The family Streptococcaceae includes several genera of morphologically similar gram-positive cocci, which are facultative anaerobes. Based on carbohydrate antigens localized in the cell wall, serological groups of streptococci A, B, C, D, E, F, G and H are distinguished. appearance colonies and the nature of hemolysis on blood agar, these pathogens are divided into hemolytic, greening and non-hemolytic types.
In the vagina healthy women Streptococci belonging to three groups may be present: viridans group streptococci (viridans streptococci), serological group B streptococci and serological group D streptococci (enterococci). The frequency of detection and the number of streptococci belonging to these groups varies significantly and is normally no more than 104 CFU/ml. In perinatology, the most relevant are two pathogens - Streptococcus pyogenes (β-hemolytic streptococcus of serological group A, which in the past caused the majority of cases of postpartum sepsis) and Streptococcus agalactiae (streptococcus of serological group B, which has recently become the most common cause infections both in newborns, especially premature babies, and in their mothers).
Infections caused by group A streptococci
Pathogen- Streptococcus pyogenes (β-hemolytic).
Risk during pregnancy- 20% of pregnant women are bacteria carriers (nasopharynx, vagina and perianal area).
Clinic for a pregnant woman- tonsillitis, pharyngitis, pyoderma, colonization of the vagina and perianal area, urinary infection, chorioamnionitis, endometritis, postpartum sepsis.
Diagnostics- cultural method (on blood agar aerobically and anaerobically).
Effect on the fetus- intrapartum transmission of infection, the risk of neonatal sepsis increases with a long anhydrous interval.
Prevention- identification of risk factors, compliance with the rules of asepsis during childbirth, antibiotic therapy based on the results of gynecological culture.
Treatment- penicillins, cephalosporins for at least 10 days.
Clinic. Group A streptococci cause respiratory tract infections (pharyngitis, scarlet fever), skin and wound infections, sepsis, acute wound fever, glomerulonephritis.
Diseases that are complications of infections caused by these streptococci are based on autoimmune mechanisms; healthy carriage is possible.
From the point of view of perinatal infections, it is necessary to take into account the possibility of vertical transmission of streptococcal infection from mother to newborn; the source of infection can be the woman’s intestines and vagina. Despite the use of antiseptics and antibiotics, an increase in the most severe infections caused by group A streptococci, including severe neonatal sepsis, has recently been reported.
Diagnostics streptococcal infections involves culturing the test material on blood agar under both aerobic and anaerobic conditions.
Treatment. If group A streptococci are detected in a pregnant woman, penicillin therapy is required for 10 days; cephalosporins and macrolides may be used. For postpartum sepsis, high doses of benzylpenicillin or ampicillin are prescribed parenterally. Newborns with streptococcal infection are also prescribed high doses of benzylpenicillin, ampicillin or cephalosporins.
Prevention. Streptococcus pyogenes is transmitted by contact. Prevention consists of following the rules of asepsis during childbirth.
Infections caused by group B streptococci
Pathogen- Streptococcus agalactiae.
Risk in pregnant women- is part of the vaginal microflora in 20% of pregnant women.
Prevalence- the incidence of neonatal sepsis caused by group B streptococcus in the United States is 2 per 1000 live births.
Clinic for a pregnant woman- asymptomatic bacterial colonization of the vagina and perianal area, urinary tract infection, chorioamnionitis, endometritis.
Diagnostics- cultural method.
Effect on the fetus- in 80% - early infection (infection during childbirth) - sepsis; in 20% - late infection - meningitis, severe neurological complications.
Prevention- identification of risk factors, antibiotic therapy based on the results of gynecological culture.
Treatment- penicillins, cephalosporins, macrolides.
Streptococcus agalactiae can cause severe respiratory diseases, meningitis, septicemia, often leading to death. At the same time, this streptococcus is part of the normal vaginal microflora in 5-25% of pregnant women and can be isolated in 10-20% of cases from the intestinal tract of newborns.
In the United States, neonatal mortality associated with group B streptococci exceeds 10%. The range of infections caused by these streptococci in the perinatal period is very wide. It ranges from septic miscarriage to transient bacteremia. Premature infants are often affected, possibly because chorioamnionitis caused by group B streptococci leads to preterm birth.
The initial reservoir for group B streptococci is the normal intestinal microflora of a woman. There is a close connection between colonization of a mother and her child. The more intense the mother's infection, the more often the child becomes infected. During vaginal delivery, the incidence of intrapartum infection is 50-60%. The risk of illness in a full-term baby is 1-2%, in a premature baby - 15-20%, and at less than 28 weeks of pregnancy - 100%.
