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Group B Streptococcal Infections in Children and Hearing Loss

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Hearing Loss in Congenital, Neonatal and Childhood Infections

Part of the book series: Comprehensive ENT ((CENT))

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Abstract

Streptococcus agalactiae, also known as group B streptococcus (GBS), is an important cause of bacterial infection—in neonates and early infancy. In this early period, GBS may cause sepsis, meningitis, pneumonia, and other focal infections [1]. It commonly colonizes the gastrointestinal and genital tracts of pregnant women. Vaginal and cervical colonization is usually asymptomatic; however, maternal colonization is the primary risk factor for GBS infection in neonates and young infants [2]. The clinical disease can present as bacteremia, meningitis, pneumonia, septic arthritis, osteomyelitis, cellulitis, and adenitis. Moderate or severe neurodevelopmental impairment is common among survivors with GBS meningitis; 18% of survivors with an average follow-up of 18 months are affected [3]. Hearing loss may also occur in patients with GBS meningitis. The frequency and complications of meningitis may vary according to the time of infection [1].

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References

  1. American Academy of Pediatrics. Group B streptococcal infections. In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, editors. Red Book: 2021–2024 report of the committee on infectious diseases. 32nd ed. Itasca, IL: American Academy of Pediatrics; 2021. p. 707–13.

    Google Scholar 

  2. Puopolo KM, Baker CJ. Group B streptococcal infection in neonates and young infants. In: Edwards MS, editor. UpToDate. Waltham, MA: UpToDate. Updated 19 Sep 2022; literature review: Nov 2022. https://www.uptodate.com/contents/group-b-streptococcal-infection-in-neonates-and-young-infants. Accessed 28 Dec 2022.

  3. Kohli-Lynch M, Russell NJ, Seale AC, et al. Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017;65(Suppl 2):s190–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Pannaraj PS, Baker CJ. Group B streptococcal infections. In: Cherry J, Demmler-Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, editors. Feigin and Cherry’s textbook of pediatric infectious diseases. 8th ed. Philadelphia: Elsevier; 2019. p. 823–34.

    Google Scholar 

  5. Hanna M, Noor A. Streptococcus group B. In: StatPearls. Treasure Island: StatPearls Publishing; 2022. Updated 29 May 2022. https://www.ncbi.nlm.nih.gov/books/NBK553143. Accessed 28 Dec 2022.

    Google Scholar 

  6. American College of Obstetrician and Gynecologists. Prevention of group B streptococcal early-onset disease in newborns: committee opinion, number 797. Obstet Gynecol. 2020;135:e51–72. [Erratum: Obstet Gynecol.2020;135:978–979].

    Article  Google Scholar 

  7. Edwards MS, Baker CJ. Streptococcus agalactiae (group B streptococcus). In: Long SS, Prober CG, Fischer M, Kimberlin DW, editors. Principles and practice of pediatric infectious diseases. 6th ed. Philadelphia: Elsevier; 2023. p. 740–5.

    Chapter  Google Scholar 

  8. Anthony BF, Okada DM, Hobel CJ. Epidemiology of the group B streptococcus: maternal and nosocomial sources for infant acquisitions. J Pediatr. 1979;95:431–6.

    Article  CAS  PubMed  Google Scholar 

  9. Matorras R, Garcia-Perea A, Usandizaga JA, Omeñaca F. Natural transmission of group B streptococcus during delivery. Int J Gynaecol Obstet. 1989;30:99–103.

    Article  CAS  PubMed  Google Scholar 

  10. Jones DE, Kanarek KS, Lim DV. Group B streptococcal colonization patterns in mothers and their infants. J Clin Microbiol. 1984;20:438–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Edwards MS, Jackson CV, Baker CJ. Increased risk of group B streptococcal disease in twins. JAMA. 1981;245:2044–6.

    Article  CAS  PubMed  Google Scholar 

  12. Noya FJ, Rench MA, Metzger TG, Colman G, Naidoo J, Baker CJ. Unusual occurrence of an epidemic of type Ib/c group B streptococcal sepsis in a neonatal intensive care unit. J Infect Dis. 1987;155:1135–44.

