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$Unique_ID{BRK04239}
$Pretitle{}
$Title{Streptococcus, Group B}
$Subject{Streptococcus Group B GBS Infant Early-Onset Infant Late-Onset Adult
Onset Infectious Arthritis Infective Endocarditis Listeriosis Meningitis
Osteomyelitis }
$Volume{}
$Log{}

Copyright (C) 1992 National Organization for Rare Disorders, Inc.

890:
Streptococcus, Group B

** IMPORTANT **
It is possible that the main title of the article (Group B Streptococcus)
is not the name you expected.  Please check the SYNONYM listing to find the
alternate name and disorder subdivisions covered by this article.

Synonyms

     GBS

Disorder Subdivisions:

     Infant Early-Onset
     Infant Late-Onset
     Adult Onset

Information on the following diseases can be found in the Related
Disorders section of this report:

     Infectious Arthritis
     Infective Endocarditis
     Listeriosis
     Meningitis
     Osteomyelitis

General Discussion

** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only.  It should not be used for diagnostic or treatment
purposes.  If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.

Group B Streptococcus is a bacterial infection in which groups of
streptococcus bacteria reproduce and multiply (colonize) in the mucous
membranes.  This bacteria is found most often in the vagina and rectum of
females.  Group B Streptococci can be transmitted sexually, as well as to a
fetus as the infant passes through the birth canal.

The main groups at risk of developing disease from GBS are newborn
children of an infected mother, women after childbirth, females after
gynecologic surgery and older male and female patients with other serious
diseases.  The affects of this bacteria on newborn children as well as adults
can cause many serious problems.

Symptoms

Infant Early Onset - Early onset of Group B Streptococcus disease occurs in
the first seven days of life with more than half of the cases occuring in the
first twenty-four hours.  Symptoms of early onset Group B Streptococcus
disease may be:  lung disease in which there are airless air sacs and rigid
lungs (respiratory distress), a widened nose, cramps of the rib cage muscles,
and build up of fluid in the arms and legs; sudden swelling and inflammation
of the lungs (fulminant pneumonia); an absence of automatic breathing
(apnea); failure of the heart and blood vessel system (cardiovascular
collapse) and/or infection and swelling of the membranes covering the brain
and spinal cord (meningitis); fever and/or irritability.

Infant Late Onset - Late onset of Group B Streptococcus disease occurs
between seven days and three months after birth.  Infection or swelling of
the membranes covering the brain and spinal cord (meningitis) is the most
common symptom of late onset GBS, occuring in seventy-five percent of the
infants with this disease.  Other symptoms of late onset GBS may be:
irritability or fussiness; bone pain, muscle spasms and fever caused by
infection of the bone or bone marrow when Group B Streptococcus enters the
bloodstream (osteomyelitis); swelling in the front of the white part of the
eye causing red eyes and a thick discharge (conjunctivitis); ear infection or
inflammation of the middle ear (otitis media) that may spread to the
membranes of the brain and spinal cord; inflammation of the spongy bone that
forms most of the walls of the upper part of the nasal cavity (ethmoiditis);
an infection in the brain forming a sac filled with pus and surrounded by
swollen tissue (brain abscess);  swelling and a build up of fluid in the
lungs (pneumonia);  infection of the skin causing heat, pain, swelling,
redness, fever and/or chills (cellulitis); a pus-forming infection of the
kidney causing fever, chills, pain, nausea and/or frequent urination
(pyelonephritis); infection of the fluid that lubricates joints causing
destruction of cartilage and/or joints to freeze (pyarthrosis); and
inflammation of the lining of the heart and heart valve causing low back
pain, pain in the joints, chills and/or loss of appetite (endocarditis).

Adult Onset - Adult Group B Streptococcus disease occurs mainly in women
after childbirth or gynecologic examination or treatment, and elderly male
and female patients with other serious diseases such as diabetes mellitus,
chronic renal failure, cirrhosis of the liver or malignancy.  The most common
infections caused by GBS in adults are swelling of the mucous membrane that
lines the uterus causing fever, pain in the abdomen, discharge and swelling
of the uterus (endometritis);  and infection of the kidney causing fever,
chills, pain, nausea and frequent urination (pyelonephritis).  Other symptoms
or illnesses that may occur in adults with GBS are:  infection of the skin
causing heat over the area, pain, and swelling (cellulitis); inflammation of
the membranes around the brain or spinal cord causing fever, headache,
nausea, vomiting, a stiff neck and/or aching muscles (meningitis); swelling
and a build up of fluid in the lungs (pneumonia); inflammation of the lining
of the heart and heart valve causing low back pain, pain in the joints,
fever, night sweats, chills, headache, loss of appetite, and/or weight loss
(endocarditis); swelling of the membrane that covers the wall of the abdomen
causing nausea, pain, a rapid heart beat, chills, fever, and/or rapid
breathing (peritonitis); bone pain, muscle spasms and fever caused by the
bacteria entering the bloodstream and infecting the bone (osteomyelitis) or
bone marrow; and swelling of the joints causing pain (arthritis).

Causes

Group B Streptococcus infection occurs when the bacteria (s. agalactiae)
multiply and colonize in the mucous membranes.  It tends to occur in certain
high risk groups.  The three groups that are most at risk of developing
disease from this bacteria are newborn babies of infected mothers, women
after childbirth or gynecologic surgery, and older patients with other
serious diseases.