Clinic. Traditionally, there are two forms of infections of newborns caused by group B streptococci: “early attack” - an early form caused by vertical transmission of the pathogen, and “late attack”, developing 1-6 weeks after birth, often caused by horizontal infection.
In immature children, the infection often occurs in the form of sepsis, in full-term newborns - in the form of pneumonia. In severe cases, the disease begins immediately after birth and progresses rapidly.
Most representatives of the group of streptococci do not pose a mortal danger to humans, but can significantly harm the health of a pregnant woman and prevent normal development her child. Streptococci are classified as opportunistic spherical bacteria, which can almost always be found in the body. Some of them, under the influence of certain circumstances, provoke the development of serious diseases: food poisoning, purulent-inflammatory reactions, rheumatism, glomerulonephritis. However, streptococcus is most dangerous because it can infect the fetus, as well as cause sepsis and meningitis in the infant.
Indicators immune system a woman declines to a great extent when she learns of her fortunate situation. During the gestation period, expectant mothers easily succumb to colds, relapses of chronic diseases, and infectious diseases, which most often appear due to the active activity of streptococci.
Statistics report that streptococcal bacteria infect 10 to 30% of pregnant women. The development and course of the infectious process is almost always asymptomatic. A sure sign the presence of problematic bacteria in the body - copious discharge yellowish in color from the genital tract, which is not permanent in nature.
Some children become infected from a sick mother even at the intrauterine stage of their existence, while others remain healthy, despite their “neighborhood” with a dangerous microorganism. Based on the results of numerous studies, scientists have come to the conclusion that the ability to resist infection depends on the strength of the baby’s innate immunity.
In Russia, the following statistics have been officially announced: the probability of intrauterine infection of the fetus by streptococcus is approximately 1 - 2%. At the same time, there are factors that increase the likelihood of infection of the baby.
What is important to know about streptococcus during pregnancy
The Streptococcaceae family includes gram-positive microorganisms that are spherical in shape and do not form spores. Bacteria do not have flagella, so they cannot move independently. But they have one important advantage over other active microorganisms - they survive in an environment deprived of oxygen.
Using a microscope, you can see what streptococci look like - these are “balls” arranged in pairs or chains. The prevalence of the microorganism in the external environment is high: it lives not only in the body of animals and humans, but also in the soil and on plants. Easily tolerating various temperature changes, it retains the ability to reproduce, even if it remains in the soil for several years. Moreover, all representatives of the streptococcal family are extremely sensitive to penicillin antibiotics, macrolides and sulfonamides. They multiply at lightning speed in nutrient media such as serum, blood, and sweet solution.
Ways of infection with streptococcus during pregnancy
Streptococcus in expectant mothers is found mainly in the urine. There are three options for infection:
- with unprotected intimacy;
- as a result of ignorance of the basic rules of intimate hygiene;
- due to wearing synthetic underwear.
Types of streptococci during pregnancy
The vaginal microflora of the expectant mother contains streptococci belonging to 3 different species;
- serological group D (enterococci);
- serological group B;
- viridans streptococci.
Doctors also know the 2 most dangerous types of pathogens that can harm the body of the expectant mother:
- hemolytic streptococcus group A, which occurs during pregnancy due to repeated cases of bacterial sepsis;
- group B hemolytic streptococcus, which currently infects newborns.
Group A streptococci during pregnancy
The bacterial strain poses the greatest health hazard and is often localized on the skin and mucous membranes. When such bacteria enter wounds and injuries, an acute inflammatory reaction begins with the formation of pus. In the internal environment of the body, streptococci of this group behave very aggressively and can cause tissue atrophy or provoke infectious-toxic shock. The infection is concentrated in the nasopharynx, vagina and perianal area.
The consequences of group A streptococcus during pregnancy are as follows:
- tonsillitis;
- pharyngitis;
- genitourinary system infections;
- endometritis;
- postpartum sepsis.
How dangerous is streptococcus during pregnancy for the fetus? Children infected with this pathogen before birth often subsequently develop diseases affecting the respiratory system.
Group B streptococci during pregnancy
Opportunistic microorganisms of this group are better known during pregnancy as Streptococcus agalactiae (S. agalactiae). Bacteria accumulate mainly in the nasopharynx, gastrointestinal tract and vagina. I diagnose the infection in more than 20% of expectant mothers. In the absence of a timely response to the pathogen, a pregnant woman may encounter a wide range of diseases caused by streptococcus agalactia:
- inflammatory reaction in the genitourinary system;
- miscarriage;
- endometritis after childbirth;
- sepsis;
- meningitis;
- endocarditis;
- inflammation of the membranes;
- pneumonia in a newborn;
- mental disorders in the child.