    Article  CAS  PubMed  Google Scholar 

  13. Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A. Late-onset and recurrent neonatal group B streptococcal disease associated with breast-milk transmission. Pediatr Dev Pathol. 2003;6:251–6.

    Article  PubMed  Google Scholar 

  14. Madrid L, Seale AC, Kohli-Lynch M, et al. Infant group B streptococcal disease incidence and serotypes worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017;65(Suppl 2):s160–72.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Edmond KM, Kortsalioudaki C, Scott S, et al. Group B streptococcal disease in infants aged younger than 3 months: systematic review and meta-analysis. Lancet. 2012;379:547–56.

    Article  PubMed  Google Scholar 

  16. Seale AC, Bianchi-Jassir F, Russell NJ, et al. Estimates of the burden of group B streptococcal disease worldwide for pregnant women, stillbirths, and children. Clin Infect Dis. 2017;65(Suppl 2):s200–19.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011;364:2016–25.

    Article  CAS  PubMed  Google Scholar 

  18. Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Recomm Rep. 1996;45(RR-7):1–24. [Correction: MMWR Recomm Rep. 1996;45(31):679].

    Google Scholar 

  19. Puopolo KM, Lynfield R, Cummings JJ, American Academy of Pediatrics, Committee on Fetus and Newborn, Committee on Infectious Diseases. Management of infants at risk for group b streptococcal disease. Pediatrics. 2019;144:20191881.

    Article  Google Scholar 

  20. Lin FY, Weisman LE, Troendle J, Adams K. Prematurity is the major risk factor for late-onset group B streptococcus disease. J Infect Dis. 2003;188:267–71.

    Article  PubMed  Google Scholar 

  21. Schrag S, Gorwitz R, Fultz-Butts K, Schuchat A. Prevention of perinatal group B streptococcal disease. revised guidelines from CDC. MMWR Recomm Rep. 2002;51(RR-11):1–22.

    Google Scholar 

  22. 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;162:672–7.

    Article  CAS  PubMed  Google Scholar 

  23. Hussain SM, Luedtke GS, Baker CJ, Schlievert PM, Leggiadro RJ. Invasive group B streptococcal disease in children beyond early infancy. Pediatr Infect Dis J. 1995;14:278–81.

    Article  CAS  PubMed  Google Scholar 

  24. Schrag SJ, Zywicki S, Farley MM, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med. 2000;342:15–20.

    Article  CAS  PubMed  Google Scholar 

  25. Guilbert J, Levy C, Cohen R, Delacourt C, Renolleau S, Flamantet C. Late and ultra late onset streptococcus B meningitis: clinical and bacteriological data over 6 years in France. Acta Paediatr. 2010;99:47–51.

    Article  CAS  PubMed  Google Scholar 

  26. Likitnukul S, Pokato S, Nunthapisud P. Group B streptococcal sepsis and meningitis complicated with severe sensorineural hearing loss in a fourteen-year-old boy. Pediatr Infect Dis J. 1996;15:468–70.

    Article  CAS  PubMed  Google Scholar 

  27. Escobar GJ, Li DK, Armstrong MA, et al. Neonatal sepsis workups in infants ≥2,000 grams at birth: a population-based study. Pediatrics. 2000;106:256–63.

    Article  CAS  PubMed  Google Scholar 

  28. Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 2019;173:224–33.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Weisman LE, Stoll BJ, Cruess DF, et al. Early-onset group B streptococcal sepsis: a current assessment. J Pediatr. 1992;121:428–33.

    Article  CAS  PubMed  Google Scholar 

  30. Payne NR, Burke BA, Day DL, Christenson PD, Thompson TR, Ferrieriet P. Correlation of clinical and pathologic findings in early-onset neonatal group B streptococcal infection with disease severity and prediction of outcome. Pediatr Infect Dis J. 1988;7:836–47.

    Article  CAS  PubMed  Google Scholar 

  31. Berardi A, Rossi C, Lugli L, et al. Group B streptococcus late-onset disease: 2003-2010. Pediatrics. 2013;131:e361–8.

