Group B streptococcal infection
Summary
Definition
History and exam
Key diagnostic factors
- presence of risk factors
- fever
- symptoms of meningitis
- signs of meningitis
- symptoms of sepsis
- signs of sepsis
- symptoms of pneumonia
- signs of pneumonia
- symptoms of UTI
- signs of UTI
- symptoms of cellulitis
- signs of cellulitis
- symptoms of septic arthritis
- signs of septic arthritis
- symptoms of conjunctivitis
- symptoms of sinusitis
- signs of sinusitis
- symptoms of otitis media
- signs of otitis media
- symptoms of endometritis
- signs of endometritis
- signs of chorioamnionitis
Other diagnostic factors
- non-specific signs of infection in neonate
- non-specific signs of infection in older patients
- symptoms of intra-abdominal infection
- signs of intra-abdominal infection
- mid-gestation abortion or pre-term labour
Risk factors
- 0 to 7 days of age
- maternal fever during labour
- premature rupture of membranes (PROM)
- previous baby with GBS disease
- maternal GBS colonisation
- GBS bacteriuria during pregnancy
- preterm delivery (<37 weeks)
- low birth weight (<2500 g)
- deficient maternal-specific IgG at term
- twin sibling with GBS disease
- maternal age <20 years
- chorioamnionitis
- age >60 years
- pregnancy
- diabetes mellitus
- advanced hepatic disease
- advanced renal disease
- presence of central venous catheter
- urological disorders
- break in skin integrity or skin ulcers
- neurological disease
- immunosuppression
- nursing-home resident
- black or Hispanic race
- malignancy
- primiparity
- obstetric manipulation
- presence of urinary catheter
- HIV infection
- trauma
- asthma
- consumption of placenta capsules
Diagnostic investigations
1st investigations to order
- FBC
- serum urea nitrogen and creatinine
- serum electrolytes
- serum glucose
- coagulation studies
- LFTs
- C-reactive protein (CRP)
- blood culture
- cerebrospinal fluid (CSF) Gram stain
- CSF culture
- CSF cell count and differential
- CSF glucose and protein
- antigen detection in CSF
- Gram stain and culture of other sterile body fluids
- chest x-ray
- joint x-ray
- CT head
Investigations to consider
- echocardiography
Treatment algorithm
early- or late-onset neonatal infection (0-89 days of age)
infants and children
adults
Contributors
Authors
Brendan Healy, MBChB, BSc (Hons), MRCP, FRCPath
Consultant in Microbiology and Infectious Diseases
University Hospital of Wales
Cardiff
UK
Disclosures
BH has received educational grants and fees for consultancy from a number of pharmaceutical companies, including BMS, Gilead, Jannsenn, Abbvie, ViiV, and MSD. This is principally in work relating to hepatitis C and HIV. BH has carried out consultancy work on some antibiotics, including fidaxomicin, linezolid, tedizolid, ceftobiprole, and ceftaroline. BH declares he has no competing interests in relation to the work carried out for this topic review, Group B streptococcus.
Acknowledgements
Dr Brendan Healy would like to gratefully acknowledge Dr Susannah Froude and Dr Harriet Hughes, previous contributors to this topic.
Disclosures
SF declares that she has no competing interests. HH declares that she has received funds from Gilead and Biocomposites related to conference registration, travel, accommodation, and speaker fees.
Peer reviewers
William A. Petri, Jr, MD, PhD, FACP
Chief and Professor of Medicine
Division of Infectious Diseases and International Health
University of Virginia Health System
Charlottesville
VA
Disclosures
WAP declares that he has no competing interests.
James R. Hanley, MD, FAAP
Assistant Professor
Pediatrics
Attending Physician
Pediatric Emergency Medicine
University of Southern Alabama Children's and Women's Hospital
Mobile
AL
Disclosures
JRH declares that he has no competing interests.
Differentials
- Sepsis caused by other organisms
- Endocarditis caused by other organisms
- Neonatal CMV infection
More DifferentialsGuidelines
- Prevention of early-onset group B streptococcal disease in newborns
- The prevention of early-onset neonatal group B streptococcal disease
More GuidelinesPatient leaflets
Cellulitis and erysipelas
Group B strep infection in newborns
More Patient leaflets
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