboratory findings, including GBS subtype, treatment, clinical course, and outcome. Cerebral magnetic resonance imaging was reviewed with special emphasis on stroke pattern and cerebrovascular findings. Fourteen patients were identified. In 6 out of 9 patients serotype III was causative and positive for surface protein hvgA in 5. Ten had arterial ischemic stroke accompanied by a cerebral sinovenous thrombosis in 2 patients. Evidence of cerebral vasculopathy was found in 4 cases. The stroke pattern was variable with cortical, multifocal ischemia, basal ganglia involvement, or had a clear territorial arterial infarction. Ten patients were treated with anticoagulation. No significant bleeding complications, and no recurrent strokes occurred. Twelve patients had clinical and/or subclinical seizures. Developmental outcome was good in 8 cases. Six patients had moderate to severe developmental delay. Central nervous system complications included subdural empyema, hydrocephalus, epilepsy, microcephaly, and hemiplegia. Late-onset GBS meningitis can be complicated by severe cerebrovascular disease, including arterial ischemic stroke and cerebral sinovenous thrombosis. These complications may be underestimated. We recommend a low threshold for cerebral imaging in these cases. Future studies on the exact incidence, the role of GBS subtypes, and on safety and efficiency of preventive anticoagulation therapy are warranted.

G464(P) Time to discuss prevention strategies for group b streptococcus disease

Aims Group B Streptococcus (GBS) can cause neonatal septicaemia, meningitis and rarely, infective endocarditis. Through this case study, we aim to raise awareness of the devastating sequelae of GBS disease and the importance of early recognition of complications. Case discussion: A term infant born in good condition was being managed by the community midwifery team for feeding difficulties, failing to thrive and presented to A&E twice with lethargy and maternal concern. At two weeks of age he represented having additionally developed fever and was admitted and treated for GBS septicaemia and meningitis. He was discharged after 5 days to ambulatory care for continuation of antibiotics. 10 days into treatment his mother became worried and he presented to A&E in cardiogenic shock with a heart murmur, enlarged liver and rising lactate. Once transferred to the Paediatric Intensive Care Unit, he required ventilation and inotropic support for poor cardiac output, and conservative medical treatment for necrotising enterocolitis, presumed secondary to embolic pathology. An echocardiogram demonstrated two large, mobile masses attached to the mitral valve leaflets with severe mitral regurgitation and right ventricular dysfunction, consistent with infective endocarditis in an otherwise structurally normal heart (Figure 1). Surgical repair of his valve was not possible and so a 17mm prosthetic St Jude’s Valve was placed in the mitral position. Post–operatively he developed a low cardiac output state, seizures, and recurrent thrombus formation requiring valve replacement. He is currently stable on full anticoagulation therapy. Conclusion Our case highlights the aggressive nature of GBS with potentially fatal complications requiring a high index of suspicion, as only with early recognition and management of endocarditis can morbidity and mortality be improved. We recommend that repeated parental concern in the context of failing to thrive, lethargy or fever should alert health professionals to the possibility of sepsis. Although Screening for GBS is not recommended by the UK National Screening Committee nor the Royal College of Obstetricians and Gynaecologists, it has a high profile in the United States where the Centres for Disease Control and Prevention recommends routine screening for all pregnant women, and we suggest this should be so in the UK.

Group B Streptococcal Meningitis: A Description of Six Case Reports

Group B Streptococcus (GBS) is considered the leading bacterial cause of neonatal infections and meningitis is the most serious manifestation. Its clinical manifestations are usually non-specific and its signs and symptoms may be subtle, unspecific, vague, atypical or absent. We report six clinical cases of GBS meningitis with early onset in three infants (first week of life) and late onset (after 1 month of life) in the remaining three. Prenatal GBS screening, performed on four infants, resulted positive only in one case. Cerebral ultrasonography showed high sensitivity in detecting early meningeal involvement confirmed by MRI in all infants. Our study describes the clinical characteristics, antibiotic sensitivity and outcome of the six cases. The results of our analysis emphasize the severity of GBS meningitis and show that cerebrovascular involvement is a common but poorly studied pathologic process in GBS meningitis. In addition, cranial ultrasonography plays an important role in detecting infarctions, cerebritis, hemorrhages or abscesses and in monitoring complications. Neonates with GBS meningitis are prone to adverse outcomes or sequelae. Mortality in GBS meningitis approaches 30% and neurologic sequelae are present in 25% of cases. Int J Clin Pediatr. 2015;4(1):127-136 doi: http://dx.doi.org/10.14740/ijcp179w

The Role of Autophagy during Group B Streptococcus Infection of Blood-Brain Barrier Endothelium