    Article  PubMed  Google Scholar 

  32. Edwards MS, Nizet V, Baker CJ. Group B streptococcal infections. In: Wilson CB, Nizet V, Maldonado YA, Remington JS, Klein JO, editors. Remington and Klein’s infectious diseases of the fetus and newborn infant. 8th ed. Philadelphia: Elsevier; 2016. p. 411–56.

    Google Scholar 

  33. Baker CJ, Barrett FF, Gordon RC, Yow MD. Suppurative meningitis due to streptococci of Lancefield group B: a study of 33 infants. J Pediatr. 1973;82:724–9.

    Article  CAS  PubMed  Google Scholar 

  34. Farley MM, Harvey RC, Stull T, et al. A population-based assessment of invasive disease due to group B Streptococcus in non-pregnant adults. N Engl J Med. 1992;328:1807–11.

    Article  Google Scholar 

  35. Moon CJ, Kwon TH, Lee KS, Lee HS. Recurrent neonatal sepsis and progressive white matter injury in a premature newborn culture-positive for group B streptococcus: a case report. Medicine (Baltimore). 2021;100:26387.

    Article  Google Scholar 

  36. Schimmel MS, Schlesinger Y, Berger I, Steinberg A, Eidelman AI. Transverse myelitis: unusual sequelae of neonatal group B streptococcus disease. J Perinatol. 2002;22:580–1.

    Article  PubMed  Google Scholar 

  37. Goirand M, Berthaud R, Al Ikhtiar I, Lachtar M, Montoro J, Walter-Nicolet E. Orchi-épididymite néonatale: une affection rare révélatrice d’un sepsis secondaire à streptocoque du groupe B [Epididymo-orchitis in a newborn: rare illness revealing late-onset Streptococcus agalactiae meningitis]. Arch Pediatr. 2014;21:219–22.

    Article  CAS  PubMed  Google Scholar 

  38. Newman TB, Puopolo KM, Wi S, Draper D, Escobar GJ. Interpreting complete blood counts soon after birth in newborns at risk for sepsis. Pediatrics. 2010;126:903–9.

    Article  PubMed  Google Scholar 

  39. Wiswell TE, Baumgart S, Gannon CM, Spitzer AR. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed? Pediatrics. 1995;95:803–6.

    CAS  PubMed  Google Scholar 

  40. Albanyan EA, Baker CJ. Is lumbar puncture necessary to exclude meningitis in neonates and young infants: lessons from the group B streptococcus cellulitis adenitis syndrome. Pediatrics. 1998;102:985–6.

    Article  CAS  PubMed  Google Scholar 

  41. Levent F, Baker CJ, Rench MA, Edwards MS. Early outcomes of group B streptococcal meningitis in the 21st century. Pediatr Infect Dis J. 2010;29:1009–12. [Erratum: Pediatr Infect Dis J. 2011;30:94].

    Article  PubMed  Google Scholar 

  42. Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect. 2017;74:34–40.

    Article  Google Scholar 

  43. Freudenhammer M, Karampatsas K, Le Doare K, et al. Invasive group B streptococcus disease with recurrence and in multiples: towards a better understanding of GBS late-onset sepsis. Front Immunol. 2021;12:617925.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Moylett EH, Fernandez M, Rench MA, Hickman ME, Baker CJ. A 5-year review of recurrent group B streptococcal disease: lessons from twin infants. Clin Infect Dis. 2000;30:282–7.

    Article  CAS  PubMed  Google Scholar 

  45. Ueda NK, Nakamura K, Go H, et al. Neonatal meningitis and recurrent bacteremia with group B Streptococcus transmitted by own mother’s milk: a case report and review of previous cases. Int J Infect Dis. 2018;74:13–5.

    Article  PubMed  Google Scholar 

  46. Fernandez M, Rench MA, Albanyan EA, Edwards MS, Baker CJ. Failure of rifampin to eradicate group B streptococcal colonization in infants. Pediatr Infect Dis J. 2001;20:371–6.

    Article  CAS  PubMed  Google Scholar 

  47. Kadambari S, Trotter CL, Heath PT, Goldacre MJ, Pollard AJ, Goldacre R. Group B streptococcal disease in England (1998–2017): a population-based observational study. Clin Infect Dis. 2021;72:791–8.

