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Hypervirulent Streptococcus agalactiae septicemia in twin ex-premature infants transmitted by breast milk: report of source detection and isolate characterization using commonly available molecular diagnostic methods
Annals of Clinical Microbiology and Antimicrobials ( IF 5.7 ) Pub Date : 2020-11-26 , DOI: 10.1186/s12941-020-00396-6
Edward P C Ager 1 , Eric D Steele 2 , Lindsey E Nielsen 2 , Matthew A Nestander 3 , Katrin Mende 4, 5, 6 , Steven E Spencer 3
Affiliation  

Group B Streptococcus (GBS) infections caused by Streptococcus agalactiae is a leading cause of meningitis and sepsis in neonates, with early-onset GBS symptoms emerging during the first week of life and late-onset occurring thereafter. Perinatal transmission of GBS to the neonate through the birth canal is the main factor associated with early-onset neonate infections, while less is understood about the source of late-onset infections. In this report we describe a case of twin ex-premature infants who presented one month after birth with GBS septicemia. The mother had been appropriately screened at gestational age 35–37 weeks and laboratory methods failed to detect GBS colonization by culture or clinical molecular methods. In attempts to identify and isolate the source of GBS infection, additional surveillance swabs were collected from the mother at the time of neonate admission. Culture and a commercially available, FDA-cleared molecular PCR assay were performed. No GBS was detected from swabs collected from the perianal, thigh/groin or axillary areas. However, expressed breast milk and swabs from the breastmilk pump were positive by both methods. Since simultaneous culture and molecular methods which used breastmilk as a source were performed, investigators ascertained the limit of detection for GBS in breastmilk. The limit of detection was determined to be tenfold lower than that of LIM-broth enriched cultures—the FDA-approved source. Subsequent whole genome sequencing (WGS) analysis of isolates recovered from breastmilk and blood cultures from the infants demonstrated all strains were related and characterized as ST-452. Both infants responded very well to treatment and continued to have no related events or concerns at the two-year follow up appointment. Strain type 452 (capsular type IV) has recently emerged as a hypervirulent strain and has previously been documented as causing GBS infections in elderly populations. Antibiotic therapy resolved both mother and infant infections. Subsequent testing for the presence of GBS in breastmilk samples also showed an absence of bacteria. This is the first report of infant twins late-onset GBS infections caused by the hypervirulent S. agalactiae ST-452 with breastmilk as the source.

中文翻译:

通过母乳传播的双胞胎早产儿的高毒力无乳链球菌败血症:使用常用分子诊断方法进行源检测和分离鉴定的报告

由无乳链球菌引起的 B 组链球菌 (GBS) 感染是新生儿脑膜炎和败血症的主要原因,早发型 GBS 症状出现在出生后的第一周,随后出现晚发型。GBS 通过产道在围产期传播给新生儿是与早发性新生儿感染相关的主要因素,而对晚发性感染的来源知之甚少。在本报告中,我们描述了一例双胞胎早产儿,他们在出生后一个月出现 GBS 败血症。母亲在孕 35-37 周时接受了适当筛查,实验室方法未能通过培养或临床分子方法检测 GBS 定植。在尝试识别和隔离 GBS 感染源的过程中,在新生儿入院时从母亲身上收集了额外的监测拭子。进行了培养和市售的、FDA 批准的分子 PCR 检测。从肛周、大腿/腹股沟或腋窝区域采集的拭子未检测到 GBS。然而,两种方法均显示挤出的母乳和来自母乳泵的拭子均为阳性。由于同时进行了以母乳为来源的培养和分子检测方法,研究人员确定了母乳中 GBS 的检测限。检测限经确定比富含 LIM 肉汤的培养物(FDA 批准的来源)低十倍。随后对从婴儿的母乳和血培养中回收的分离株进行的全基因组测序 (WGS) 分析表明,所有菌株都是相关的,并被定性为 ST-452。两个婴儿对治疗的反应都很好,并且在为期两年的随访预约中继续没有相关事件或担忧。452 型菌株(IV 型荚膜)最近已成为一种高毒力菌株,之前已被记录为导致老年人群 GBS 感染。抗生素治疗解决了母婴感染。随后对母乳样品中 GBS 的检测也表明不存在细菌。这是首次报道以母乳为来源的高毒力无乳链球菌ST-452引起婴儿双胞胎迟发性GBS感染。452 型菌株(IV 型荚膜)最近已成为一种高毒力菌株,之前已被记录为导致老年人群 GBS 感染。抗生素治疗解决了母婴感染。随后对母乳样品中 GBS 的检测也表明不存在细菌。这是首次报道以母乳为来源的高毒力无乳链球菌ST-452引起婴儿双胞胎迟发性GBS感染。452 型菌株(IV 型荚膜)最近已成为一种高毒力菌株,之前已被记录为导致老年人群 GBS 感染。抗生素治疗解决了母婴感染。随后对母乳样品中 GBS 的检测也表明不存在细菌。这是首次报道以母乳为来源的高毒力无乳链球菌ST-452引起婴儿双胞胎迟发性GBS感染。
更新日期:2020-11-27
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