Affected Population

Group B Streptococcus infection is a prevalent disorder.  The GBS bacterial
infection is found throughout the world.  It has been estimated that 15-35%
of all women have the GBS bacteria in the vaginal region and/or intestines.
In the majority of cases this bacteria will not cause any symptoms in adult
females and as a result, many are not aware that they have it.

Approximately 12,000 babies in the United States get this disease yearly.
Group G Streptococcus infection tends to affect newborn babies, women after
childbirth and/or gynecologic surgery, and elderly male and female patients
with other diseases.

Related Disorders

The following disorders may be associated with Group B Streptococcus or may
have other causes.  Comparisons may be useful for a differential diagnosis:

Infectious Arthritis is an infection of tissues in a joint by bacteria,
viruses or fungi.  Symptoms of this disorder depend upon which agent has
caused the infection.  The symptoms may include fever, chills, general
weakness and headaches, followed by inflammation of one or more joints.  The
affected joint or joints often become very painful, swollen, slightly red and
stiff within a few hours or days.  Rapid onset of symptoms may indicate that
a bacterium is the cause.  (For more information on this disorder choose
"Infectious Arthritis" as your search term in the Rare Disease Database).

Infective Endocarditis is a bacterial infection of the inner lining of
the heart muscle (endocardium).  This inner lining also covers the heart
valves, and it is these valves which are primarily affected by infective
endocarditis.  There are several forms of infective endocarditis.  Two types
that have similar symptoms but are caused by different bacteria are acute
bacterial endocarditis and subacute bacterial endocarditis.  Acute bacterial
endocarditis may affect normal heart valves, while subacute bacterial
endocarditis more commonly affects heart valves which have been previously
damaged by disease.  A third type of infective endocarditis, prosthetic
valvular endocarditis (PVE), may develop in patients who have previously had
artificial (prosthetic) valve replacement or tissue valve replacement.  (For
more information on this disorder, choose "Endocarditis " as your search term
in the Rare Disease Database).

Listeriosis is a disorder caused by a bacterial infection (Listeria
monocytogenes) transmitted to humans through contaminated food
products, usually improperly pasteurized milk or cheese.  Some cases have been
transmitted through contact with other infected persons or animals.  Cases
range in severity from a transient carrier state with no apparent symptoms,
to acute (suddenly occuring) spread of bacteria throughout the blood stream.
Listeriosis of pregnancy may exhibit no symptoms or may be marked only by a
fever and back pain.  This condition can be mistaken for a bacterial
infection of the kidney (pyelonephritis).  (For more information on this
disorder choose "Listeriosis" as your search term in the Rare Disease
Database).

Meningitis is a disorder characterized by inflammation of the membranes
(meninges) around the brain or spinal chord.  The disorder can occur in three
different forms:  adult, infantile, and neonatal.  This inflammation can be
caused by different types of bacteria, fungi, or malignant tumors.  Chemical
reactions to certain injections into the spinal canal can also cause
meningitis.  In it's acute form the disorder is characterized by fever,
headache, a stiff neck and vomiting.  (For more information on the disorder
choose "Meningitis" as your search term in the Rare Disease Database).

Osteomyelitis is a common infection of the bone caused by bacteria,
frequently Staphylococcus.  This disorder is usually due to an infection in
another part of the body that is transported through the bloodstream to a
bone in a distant location.  In some cases the cause is unknown.  Initially
there may be several days of fever and a generalized feeling of ill health.
This may be followed by an increase in fever, deep localized bone pain,
chills, sweating, swelling and painful or limited movement of the nearby
joints.  (For more information on this disorder choose "Osteomyelitis" as
your search term in the Rare Disease Database).

Therapies:  Standard

Group B Streptococcus is diagnosed by isolating the organism from the blood,
cerebrospinal fluid, or fluid from the stomach.

Penicillin G and Ampicillin are antibiotic drugs prescribed to treat
Group B Streptococcus.  Patients allergic to these drugs may be given other
antibiotics such as cephalosporins, erythromycin and/or chloramphenicol.

There is now a rapid screen blood test that detects part of the GBS
bacterium within hours.  This test can detect if the pregnant woman is
infected while in labor, allowing the doctor to administer antibiotics
immediately in order to prevent the newborn from acquiring GBS.

Therapies:  Investigational

Researchers are currently trying to develop a vaccine for Group B
Streptococcus so that the infection can be prevented.

This disease entry is based upon medical information available through
February 1992.  Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate.  Please check with the agencies listed in the Resources section for
the most current information about this disorder.

Resources

For more information on Group B Streptococcus, please contact:

     National Organization for Rare Disorders (NORD)
     P.O. Box 8923
     New Fairfield, CT  06812-1783
     [phone]

     Group B Strep Association
     P.O. Box 16515
     Chapel Hill, North Carolina  27516
     [phone]

     NIH/National Institute of Allergy and Infectious Diseases (NIAID)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]

     Centers for Disease Control (CDC)
     1600 Clifton Road, NE
     Atlanta, GA  30333
     [phone]

References

INTERNAL MEDICINE, 2nd Ed.:  Jay H. Stein, Editor-In-Chief; Little, Brown and
Co., 1987.  Pp. 1647-1648.

CECIL TEXTBOOK OF MEDICINE, 19th Ed.:  James B. Wyngaarden, and Lloyd H.
Smith, Jr., Editors; W.B. Saunders Co., 1990.  Pp. 1572-73.

ANTIMICROBIAL PROPHYLAXIS OF NEONATAL GROUP B STREPTOCOCCAL SEPSIS:
Kenneth M. Boyer, et al.; Clinics in Perinatology; (December 1988, issue
15(4)).  Pp. 831-51.