Patras Kathryn A, Nizet Victor
Division of Host-Microbe Systems & Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA, United States.
Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States.
Front Pediatr. 2018 Feb 22;6:27. doi: 10.3389/fped.2018.00027. eCollection 2018.
Group B (GBS) colonizes the gastrointestinal and vaginal epithelium of a significant percentage of healthy women, with potential for ascending intrauterine infection or transmission during parturition, creating a risk of serious disease in the vulnerable newborn. This review highlights new insights on the bacterial virulence determinants, host immune responses, and microbiome interactions that underpin GBS vaginal colonization, the proximal step in newborn infectious disease pathogenesis. From the pathogen perspective, the function GBS adhesins and biofilms, β-hemolysin/cytolysin toxin, immune resistance factors, sialic acid mimicry, and two-component transcriptional regulatory systems are reviewed. From the host standpoint, pathogen recognition, cytokine responses, and the vaginal mucosal and placental immunity to the pathogen are detailed. Finally, the rationale, efficacy, and potential unintended consequences of current universal recommended intrapartum antibiotic prophylaxis are considered, with updates on new developments toward a GBS vaccine or alternative approaches to reducing vaginal colonization.
B组链球菌（GBS）可定植于相当比例健康女性的胃肠道和阴道上皮，有可能在分娩期间上行至子宫内感染或传播，从而使脆弱的新生儿面临患严重疾病的风险。本综述着重介绍了关于细菌毒力决定因素、宿主免疫反应以及微生物组相互作用的新见解，这些因素构成了GBS阴道定植，而这是新生儿传染病发病机制的近端步骤。从病原体角度，综述了GBS黏附素和生物膜、β-溶血素/细胞毒素、免疫抗性因子、唾液酸模拟以及双组分转录调控系统的功能。从宿主角度，详细阐述了病原体识别、细胞因子反应以及阴道黏膜和胎盘对病原体的免疫。最后，考虑了当前普遍推荐的产时抗生素预防的基本原理、疗效及潜在的意外后果，并介绍了GBS疫苗或减少阴道定植的替代方法的新进展。