Streptococcus in a smear in women during pregnancy: previous symptoms of infection
Opportunistic bacteria that cause the development of such skin diseases, like erysipelas and impetigo, manifest themselves with the following symptoms:
- redness of the affected skin;
- manifestation of a clear line dividing diseased and healthy skin;
- severe pain when palpating the inflamed area;
- swelling and specific “gloss” of the affected area;
- in some cases - an increase in temperature.
If, as a result of the active activity of the pathogen, erysipelas develops, the face, arms and legs turn red. With streptoderma, the skin is strewn with blisters containing purulent contents, which after a while burst and dry out to form a crust. At the same time, the patient is plagued by painful itching. If you scratch the itchy areas, the infection will spread further.
Symptoms of streptococcus in the throat during pregnancy:
- high body temperature (up to 40°C);
- painful swallowing;
- protrusion of lymph nodes on the sides of the neck;
- severe weakness;
- spread of light plaque over swollen tonsils;
- sudden changes in sensations - changes from fever to chills;
- difficulty moving the neck muscles.
The development of the disease is acute, and complications such as pneumonia, otitis, and sinusitis are often associated.
If a harmful bacterium has infected the genitourinary system during pregnancy, the signs will be as follows:
- acute inflammation of the membranes;
- infection of the fetus in the womb, which subsequently results in miscarriage or stillbirth child;
- with the development of endometritis after cesarean section, the symptoms are not obvious: fever, general weakness, unpleasant discomfort in the lower abdomen, pain when examining the uterus.
If a newborn is infected, the baby may be diagnosed with sepsis on the same day, and 10 days after birth - meningitis.
Methods for diagnosing streptococcus during pregnancy
In most cases, it is very difficult to detect a streptococcal infection without laboratory testing. Most often, streptococcus is diagnosed in women during pregnancy in a smear. Biological material is collected from the following foci:
- sputum - to find out on what basis inflammation of the bronchi began and pneumonia developed;
- mucus from the throat and tonsils - if there is reason to believe that the cause of tonsillitis or pharyngitis during pregnancy is streptococcus in the woman’s throat;
- mucus from the vagina - to confirm or deny the presence of streptococcus in the cervical canal during pregnancy;
- urine - this is where the streptococcal nephritis pathogen is found;
- mucus from the urethra - to diagnose urethritis;
- purulent fluid - blot with a cotton swab and examine if the development of streptococcal pyoderma or erysipelas is suspected.
To clarify the nature of the infectious process, the patient to the expectant mother a blood test for streptococcus is prescribed using the polymerase chain reaction (PCR) method. If we are talking about a pyogenic pathogen, they can additionally test for the susceptibility of pathogenic microorganisms to various antibiotics. However, you will have to wait for a response for several days, and all this time the infection will quietly multiply without drug intervention. In order not to aggravate an already dangerous situation, doctors often choose an antibacterial drug at their discretion. Naturally, the specialist is primarily guided by his own experience, as well as information about the streptococcus that predominates in a given region.
We remind you once again that every person has a streptococcal infection. She will “sleep” as long as the body is guarded by a strong immune system. The norm of streptococcus in a smear during pregnancy is no more than 104 CFU/ml.
However, for a correct diagnosis, the most reliable way for the expectant mother is to submit urine for bacteriological culture. Since opportunistic bacteria of this family are almost always present in the vaginal microflora, after the onset of the disease, streptococcus appears in the urine during pregnancy almost immediately. Such a study is currently prescribed for preventive purposes: in the early stages, as well as at the end of gestation. Early detection of infection allows you to protect the child from intrauterine or birth infection.
To ensure the most accurate test result, a woman needs to follow these recommendations:
- do not take choleretic and diuretic medications 3 days before collecting biological material;
- 6 - 8 hours before urine collection, avoid salty foods and smoked foods;
- before collecting urine, thoroughly wash the external genitalia and insert a hygienic tampon into the vagina;
- A sterile container is used to collect biological material. The container is filled with the second portion of morning urine;
- urine must be delivered to the laboratory no later than 2 hours after its collection.
The presence of streptococcal bacteria in urine looks like colonies of “balls”. Normally, there should be no streptococcus in the urine during pregnancy.
How to treat streptococcus during pregnancy
If streptococcal bacteria are found in a woman’s smear during pregnancy, treatment is urgent. The fight against pathogenic microorganisms is multi-stage:
- Treatment with antibiotics (Penicillin, Ampicillin - side effects Dont Have).
- Increasing the body's defenses.
- Restoration and support of intestinal microflora simultaneously with antibacterial therapy (Linex, Bifiform, Acipol).
- Cleansing the body of toxins.
- Symptomatic treatment (Zodak, Cetrin).
