Group B Streptococcus Meningitis Research Articles

Postpartum Maternal Group B Streptococcal Meningitis

Maternal group B streptococcal (GBS) meningitis is rare, with only four cases previously reported in the literature. In this review a fifth case of postpartum GBS meningitis is presented. The five cases are compared with 34 cases of GBS meningitis in nonparturient adults. All cases of maternal GBS meningitis followed a vaginal delivery. The mean age of patients who had GBS meningitis outside the perinatal setting was 55 years, and most of these individuals had associated illnesses or frank immunosuppression; the mortality rate in this group was 23%. In contrast, all five patients with maternal GBS meningitis recovered. The case presented herein, like the four previous cases, illustrates the point that when patients with maternal GBS meningitis are treated immediately and have been healthy before the infection, the prognosis is good.

Patterns of Immune Response among Survivors of Group B Streptococcal Meningitis

Serum samples from 10 infants surviving type III, group B streptococcal (GBS) meningitis were collected acutely and longitudinally for 6 months to determine patterns of antibody response to the capsular polysaccharide and their in vitro functional correlates. Five infants who failed to develop specific antibody at a mean of 3.8 weeks after diagnosis had an increase of greater than or equal to 1.0 microgram/ml after another 4-8 weeks. This IgM-predominant type-specific antibody declined to baseline 2-4 months later. Opsonophagocytosis of type III GBS increased from 0 to 88% in parallel with peak antibody response. Three infants developed increased antibody and opsonophagocytosis at 15-31 weeks after diagnosis, while two had no detectable response. Despite increasing complement levels, opsonophagocytosis of type III GBS was poor with low specific antibody levels These results suggest that survivors of GBS meningitis transiently develop specific antibody and associated efficient opsonophagocytosis, but functional competence does not persist despite maturation to adult levels of complement proteins.

Detection of group B streptococcal antigen in body fluids by a latex-coupled monoclonal antibody assay

A commercially available latex agglutination reagent, Directigen (Hynson, Westcott & Dunning, Div. Becton Dickinson & Co., Baltimore, Md.), in which a murine monoclonal antibody to group B streptococcal (GBS) antigen is the active component, was evaluated by using body fluid specimens from 94 sick infants. Antigen was detected in one or more admission specimens from 18 of 19 (94.7%) infants with symptomatic GBS infection. In 15 patients with GBS meningitis, cerebrospinal fluid, serum, and 10-fold-concentrated urine specimens were positive in 87, 50, and 100%, respectively. GBS antigen was detected in 50% of unconcentrated urines, but in no sera from infants with nonmeningitic GBS sepsis. Among specimens from 27 infants with invasive infection due to organisms other than GBS and from 48 culture-negative sick infants, false-positive latex agglutination reactions occurred in only 4 (9.5%) urine specimens and in no cerebrospinal fluid or serum specimens. The 94.7% sensitivity and specificity of the Directigen GBS test indicate that it is a useful reagent for the rapid diagnosis of invasive GBS infection in young infants.

ASYMPTOMATIC HYPOGAMMAGLOBULINEMIA IN A MOTHER PRESENTING AS NEONATAL MENINGITIS IN TWO SIBLINGS

The unusual occurrence of group B streptococcal (GBS) disease in siblings lead to immune studies of a boy who mimicked his older sister in developing septicemia and meningitis from GBS by the 4th day of life. His serum IgG level was only 40 mg%. His IgM was 36 and IgA was < 7. Maternal levels were all low: IgG 40, IgM 36, IgA 14 and IgE<10 mg%. Despite 14 days of penicillin and intravenous immunoglobulins, the boy's GBS (type Ic) meningitis recurred within 3 days with fever and a rise in the CSF leukocyte count from 20 to 2,025. He recovered completely during 2 more weeks of antibiotic Tx and at 7 months his Ig levels are normal. His sister had neonatal septicemia, meningitis, septic arthritis, and pneumonia which responded to 32 days of Tx. At 3 years, she is healthy with normal Ig levels: IgG 761, IgM 113, and IgA 62 mg%. The mother is healthy and has not had excess infections. GBS (type Ic) was also recovered from her vagina. She was unresponsive to rubella immunization. She has low levels of IgA in saliva: 2 mg%, and breast milk: 3 mg%. Her panhypogammaglobulinemia is associated with normal numbers of B cells that have IgA, IgG, and IgM surface markers. Her lymphocytes had a normal in vitro response to phytohemagglutinin, Concanavalin A, and pokeweed mitogen. This unique family emphasizes the importance of passive immunity in protecting newborns against GBS and it suggests that serious bacterial infections in neonates should prompt inquiry into the mother's immune competence.

Endophthalmitis Associated With Group-B Streptococcal Meningitis in an Infant

In newborns, group-B streptococcal (GBS) infections occur most often as septicemia with or without meningitis and pneumonia. 1 Less frequently, infections at many sites are due to this organism. The following report describes GBS meningitis associated with endophthalmitis in a neonate. We are unable to find another report of an intraocular infection associated with this organism. Report of a Case .—An 8-day-old girl was admitted to the Children's Hospital of Orange County California on Jan 12, 1976. There was a two-day history of diarrhea and decreased feeding along with periods of lethargy and irritability. The patient was a 3,350-g product of an uncomplicated pregnancy, labor, and delivery. On admission, the patient's temperature was 38.6 °C rectally, the pulse rate was 120 beats, respirations were 32/min, and weight was 3,345 g. The infant was very irritable, with a sharp, shrill cry. The neck was supple and the anterior fontanelle was soft