Bacterial meningitis occurs when bloodborne pathogens invade and penetrate the blood-brain barrier (BBB), provoking inflammation and disease. Group B Streptococcus (GBS), the leading cause of neonatal meningitis, can enter human brain microvascular endothelial cells (hBMECs), but the host response to intracellular GBS has not been characterized. Here we sought to determine whether antibacterial autophagy, which involves selective recognition of intracellular organisms and their targeting to autophagosomes for degradation, is activated in BBB endothelium during bacterial infection. GBS infection resulted in increased punctate distribution of GFP-microtubule-associated protein 1 light chain 3 (LC3) and increased levels of endogenous LC3-II and p62 turnover, two hallmark indicators of active autophagic flux. Infection with GBS mutants revealed that bacterial invasion and the GBS pore-forming β-hemolysin/cytolysin (β-h/c) trigger autophagic activation. Cell-free bacterial extracts containing β-h/c activity induced LC3-II conversion, identifying this toxin as a principal provocative factor for autophagy activation. These results were confirmed in vivo using a mouse model of GBS meningitis as infection with WT GBS induced autophagy in brain tissue more frequently than a β-h/c-deficient mutant. Elimination of autophagy using Atg5-deficient fibroblasts or siRNA-mediated impairment of autophagy in hBMECs led to increased recovery of intracellular GBS. However, electron microscopy revealed that GBS was rarely found within double membrane autophagic structures even though we observed GBS-LC3 co-localization. These results suggest that although autophagy may act as a BBB cellular defense mechanism in response to invading and toxin-producing bacteria, GBS may actively thwart the autophagic pathway.

Incidence, etiology, and outcome of bacterial meningitis in infants aged

Bacterial meningitis remains a major cause of morbidity and mortality in young infants. Understanding the epidemiology and burden of disease is important. Prospective, enhanced, national population-based active surveillance was undertaken to determine the incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United Kingdom and Ireland. During July 2010-July 2011, 364 cases were identified (annual incidence, 0.38/1000 live births; 95% confidence interval [CI], .35-.42). In England and Wales, the incidence of confirmed neonatal bacterial meningitis was 0.21 (n = 167; 95% CI, .18-.25). A total of 302 bacteria were isolated in 298 (82%) of the cases. The pathogens responsible varied by route of admission, gestation at birth, and age at infection. Group B Streptococcus (GBS) (150/302 [50%]; incidence, 0.16/1000 live births; 95% CI, .13-.18) and Escherichia coli (41/302 [14%]; incidence, 0.04/1000; 95% CI, .03-.06) were responsible for approximately two-thirds of identified bacteria. Pneumococcal (28/302 [9%]) and meningococcal (23/302 [8%]) meningitis were rare in the first month, whereas Listeria meningitis was seen only in the first month of life (11/302 [4%]). In hospitalized preterm infants, the etiology of both early- and late-onset meningitis was more varied. Overall case fatality was 8% (25/329) and was higher for pneumococcal meningitis (5/26 [19%]) than GBS meningitis (7/135 [5%]; P = .04) and for preterm (15/90 [17%]) compared with term (10/235 [4%]; P = .0002) infants. The incidence of bacterial meningitis in young infants remains unchanged since the 1980s and is associated with significant case fatality. Prevention strategies and guidelines to improve the early management of cases should be prioritized.

Group B Streptococcal Meningitis in Infants Beyond the Neonatal Period

To describe the clinico-bacteriological profile, and early outcomes of infants diagnosed with Group B streptococcus (GBS) meningitis. This was a retrospective review of infants (aged 1mo to 2y) diagnosed with GBS meningitis in a tertiary care hospital in New Delhi from October 2010 through January 2012. The clinico-bacteriological data and early outcomes of infants with suspected bacterial meningitis and a positive CSF latex agglutination test for GBS were studied. The CSF samples were subjected to PCR for broad spectrum 16s ribosomal DNA and the GBS species specific gene, the scpB. Twenty seven patients (13 boys, and 14 girls) were diagnosed with GBS meningitis during the study period. Broad spectrum 16s ribosomal DNA PCR was performed on 18 of the 27 CSF samples. Sixteen were positive. All these 16 were also positive for the species specific scpB gene. The median duration of hospital stay was 7d (range 1-72d). Nine patients died. One patient each developed ventriculitis, optic atrophy and hydrocephalus. Overall, 12 patients had a complete recovery at discharge. GBS must be considered in the etiology of bacterial meningitis in Indian infants.