    Article  Google Scholar 

  48. Joubrel C, Tazi A, Six A, et al. Group B streptococcus neonatal invasive infections, France 2007-2012. Clin Microbiol Infect. 2015;21:910–6.

    Article  CAS  PubMed  Google Scholar 

  49. Hamada S, Vearncombe M, McGeer A, Shah PS. Neonatal group B streptococcal disease: incidence, presentation, and mortality. J Matern Fetal Neonatal Med. 2008;21:53–7.

    Article  PubMed  Google Scholar 

  50. Mynarek M, Bjellmo S, Lydersen S, Afset JE, Andersen GL, Vik T. Incidence of invasive group B streptococcal infection and the risk of infant death and cerebral palsy: a Norwegian cohort study. Pediatr Res. 2021;89:1541–8.

    Article  CAS  PubMed  Google Scholar 

  51. Horváth-Puhó E, van Kassel MN, Gonçalves BP, et al. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and Netherlands: a national matched cohort study. Lancet Child Adolesc Health. 2021;5:398–407.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kral A, O’Donoghue GM. Profound deafness in childhood. N Engl J Med. 2010;363:1438–50.

    Article  CAS  PubMed  Google Scholar 

  53. Yoshinaga-Itano C, Sedey AL, Coulter DK, Mehl AL. Language of early- and later-identified children with hearing loss. Pediatrics. 1998;102:1161–71.

    Article  CAS  PubMed  Google Scholar 

  54. Downs MP, Yoshinaga-Itano C. The efficacy of early identification and intervention for children with hearing impairment. Pediatr Clin N Am. 1999;46:79–87.

    Article  CAS  Google Scholar 

  55. Watkin P, McCann D, Law C, et al. Language ability in children with permanent hearing impairment: the influence of early management and family participation. Pediatrics. 2007;120:694–701.

    Article  Google Scholar 

  56. Vohr B, Jodoin-Krauzyk J, Tucker R, Johnson MJ, Topol D, Ahlgren M. Early language outcomes of early-identified infants with permanent hearing loss at 12 to 16 months of age. Pediatrics. 2008;122:535–44.

    Article  PubMed  Google Scholar 

  57. Pimperton H, Kennedy CR. The impact of early identification of permanent childhood hearing impairment on speech and language outcomes. Arch Dis Child. 2012;97:648–53.

    Article  PubMed  Google Scholar 

  58. Ching TYC, Dillon H, Button L, et al. Age at intervention for permanent hearing loss and 5-year language outcomes. Pediatrics. 2017;140:e20164274.

    Article  PubMed  Google Scholar 

  59. Landwehr-Kenzel S, Henneke P. Interaction of Streptococcus agalactiae and cellular innate immunity in colonization and disease. Front Immunol. 2014;5:519.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Vallejo JG, Baker CJ, Edwards MS. Demonstration of circulating Group B streptococcal immune complexes in neonates with meningitis. J Clin Microbiol. 1994;32:2041–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Vallejo JG, Baker CJ, Edwards MS. Roles of the bacterial cell wall and capsule in the induction of tumor necrosis factor-alpha by type III group B streptococci. Infect Immun. 1996;64:5042–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Dokter WH, Dijkstra AJ, Koopmans SB, et al. G(AnH)MTetra, a naturally occurring 1,6-anhydro-muramyl-dipeptide, induces granulocyte colony-stimulating factor expression in human monocytes: a molecular analysis. Infect Immun. 1994;62:2953–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Heumann D, Barras C, Severin A, Glauser MP, Tomaszet A. Gram-positive cell walls stimulate the synthesis of tumor necrosis factor-alpha and interleukin-6 by human monocytes. Infect Immun. 1994;62:2715–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Bhakdi S, Klonisch T, Nuber P, Fischer W. Stimulation of monokine production by lipoteichoic acids. Infect Immun. 1991;59:4614–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Keller R, Fischer W, Keist R, Bassetti S. Macrophage response to bacteria: induction of marked secretory and cellular activities by lipoteichoic acids. Infect Immun. 1992;60:3664–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Adams JC. Clinical implications of inflammatory cytokines in the cochlea: a technical note. Otol Neurotol. 2002;23:316–22.

