Group B streptococcal infections in nonpregnant adults

INTRODUCTION

Group B streptococcus (GBS; Streptococcus agalactiae) is a gram-positive coccus that frequently colonizes the human genital and gastrointestinal tracts, and the upper respiratory tract in young infants [1,2]. It is an important cause of infection in three populations:

Neonates — GBS infection is acquired in utero or during passage through the vagina. The most common manifestations of neonatal disease are bacteremia without a focus, sepsis, pneumonia, and/or meningitis. (See "Group B streptococcal infection in neonates and young infants".)

Pregnant women — GBS is a frequent cause of urinary tract infection, chorioamnionitis, postpartum endometritis, and bacteremia in pregnant women. (See "Group B streptococcal infection in pregnant women".)

Nonpregnant adults — GBS is increasingly recognized as a cause of bacteremia without a focus, sepsis, soft tissue infections, and other focal infections in nonpregnant adults.

GBS infection in nonpregnant adults will be reviewed here. The microbiology and epidemiology of infections caused by this organism and prevention strategies through chemoprophylaxis and vaccination are discussed separately. (See "Group B streptococcus: Virulence factors and pathogenic mechanisms" and "Neonatal group B streptococcal disease: Prevention" and "Vaccines for the prevention of group B streptococcal disease".)

                   