Long-term Outcomes of Group B Streptococcal Meningitis

Group B Streptococcus (GBS) is the leading cause of meningitis in young infants. We evaluated long-term outcomes among GBS meningitis survivors. We hypothesized that despite reduced mortality, GBS meningitis would remain a significant cause of morbidity among GBS survivors. Ninety term and near-term infants diagnosed with GBS meningitis from 1998 through 2006 were identified from 2 children's hospitals. Five died acutely, and 5 died at 6 months to 3 years of age. Forty-three survivors (54%; mean age 6.8, range 3-12 years) were consented for evaluation and underwent physical and neurologic examinations, hearing and vision screening, and standardized developmental assessments. Associations among presenting features, laboratory parameters, neurologic status at hospital discharge, and later developmental outcomes were explored by using descriptive statistics and logistic regression. Twenty-four of 43 (56%) children evaluated demonstrated age-appropriate development, 11 (25%) had mild-to-moderate impairment, and 8 (19%) had severe impairment. Admission features associated with death after hospital discharge or severe impairment included lethargy (P = .003), respiratory distress (P = .022), coma or semicoma (P = .022), seizures (P = .015), bulging fontanel (P = .034), leukopenia (P = .026), acidosis (P = .024), cerebrospinal fluid protein >300 mg/dL (P = .006), cerebrospinal fluid glucose <20 mg/dL (P = .026), and need for ventilator (P = .002) or pressor support (P < .001). Features at discharge associated with late death or severe impairment included failed hearing screen (P = .004), abnormal neurologic examination (P < .001), and abnormal end of therapy brain imaging (P = .038). Survivors of GBS meningitis continue to have substantial long-term morbidity, highlighting the need for ongoing developmental follow-up and prevention strategies such as maternal immunization.

Non-culture detection of Streptococcus agalactiae (Lancefield group B Streptococcus) in clinical samples by real-time PCR

A real-time PCR assay targeting the cylB gene was developed to detect Streptococcus agalactiae [Lancefield group B Streptococcus (GBS)] from clinical samples. A total of 110 blood culture-negative samples [75 cerebrospinal fluid (CSF) and 35 EDTA blood samples] from neonates with probable GBS sepsis or meningitis were analysed. Among these, 16 of the 75 CSF samples were positive [21.3%, 95% confidence interval (CI) 12.7-32.3%] and two of the 35 EDTA blood samples were positive (5.7%, 95% CI 0.7-19.2%). The proportion testing positive in the CSF samples was significantly higher than in the EDTA blood samples (P=0.05, Fisher's exact test). Overall, this real-time PCR assay was shown to be superior to culture methods for detection of GBS from CSF and EDTA blood samples.

Group B streptococcal meningitis in a 10 month old infant – is it different from GBS meningitis during early infancy?

We report a case of Group B Streptococcus (GBS) meningitis in a 10 month old infant. He presented with a history of pyrexia for two days and vomiting for one day. He was admitted and became irritable within a few hours. Full septic screen was performed. CRP was 112 and FBC showed neutrophilia. Cloudy CSF showed a predominantly polymorph leucocytosis and gram positive cocci were seen. The provisional diagnosis was pneumococcal meningitis. He was started on IV dexamethasone and ceftriaxone. Both parents are French - the baby was born in the UK at term. His mother did not have a vaginal swab perinatally. There were no neonatal problems or previous significant illnesses. He had received vaccines per UK schedule. Clinical improvement was noted within 24 hours of starting treatment. Both CSF and blood cultures grew Group B streptococci. As per advice from the infectious diseases team, his dexamethasone course was completed, and his antibiotic treatment rationalised. GBS is a common pathogen in the neonatal period and early infancy, and the characteristics of early onset (first week of life) and late onset (7-89 days) infection have been well documented. GBS infection has also occasionally been reported in older infants and children,1 though relatively little is known about GBS infection beyond 3 months of age. It has been described as ‘Ultra late GBS infection’2 or ‘late late GBS infection’. The epidemiological data from a french study suggests that ultra late GBS meningitis is a same clinical and bacteriological entity as late onset GBS meninigitis.2 Ultra late GBS meningitis seems to be less severe than pneumococcal meningitis in late infancy.3 Using our case as an example, we present and discuss the relevant published literature about ultra late group B streptococcal meningitis.

Early Outcomes of Group B Streptococcal Meningitis in the 21st Century

Group B streptococcal (GBS) meningitis is diagnosed less frequently than in the 1970s and 1980s. There are few contemporary data regarding outcomes from GBS meningitis and factors that might predict an adverse outcome. A retrospective evaluation was conducted of term and near-term infants (≥36 weeks' gestation) with GBS meningitis hospitalized at Texas Children's Hospital from 1998 to 2006 to assess outcomes and to define features predictive of adverse outcomes. Six infants had early-onset (<7 days) meningitis and 47 had late-onset (≥7 days) GBS meningitis. Three infants died. Infants received broad-spectrum antibiotics initially and then penicillin (68%), ampicillin (28%), or cefotaxime (4%) for a mean of 21 (range, 15-44) days. Among survivors, 11 (22%) were neurologically impaired at hospital discharge with manifestations including persistent seizures (10), hypertonicity (9), and dysphagia (3). The 14 infants who died or had adverse outcomes at hospital discharge were more likely to present with seizures within hours of admission (P < 0.001), have coma or semicoma (P < 0.001), require pressor support (P = 0.001), and have an initial cerebrospinal fluid protein ≥300 mg/dL (P = 0.005) or glucose <20 mg/dL (P = 0.03) than were the 39 with infants with normal neurologic examinations. Seizures at admission remained a significant risk factor (P = 0.024) by multivariate analysis. Despite advances in intensive care, 26% of term and near-term infants with GBS meningitis die or have neurologic impairment at hospital discharge. Additional strategies to prevent GBS meningitis are needed.