When drawing up a complex therapy regimen for the treatment of streptococcus in a pregnant patient, doctors select the safest medications for both mother and child. Before starting treatment, all expectant mothers are given a test to determine the likelihood of allergic reaction. During treatment, a pregnant woman should not overexert herself, and if the disease is severe, if possible, adhere to bed rest.
The active form of streptococcus cannot be ignored, since the microscopic bacterium can cause damage to the membranes, childbirth ahead of schedule or stillbirth. According to doctors, streptococcus during pregnancy is easier to prevent than to cure. Prevention of infection involves careful intimate hygiene, timely treatment of colds, maintaining the body's defenses. Only in this case can one hope for a calm pregnancy and successful development of the fetus. Be healthy!
The content of the article:Streptococcus during pregnancy and during childbirth can negatively affect both the health of the mother and the fetus. Streptococci are a group of spherical bacteria that inhabit the human body. Most of them are not dangerous, but some types provoke serious illnesses: food poisoning, purulent-inflammatory processes and the development of post-streptococcal autoimmune reactions (rheumatism, glomerulonephritis), intrauterine infection of the fetus can occur, and in a newborn they can cause sepsis and meningitis.
Streptococci in pregnant women
The immune system of pregnant women is weakened, and therefore they are more susceptible than others to infectious diseases, the causative agents of which are, among other things, streptococci. Streptococcal infection can cause premature birth, placental rupture, fetal development disorders or death. This article will talk about streptococcus during pregnancy and childbirth, its types, diagnosis and methods of treating streptococcal infection.
Basic information about streptococcus
Streptococcus is a family of microorganisms that are spherical in shape and do not form spores. They belong to the gram-positive cocci of the genus Streptococcus of the family Streptococcaceae. Bacteria lack flagella, they cannot move independently, but they are able to survive in an environment where there is no oxygen.
If you try to look at streptococci through a microscope, you will see that the bacteria are arranged in pairs or in groups that resemble chains. These are common microorganisms that live in the soil, on plants, in the bodies of animals and people. Streptococci easily survive temperature changes; they are able to reproduce even after being in the soil for several years. But they are easy to destroy with the help of antibacterial drugs of the penicillin group; macrolides and sulfonamides are also used for this.
Microorganisms begin to actively multiply in a nutrient medium: serum, sweet solution or blood. Bacteria are studied in laboratories, they are populated in an environment with favorable conditions and their vital functions are observed: reproduction, fermentation of carbohydrates, release of acid and toxic substances.
Classification of streptococci
Types of streptococci:
- β-hemolytic streptococci:
Group A is the most dangerous strain of bacteria that lives on the skin and mucous membranes. Microorganisms penetrate wounds, cracks and provoke purulent inflammation. When bacteria enter the human body, there is a risk of tissue death or infectious-toxic shock. Some types of group A streptococci are similar to myocardial tissue, which causes the body to begin to destroy its own “good” heart cells.
Group B is opportunistic microorganisms, the most famous being S. agalactiae. Group B streptococci may be present in the nasopharynx, gastrointestinal tract and vagina. If a person is healthy, then bacteria do not manifest themselves in any way, but when immunity decreases, they begin to multiply, and as a result, dangerous diseases. Group B streptococcus during pregnancy can pass through the placenta, infect the embryo or cause a miscarriage; if infected during childbirth, the newborn can develop meningitis. It is quite easy to identify streptococcus during pregnancy through bacterial culture; the main thing is to undergo the study on time. Acute or chronic pharyngitis, tonsillitis, and bronchitis also occur due to the proliferation of this bacterium.
Group C.
Group G
- α-hemolytic streptococci:
Pneumococci (S. pneumoniae) lead to pneumonia.
Bacterial endocarditis (Streptococcus viridans).
Group B streptococci are the most dangerous for pregnant women, as they are located in the vagina. Streptococcus during pregnancy can be detected in a smear as a result of laboratory research. After this, the woman should consult with a gynecologist who will prescribe medications for treatment, usually penicillin antibiotics are used for this.
Diagnosis of streptococcal infection in pregnant women
Most often, identifying a streptococcal infection is quite difficult. And sometimes the disease has pronounced symptoms (for example, with scarlet fever or erysipelas). Although in most cases it is necessary to conduct a bacteriological examination to identify streptococci in a smear.
For treatment to be effective, the doctor takes smears from epidemic foci:
To identify the causative agent of tonsillitis or pharyngitis, mucus is removed from the throat and tonsils;
Streptococcal endocervicitis can be determined using a vaginal smear, and to detect urethritis, mucus is removed from the urethra;
If streptococcal pyoderma or erysipelas is suspected, purulent fluid is collected using a cotton swab;
The causative agent of nephritis can be identified after a general urine examination;
To identify the cause of bronchial inflammation or pneumonia, sputum is examined.