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Literature review current through: Mar 2014. | This topic last updated: Mar 3, 2014.
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References
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  1. Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med 2000; 342:15.
  2. Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR CDC Surveill Summ 1992; 41:25.
  3. Farley MM, Harvey RC, Stull T, et al. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med 1993; 328:1807.
  4. Blumberg HM, Stephens DS, Modansky M, et al. Invasive group B streptococcal disease: the emergence of serotype V. J Infect Dis 1996; 173:365.
  5. Phares CR, Lynfield R, Farley MM, et al. Epidemiology of invasive group B streptococcal disease in the United States, 1999-2005. JAMA 2008; 299:2056.
  6. Skoff TH, Farley MM, Petit S, et al. Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007. Clin Infect Dis 2009; 49:85.
  7. Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs) Report, Emerging Infections Program Network, group B streptococcus, 2003. 2004. www.cdc.gov/incidod/dbmd/abcs/survreports/gbs03.pdf (Accessed on September 22, 2005).
  8. Edwards MS, Baker CJ. Group B streptococcal infections in elderly adults. Clin Infect Dis 2005; 41:839.
  9. Schwartz B, Schuchat A, Oxtoby MJ, et al. Invasive group B streptococcal disease in adults. A population-based study in metropolitan Atlanta. JAMA 1991; 266:1112.
  10. Bayer AS, Chow AW, Anthony BF, Guze LB. Serious infections in adults due to group B streptococci. Clinical and serotypic characterization. Am J Med 1976; 61:498.
  11. Verghese A, Mireault K, Arbeit RD. Group B streptococcal bacteremia in men. Rev Infect Dis 1986; 8:912.
  12. Opal SM, Cross A, Palmer M, Almazan R. Group B streptococcal sepsis in adults and infants. Contrasts and comparisons. Arch Intern Med 1988; 148:641.
  13. Harrison LH, Ali A, Dwyer DM, et al. Relapsing invasive group B streptococcal infection in adults. Ann Intern Med 1995; 123:421.
  14. Jackson LA, Hilsdon R, Farley MM, et al. Risk factors for group B streptococcal disease in adults. Ann Intern Med 1995; 123:415.
  15. Muñoz P, Llancaqueo A, Rodríguez-Créixems M, et al. Group B streptococcus bacteremia in nonpregnant adults. Arch Intern Med 1997; 157:213.
  16. Henning KJ, Hall EL, Dwyer DM, et al. Invasive group B streptococcal disease in Maryland nursing home residents. J Infect Dis 2001; 183:1138.
  17. Meyn LA, Krohn MA, Hillier SL. Rectal colonization by group B Streptococcus as a predictor of vaginal colonization. Am J Obstet Gynecol 2009; 201:76.e1.
  18. Perovic O, Crewe-Brown HH, Khoosal M, Karstaedt AS. Invasive group B streptococcal disease in nonpregnant adults. Eur J Clin Microbiol Infect Dis 1999; 18:362.
  19. Dunne DW, Quagliarello V. Group B streptococcal meningitis in adults. Medicine (Baltimore) 1993; 72:1.
  20. Schuchat A, Oxtoby M, Cochi S, et al. Population-based risk factors for neonatal group B streptococcal disease: results of a cohort study in metropolitan Atlanta. J Infect Dis 1990; 162:672.
  21. Schuchat A, Wenger JD. Epidemiology of group B streptococcal disease. Risk factors, prevention strategies, and vaccine development. Epidemiol Rev 1994; 16:374.
  22. Manning SD, Neighbors K, Tallman PA, et al. Prevalence of group B streptococcus colonization and potential for transmission by casual contact in healthy young men and women. Clin Infect Dis 2004; 39:380.
  23. Kaplan EL, Johnson DR, Kuritsky JN. Rectal colonization by group B beta-hemolytic streptococci in a geriatric population. J Infect Dis 1983; 148:1120.
  24. Easmon CS, Tanna A, Munday P, Dawson S. Group B streptococci--gastrointestinal organisms? J Clin Pathol 1981; 34:921.
  25. Casey JI, Maturlo S, Albin J, Edberg SC. Comparison of carriage rates of group B streptococcus in diabetic and nondiabetic persons. Am J Epidemiol 1982; 116:704.
  26. Wessels MR, Kasper DL. The changing spectrum of group B streptococcal disease. N Engl J Med 1993; 328:1843.
  27. Slotved HC, Kong F, Lambertsen L, et al. Serotype IX, a Proposed New Streptococcus agalactiae Serotype. J Clin Microbiol 2007; 45:2929.
  28. Zaleznik DF, Rench MA, Hillier S, et al. Invasive disease due to group B Streptococcus in pregnant women and neonates from diverse population groups. Clin Infect Dis 2000; 30:276.
  29. Lachenauer CS, Kasper DL, Shimada J, et al. Serotypes VI and VIII predominate among group B streptococci isolated from pregnant Japanese women. J Infect Dis 1999; 179:1030.
  30. Ekelund K, Slotved HC, Nielsen HU, et al. Emergence of invasive serotype VIII group B streptococcal infections in Denmark. J Clin Microbiol 2003; 41:4442.
  31. Lucks DA, Venezio FR, Lakin CM. Balanitis caused by group B streptococcus. J Urol 1986; 135:1015.
  32. Stuesse DC, Robinson JH, Durzinsky DS. A late sternal wound infection caused by hematogenous spread of bacteria. Chest 1995; 108:1742.
  33. Gardam MA, Low DE, Saginur R, Miller MA. Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults. Arch Intern Med 1998; 158:1704.
  34. Holmström B, Grimsley EW. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus. South Med J 2000; 93:1096.
  35. Tang WM, Ho PL, Yau WP, et al. Report of 2 fatal cases of adult necrotizing fasciitis and toxic shock syndrome caused by Streptococcus agalactiae. Clin Infect Dis 2000; 31:E15.
  36. Farley MM. Group B streptococcal disease in nonpregnant adults. Clin Infect Dis 2001; 33:556.
  37. Ellison RT 3rd, McGregor JA. Recurrent postcoital lower-extremity streptococcal erythroderma in women. Streptococcal-sex syndrome. JAMA 1987; 257:3260.