    Article  PubMed  Google Scholar 

  67. Aminpour S, Tinling SP, Brodie HA. Role of tumor necrosis factor-alpha in sensorineural hearing loss after bacterial meningitis. Otol Neurotol. 2005;26:602–9.

    Article  PubMed  Google Scholar 

  68. Verani JR, McGee L, Schrag SJ. Prevention of perinatal group B streptococcal disease–revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59(RR-10):1–36.

    Google Scholar 

  69. Boyer KM, Gotoff SP. Prevention of early-onset neonatal group B streptococcal disease with selective intrapartum chemoprophylaxis. N Engl J Med. 1986;314:1665–9.

    Article  CAS  PubMed  Google Scholar 

  70. Schrag SJ, Zell ER, Lynfield R, et al. A population-based comparison of strategies to prevent early-onset group B streptococcal disease in neonates. N Engl J Med. 2002;347:233–9.

    Article  PubMed  Google Scholar 

  71. Fairlie T, Zell ER, Schrag S. Effectiveness of intrapartum antibiotic prophylaxis for prevention of early-onset group B streptococcal disease. Obstet Gynecol. 2013;121:570–7.

    Article  CAS  PubMed  Google Scholar 

  72. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Desjardins M, Delgaty KL, Ramotar K, Seetaram C, Toyeet B. Prevalence and mechanisms of erythromycin resistance in group A and group B streptococcus: implications for reporting susceptibility results. J Clin Microbiol. 2004;42:5620–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Madhi SA, Cutland CL, Jose L, et al. Safety and immunogenicity of an investigational maternal trivalent group B streptococcus vaccine in healthy women and their infants: a randomised phase 1b/2 trial. Lancet Infect Dis. 2016;16:923–34.

    Article  CAS  PubMed  Google Scholar 

  75. Baker CJ, Rench MA, McInnes P. Immunization of pregnant women with group B streptococcal type III capsular polysaccharide-tetanus toxoid conjugate vaccine. Vaccine. 2003;21:3468–72.

    Article  CAS  PubMed  Google Scholar 

  76. Absalon J, Segall N, Block SL, et al. Safety and immunogenicity of a novel hexavalent group B streptococcus conjugate vaccine in healthy, non-pregnant adults: a phase 1/2, randomised, placebo-controlled, observer-blinded, dose-escalation trial. Lancet Infect Dis. 2021;21:263–74.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Section of Pediatric Infectious Diseases, Tepecik Training and Research Hospital, University of Health Sciences, İzmir, Türkiye

    Eda Karadağ Öncel

  2. Division of Pediatric Infectious Diseases, Department of Pediatrics, Chobanian & Avedisian School of Medicine, Boston University, and Section of Pediatric Infectious Diseases, Boston Medical Center, Boston, MA, USA

    Mine Uzunsoy Duzgol & Vishakha Sabharwal

  3. Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Kocaeli University, Kocaeli, Türkiye

    Ayşe Engin Arısoy

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  1. Eda Karadağ Öncel
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Correspondence to Eda Karadağ Öncel .

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Editors and Affiliations

  1. Department of Pediatrics, University of Kocaeli, Medical Faculty, İzmit, Kocaeli, Türkiye

    Ayşe Engin Arısoy

  2. Department of Pediatrics, University of Kocaeli, Medical Faculty, İzmit, Kocaeli, Türkiye

    Emin Sami Arısoy

  3. Department of Otorhinolaryngology, Faculty of Medicine, Kırıkkale University, Kırıkkale, Türkiye

    Nuray Bayar Muluk

  4. Department of Otorhinolaryngology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Türkiye

    Cemal Cingi

  5. Division of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Armando G. Correa

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Karadağ Öncel, E., Uzunsoy Duzgol, M., Arısoy, A.E., Sabharwal, V. (2023). Group B Streptococcal Infections in Children and Hearing Loss. In: Arısoy, A.E., Arısoy, E.S., Bayar Muluk, N., Cingi, C., Correa, A.G. (eds) Hearing Loss in Congenital, Neonatal and Childhood Infections. Comprehensive ENT. Springer, Cham. https://doi.org/10.1007/978-3-031-38495-0_27

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