To clarify the nature of the infectious disease, the doctor prescribes a blood test (PCR) for streptococcus; screening tests are based on determining GBS Ag using latex agglutination, coagglutination and ELISA, as well as ECG (electrocardiography).
Pyogenic streptococcus, which lives on the oral mucosa, actively develops when the immune system is weakened and penetrates the intestines and organs of the genitourinary system. The first symptoms appear 3 days after infection.
Ideally, it is necessary to conduct an antibiogram - this is a test for the sensitivity of pathogens infectious diseases to antibacterial drugs. The downside is that this procedure takes several days, and bacteria are actively multiplying at this moment.
In most cases, the doctor, when choosing a drug, is based on personal experience and on data on the streptococci that predominate in their region.
The infection is present in the body of every healthy person, it simply does not manifest itself. The normal level of streptococcus during pregnancy in a smear is no more than 104 CFU/ml.
As mentioned earlier, streptococcal infection can be identified by symptoms.
Symptoms of streptococcal infection during pregnancy
Symptoms of respiratory tract infection
When pathogenic microbes multiply in the throat, the following symptoms occur:
The temperature rises to 39–40°;
acute pain when swallowing;
lymph nodes in the neck enlarge;
severe weakness appears;
the tonsils become swollen and covered with a white coating;
the patient either feels hot or shudders;
the muscles of the back of the head move with difficulty.
The disease progresses quickly, complications may occur: otitis media, sinusitis, pneumonia.
Symptoms of skin manifestations of streptococcal infection
Streptococcus provokes skin diseases, for example, erysipelas, impetigo. Symptoms of skin infection:
The skin on the damaged area turns red;
there is a clear boundary between diseased and damaged skin;
when touched there is severe pain;
skin covering the damaged area becomes inflamed, swollen, shiny;
The temperature often rises.
Erysipelas most often affects the lower and upper extremities and face.
Another type of streptococcal infection on the skin is streptoderma. Characteristic symptoms- These are blisters filled with purulent fluid, which over time burst and become crusty. Bubbles appear severe itching, the patient scratches them, and the infection spreads further. Read about streptoderma during pregnancy on our website.
Symptoms of streptococcus depend on the location of the infection.
With osteomyelitis, the bone substance dies, an abscess forms on it, the contents of which are poured out over time;
In rheumatism, bacteria destroy the connective tissue of various organs (joints, small vessels of the brain, kidneys, liver, etc.);
With furunculosis, the hair follicles become inflamed, a purulent core is formed, which matures, breaks through and scars;
Sepsis is characterized by the formation of ulcers on the lungs, liver, kidneys or brain; after their breakthrough, pathogenic microbes enter the bloodstream, which can cause the patient to die.
Symptoms in pregnant women with streptococcal infection of the genitourinary system
Pregnant women may develop chorioamnionitis, infection of the urinary system, infection of the fetus, which can lead to miscarriage or stillbirth.
After delivery, especially when caesarean section, there is a high probability of developing endometritis. Symptoms will be non-specific, such as: increased body temperature, weakness, pain in the lower abdomen, tenderness of the uterus on palpation.
After birth, a newborn may develop sepsis in the first hours of life or, after the 10th day of life, meningitis.
If you suspect diseases of the genitourinary system, the analysis will help to identify streptococcus during pregnancy in the urine and vaginal smear.
Treatment and characteristics of childbirth with streptococcus
If the test result for the presence of streptococcal infection is positive, then therapy must be started. Most often, expectant mothers are affected by group B streptococci: pyogenes and agalactic. Treatment of streptococcus during pregnancy is carried out with the help of antibacterial drugs, which are administered intravenously or through a drip. Only with the help of antibiotics can a newborn be protected from infection. Treatment begins at 35 weeks of pregnancy, as well as at the time of birth. In rare cases, antibiotics may be taken after 12 weeks of pregnancy.
The best antibacterial drugs for the treatment of streptococcal infections are penicillin antibiotics: ampicillin, benzylpenicillin, and sometimes macrolides are prescribed. These medications are the safest for the mother and fetus. However, in some cases, an allergy occurs in the form of a rash. This is possible if you are hypersensitive to penicillin.
Also, to treat infections in pregnant women, streptococcal bacteriophage is used - this is an immunobiological drug that is effective against streptococci.
Complications in a newborn
The consequences of streptococcus during pregnancy can be disastrous; the infection is especially dangerous for newborns. As a result of infection, the baby suffers from the following diseases:
Meningitis (inflammation of the membranes of the brain and spinal cord);
pneumonia;
blood poisoning (sepsis).