  38. Lefevre JC, Lepargneur JP, Bauriaud R, et al. Clinical and microbiologic features of urethritis in men in Toulouse, France. Sex Transm Dis 1991; 18:76.
  39. Procopiou M, Genné D, Abbet P, et al. Acute prostatitis with prostatic abscess caused by group B Streptococcus. Clin Infect Dis 1998; 27:403.
  40. Scully BE, Spriggs D, Neu HC. Streptococcus agalactiae (group B) endocarditis--a description of twelve cases and review of the literature. Infection 1987; 15:169.
  41. Sambola A, Miro JM, Tornos MP, et al. Streptococcus agalactiae infective endocarditis: analysis of 30 cases and review of the literature, 1962-1998. Clin Infect Dis 2002; 34:1576.
  42. Rollán MJ, San Román JA, Vilacosta I, et al. Clinical profile of Streptococcus agalactiae native valve endocarditis. Am Heart J 2003; 146:1095.
  43. Vartian CV, Septimus EJ. Tricuspid valve group B streptococcal endocarditis following elective abortion. Rev Infect Dis 1991; 13:997.
  44. Deziel PJ, McGuire N, Brown PD. Group B streptococcal meningitis complicating elective abortion: report of 2 cases. Clin Infect Dis 2000; 31:E23.
  45. Wilder-Smith E, Chow KM, Kay R, et al. Group B streptococcal meningitis in adults: recent increase in Southeast Asia. Aust N Z J Med 2000; 30:462.
  46. Domingo P, Barquet N, Alvarez M, et al. Group B streptococcal meningitis in adults: report of twelve cases and review. Clin Infect Dis 1997; 25:1180.
  47. Lee SY, Chee SP. Group B Streptococcus endogenous endophthalmitis : case reports and review of the literature. Ophthalmology 2002; 109:1879.
  48. Barnham M. The gut as a source of the haemolytic streptococci causing infection in surgery of the intestinal and biliary tracts. J Infect 1983; 6:129.
  49. Burnet NG, Wilkinson RC, Evans DS. Mycotic aneurysm caused by group B streptococcus: a cautionary tale of management problems and a rare organism. Br J Clin Pract 1990; 44:372.
  50. Baddour LM, Cox JW Jr. Group B streptococcal infection of a pacemaker wire following sigmoidoscopy. Clin Infect Dis 1992; 15:1069.
  51. Schlievert PM, Gocke JE, Deringer JR. Group B streptococcal toxic shock-like syndrome: report of a case and purification of an associated pyrogenic toxin. Clin Infect Dis 1993; 17:26.
  52. Fernandez M, Hickman ME, Baker CJ. Antimicrobial susceptibilities of group B streptococci isolated between 1992 and 1996 from patients with bacteremia or meningitis. Antimicrob Agents Chemother 1998; 42:1517.
  53. Pearlman MD, Pierson CL, Faix RG. Frequent resistance of clinical group B streptococci isolates to clindamycin and erythromycin. Obstet Gynecol 1998; 92:258.
  54. Borchardt SM, DeBusscher JH, Tallman PA, et al. Frequency of antimicrobial resistance among invasive and colonizing Group B streptococcal isolates. BMC Infect Dis 2006; 6:57.
  55. DiPersio LP, DiPersio JR. High rates of erythromycin and clindamycin resistance among OBGYN isolates of group B Streptococcus. Diagn Microbiol Infect Dis 2006; 54:79.
  56. Back EE, O'Grady EJ, Back JD. High rates of perinatal group B Streptococcus clindamycin and erythromycin resistance in an upstate New York hospital. Antimicrob Agents Chemother 2012; 56:739.
  57. Diekema DJ, Andrews JI, Huynh H, et al. Molecular epidemiology of macrolide resistance in neonatal bloodstream isolates of group B streptococci. J Clin Microbiol 2003; 41:2659.
  58. Wehbeh W, Rojas-Diaz R, Li X, et al. Fluoroquinolone-resistant Streptococcus agalactiae: epidemiology and mechanism of resistance. Antimicrob Agents Chemother 2005; 49:2495.
  59. Biedenbach DJ, Toleman MA, Walsh TR, Jones RN. Characterization of fluoroquinolone-resistant beta-hemolytic Streptococcus spp. isolated in North America and Europe including the first report of fluoroquinolone-resistant Streptococcus dysgalactiae subspecies equisimilis: report from the SENTRY Antimicrobial Surveillance Program (1997-2004). Diagn Microbiol Infect Dis 2006; 55:119.
  60. Wang H, Zhao C, He W, et al. High prevalence of fluoroquinolone-resistant group B streptococci among clinical isolates in China and predominance of sequence type 19 with serotype III. Antimicrob Agents Chemother 2013; 57:1538.
  61. Chu YW, Tse C, Tsang GK, et al. Invasive group B Streptococcus isolates showing reduced susceptibility to penicillin in Hong Kong. J Antimicrob Chemother 2007; 60:1407.
  62. Park C, Nichols M, Schrag SJ. Two cases of invasive vancomycin-resistant group B streptococcus infection. N Engl J Med 2014; 370:885.
  63. Trivalle C, Martin E, Martel P, et al. Group B streptococcal bacteraemia in the elderly. J Med Microbiol 1998; 47:649.
  64. Kasper DL, Paoletti LC, Wessels MR, et al. Immune response to type III group B streptococcal polysaccharide-tetanus toxoid conjugate vaccine. J Clin Invest 1996; 98:2308.
  65. Paoletti LC, Kasper DL. Glycoconjugate vaccines to prevent group B streptococcal infections. Expert Opin Biol Ther 2003; 3:975.
  66. Baker CJ, Kasper DL. Correlation of maternal antibody deficiency with susceptibility to neonatal group B streptococcal infection. N Engl J Med 1976; 294:753.
  67. Baker CJ, Edwards MS, Kasper DL. Role of antibody to native type III polysaccharide of group B Streptococcus in infant infection. Pediatrics 1981; 68:544.
  68. Wessels MR, Kasper DL, Johnson KD, Harrison LH. Antibody responses in invasive group B streptococcal infection in adults. J Infect Dis 1998; 178:569.
  69. Amaya RA, Baker CJ, Keitel WA, Edwards MS. Healthy elderly people lack neutrophil-mediated functional activity to type V group B Streptococcus. J Am Geriatr Soc 2004; 52:46.
  70. Edwards MS, Rench MA, Palazzi DL, Baker CJ. Group B streptococcal colonization and serotype-specific immunity in healthy elderly persons. Clin Infect Dis 2005; 40:352.