According to statistics, 5% of children with such diseases die. But there are cases when a child does not become infected with streptococcus during childbirth from an infected mother.
Streptococcal infection can further provoke the development of the following problems:
Cerebral palsy (cerebral palsy) is a disease that affects the central nervous system, disrupts brain development, and causes motor and other disorders;
Hearing disorders;
Mental retardation;
Retarded physical development.
Read about the characteristics of streptococcus in children in the article on our website.
To avoid such diseases, it is necessary to protect the newborn from streptococci; for this purpose, prophylactic doses of antibiotics are used.
Streptococcus during pregnancy is very dangerous for the expectant mother and fetus. According to doctors, it is easier to prevent a disease than to treat it; to do this, take vitamins, eat right, and healthy image life.
Neonatal sepsis
Group B streptococcus(English) Group B Streptococcus or abbreviated G.B.S.) is a type gram-positive streptococcal bacteria, also known as Streptococcus agalactiae. This type of bacteria (not to be confused with group A streptococcus, which causes throat infection with streptococcus) is usually found in the human body (called colonization), and usually does not cause any symptoms. However, in some cases this may be dangerous cause various infections that can affect non-pregnant adults, pregnant women and newborns. Group B streptococcal infection is the most common cause neonatal sepsis And meningitis in developed countries.
Group B streptococcal infection may also occur in non-pregnant adults with certain chronic diseases such as diabetes, cardiovascular disease, obesity and cancer. The incidence of group B streptococcal disease in adults increases with age, with the highest rate in adults 65 years and older (25 cases out of 100,000). Although the incidence of congenital group B streptococcal infection is decreasing, the incidence of GBS infection is increasing in nonpregnant adults.
Group B streptococcus bacteria can usually be found in about 25% of all healthy pregnant women. Group B streptococcus is commonly found in the intestines, vagina, and rectal area. Most women who carry the bacteria (colonized) will not have any symptoms; however, under certain circumstances, perinatal group B streptococcal infection of both mother and/or newborn may develop. In newborns, if GBS infection develops in the first week of life, it is called early onset infections. If a GBS infection develops between 1 week and 3 months, it is called late onset of infection.
How do people get group B streptococcus?
In newborns, group B streptococcal infection is acquired through direct contact with bacteria in the uterus or during birth; thus, gestational bacterial infection transmitted from a colonized mother to her newborn. Approximately 50% of colonized mothers will pass the bacteria to their infants during pregnancy and vaginal birth. However, not all babies will be affected by the bacteria, and statistics show that about one in 200 babies born to a mother infected with group B streptococcus will actually develop a GBS infection.
Group B streptococcal infection is more common in African Americans than in whites. There are also risk factors for the mother that increase the likelihood of transmitting group B streptococcus to the newborn, leading to early onset of the disease:
- Membrane rupture before 37 weeks of pregnancy;
- Membrane rupture more than 18 hours before birth;
- Urinary tract infection with group B streptococci during pregnancy;
- Previous child with GBS infection;
- Fever during childbirth;
- Positive culture of group B streptococci at 35-37 weeks of pregnancy.
Late-onset group B streptococcal disease is more common in infants who are born prematurely (<37 недель) и у тех младенцев, чья мать испытывала положительный результат для стрептококков группы B во время беременности.
Group B streptococcal infection is not sexually transmitted disease (STD).
What are the signs and symptoms of group B streptococcal infection?
In newborns with early illness GBS signs and symptoms usually develop over first 24 hours after birth. Those children who develop late initial infection GBS often appears healthy at birth, signs and symptoms of the disease develop after the first week life. Signs and symptoms that may occur with group B streptococcal infection in infants include:
- Increased body temperature;
- breathing problems/grumbling sounds;
- Bluish skin (cyanosis);
- Convulsions;
- Fragility or rigidity;
- Abnormalities of heart rhythm (arrhythmia) and blood pressure;
- Poor nutrition;
- Vomit;
- Diarrhea;
- Fussiness.
Adults who develop invasive group B streptococcus infection may develop:
- Blood infections (sepsis);
- Skin and soft tissue infections;
- Infection of bones and joints;
- Pulmonary infection (pneumonia);
- Urinary tract infections;
- Rarely, an infection of the fluid and lining tissues surrounding the brain (meningitis).
The exact source of group B streptococcal infection in nonpregnant adults is often not determined.
What tests do doctors use to diagnose group B streptococcus infection?
In newborns and adults, doctors isolate group B streptococcus bacteria for a definitive diagnosis. Laboratory tests that isolate the body from certain body fluids, such as blood, cerebrospinal fluid, and urine, help make the diagnosis. To screen pregnant women, a health care provider will obtain a swab of the woman's vaginal and rectal area to detect group B streptococcus infection at 35 to 37 weeks of pregnancy. Test results may take several days. A lumbar puncture may be required if meningitis is suspected. A chest x-ray may be done to evaluate for pneumonia.
What is the treatment for group B streptococcus?
For women who test positive and for those who have certain risk factors for developing or transmitting group B streptococci during pregnancy or childbirth, intravenous antibiotics are recommended. Antibiotics given to women before delivery who are known to be colonized with group B streptococci are not effective in preventing early onset of the disease, as it has been found that group B streptococci can regrow rapidly. Pregnant women with group B streptococci detected in the urine at any time during pregnancy, and those women who have had a previous child with invasive GBS infection, should receive antibiotics at the time of delivery and therefore do not require routine testing for group B streptococcus at 35 -37 weeks of pregnancy.
Pregnant women who are unaware of group B streptococcal status should be given antibiotics during labor:
- If they develop preterm labor (less than 37 weeks' gestation);
- If they have a membrane rupture for 18 hours or longer;
- If they develop a fever during labor.
Penicillin or ampicillin are the recommended antibiotics, whereas people who are penicillin-allergic can take antibiotics as cefazolin, clindamycin And vancomycin. Administration of antibiotics has been shown to significantly reduce early infection in neonates; however, it does not prevent late GBS infection. If a pregnant woman with group B streptococcus receives intravenous antibiotics during labor, her baby has a 1 in 4,000 chance of developing a GBS infection. Without antibiotics, her baby has a 1 in 200 chance.
Newborns and nonpregnant adults who develop invasive group B streptococcal disease also receive intravenous antibiotics. There are certain conditions associated with invasive GBS infection that may require surgery, such as surgical removal in some patients with soft tissue/skin/bone infections.
What types of doctors treat group B streptococcal infections?
Depending on the age of the patient and the possible complications the patient faces, group B streptococcal infections may be diagnosed and treated by various specialists.
- In pregnant women, group B streptococcal infection can be diagnosed and treated at the time of delivery by the patient's obstetrician/gynecologist or family physician.
- Infants who develop group B streptococcal infections will be treated by a pediatrician, a neonatologist, and sometimes an infectious disease specialist.
- Non-pregnant adults will often be treated by a primary care physician, an infectious disease specialist, and rarely by a surgeon or orthopedic surgeon if a skin or bone infection requiring surgery is present.
What are the complications of group B streptococcus infection?
Invasive group B streptococcal infection in infants can lead to sepsis, pneumonia, meningitis, or sometimes death. Some children who survive may develop meningitis, deafness, blindness, or developmental disorders.
In pregnant women, infection with group B streptococci can cause urinary tract infections, infections of the uterus and placenta, as well as premature birth, fetal death, or miscarriage.
In nonpregnant adults with chronic illnesses who develop invasive group B streptococcal infection, complications may include pneumonia, urinary tract infection, sepsis, skin and soft tissue infection, bone and joint infection, and rarely, meningitis.
What is the prognosis for group B streptococcus infection?
The prognosis for group B streptococcal infection varies depending on various factors, including the patient's age and the presence of any other diseases. Pregnant women who develop symptoms of group B streptococcal infection also have a low mortality rate because they are generally healthy. Non-pregnant adults who develop invasive GBS infection tend to have a higher mortality rate, ranging from 5% to 47% depending on the study, since this group of patients tend to be older and they often have serious underlying diseases.
Can Group B Strep infection be prevented?
Currently, the best measure to prevent group B streptococcus infection is regular screening during pregnancy. This testing has reduced the overall number of early onset cases of GBS in newborns by approximately 80% since aggressive preventive measures were introduced in the 1990s. Screening for group B streptococcal colonization is strongly recommended in pregnant women. This screening test is performed between 35-37 weeks of pregnancy. The test involves using a sterile swab to collect a sample from both the vaginal and rectal areas, with results usually available within 24 to 72 hours.
Antibiotics during labor for pregnant women colonized with GBS and for those with the risk factors described above may help prevent transmission of group B streptococcal infection and thus reduce the incidence of early onset group B streptococcal disease in neonates.
Although there is currently no licensed vaccine to prevent GBS infection, research is being conducted to try to develop one for future use.
The family Streptococcaceae includes several genera of morphologically similar gram-positive cocci, which are facultative anaerobes. Based on carbohydrate antigens localized in the cell wall, serological groups of streptococci A, B, C, D, E, F, G and H are distinguished. Based on the appearance of the colonies and the nature of hemolysis on blood agar, these pathogens are divided into hemolytic, greening and non-hemolytic types .
Streptococci belonging to three groups may be present in the vagina of healthy women: streptococci of the viridans group (viridans streptococci), streptococci of serological group B and streptococci of serological group D (enterococci). The frequency of detection and the number of streptococci belonging to these groups varies significantly and is normally no more than 104 CFU/ml. In perinatology, the most relevant are two pathogens - Streptococcus pyogenes (β-hemolytic streptococcus of serological group A, which in the past caused the majority of cases of postpartum sepsis) and Streptococcus agalactiae (streptococcus of serological group B, which has recently become the most common cause of infections in newborns, especially premature infants , and their mothers).
Infections caused by group A streptococci
Pathogen- Streptococcus pyogenes (β-hemolytic).
Risk during pregnancy- 20% of pregnant women are bacteria carriers (nasopharynx, vagina and perianal area).
Clinic for a pregnant woman- tonsillitis, pharyngitis, pyoderma, colonization of the vagina and perianal area, urinary infection, chorioamnionitis, endometritis, postpartum sepsis.
Diagnostics- cultural method (on blood agar aerobically and anaerobically).
Effect on the fetus- intrapartum transmission of infection, the risk of neonatal sepsis increases with a long anhydrous interval.
Prevention- identification of risk factors, compliance with the rules of asepsis during childbirth, antibiotic therapy based on the results of gynecological culture.
Treatment- penicillins, cephalosporins for at least 10 days.
Clinic. Group A streptococci cause respiratory tract infections (pharyngitis, scarlet fever), skin and wound infections, sepsis, acute wound fever, glomerulonephritis.
Diseases that are complications of infections caused by these streptococci are based on autoimmune mechanisms; healthy carriage is possible.
From the point of view of perinatal infections, it is necessary to take into account the possibility of vertical transmission of streptococcal infection from mother to newborn; the source of infection can be the woman’s intestines and vagina. Despite the use of antiseptics and antibiotics, an increase in the most severe infections caused by group A streptococci, including severe neonatal sepsis, has recently been reported.
Diagnostics streptococcal infections involves culturing the test material on blood agar under both aerobic and anaerobic conditions.
Treatment. If group A streptococci are detected in a pregnant woman, penicillin therapy is required for 10 days; cephalosporins and macrolides may be used. For postpartum sepsis, high doses of benzylpenicillin or ampicillin are prescribed parenterally. Newborns with streptococcal infection are also prescribed high doses of benzylpenicillin, ampicillin or cephalosporins.
Prevention. Streptococcus pyogenes is transmitted by contact. Prevention consists of following the rules of asepsis during childbirth.
Infections caused by group B streptococci
Pathogen- Streptococcus agalactiae.
Risk in pregnant women- is part of the vaginal microflora in 20% of pregnant women.
Prevalence- the incidence of neonatal sepsis caused by group B streptococcus in the United States is 2 per 1000 live births.
Clinic for a pregnant woman- asymptomatic bacterial colonization of the vagina and perianal area, urinary tract infection, chorioamnionitis, endometritis.
Diagnostics- cultural method.
Effect on the fetus- in 80% - early infection (infection during childbirth) - sepsis; in 20% - late infection - meningitis, severe neurological complications.
Prevention- identification of risk factors, antibiotic therapy based on the results of gynecological culture.
Treatment- penicillins, cephalosporins, macrolides.
Streptococcus agalactiae can cause severe respiratory diseases, meningitis, septicemia, often leading to death. At the same time, this streptococcus is part of the normal vaginal microflora in 5-25% of pregnant women and can be isolated in 10-20% of cases from the intestinal tract of newborns.
In the United States, neonatal mortality associated with group B streptococci exceeds 10%. The range of infections caused by these streptococci in the perinatal period is very wide. It ranges from septic miscarriage to transient bacteremia. Premature infants are often affected, possibly because chorioamnionitis caused by group B streptococci leads to preterm birth.
The initial reservoir for group B streptococci is the normal intestinal microflora of a woman. There is a close connection between colonization of a mother and her child. The more intense the mother's infection, the more often the child becomes infected. During vaginal delivery, the incidence of intrapartum infection is 50-60%. The risk of illness in a full-term baby is 1-2%, in a premature baby - 15-20%, and at less than 28 weeks of pregnancy - 100%.
Clinic. Traditionally, there are two forms of infections of newborns caused by group B streptococci: “early attack” - an early form caused by vertical transmission of the pathogen, and “late attack”, developing 1-6 weeks after birth, often caused by horizontal infection.
In immature children, the infection often occurs in the form of sepsis, in full-term newborns - in the form of pneumonia. In severe cases, the disease begins immediately after birth and progresses rapidly.
