From the Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Perinatal HIV Research Unit, Faculty of Health Sciences, Department of Pediatrics, University of the Witwatersrand, Johannesburg, South Africa.
Pediatr Infect Dis J. 2020 Sep;39(9):794-798. doi: 10.1097/INF.0000000000002695.
Invasive group B streptococcal (GBS) disease causes considerable morbidity and mortality in young infants, and 18% of GBS-meningitis survivors have moderate-to-severe neurodevelopmental impairment. However, there is a paucity of data regarding neurologic impairment following GBS sepsis.
A case-control study was undertaken in infants at 3 secondary-tertiary hospitals in Johannesburg, South Africa. Neurodevelopmental assessments were done at 1 year of age using the Denver II Developmental screening tool. A case was defined as isolation of GBS from blood or cerebrospinal fluid in infants less than 90 days of age. Three healthy controls (range: 1-6) were matched to maternal age, maternal HIV-infection status, gestational age and timing of enrollment.
Of 122 invasive GBS cases, 78 (63.9%) had sepsis and 44 (36.1%) meningitis. Twenty-two (18%) invasive GBS cases (17 of 78; 21.8% with sepsis and 5 of 44; 11.4% with meningitis) died during the course of hospitalization, and a further 2 (1.6%; 1 sepsis and 1 meningitis case) died by 1 year of age. Five (1.1%) of 449 controls died by 1 year of age. Of the 45 GBS sepsis cases and 141 matched controls followed through to 1 year of age, 11 (24.4%) cases (3 with moderate-to-severe impairment) and 10 (7.1%) controls had an abnormal Denver score with an adjusted (for gender) odds ratio of 3.51; 95% confidence interval (CI): 1.23-10.04; P = 0.019. Four (20%) of the 20 GBS meningitis cases compared with 1 (1.5%) control had neurologic impairment at 1-year of age (aOR: 8.29; 95% CI: 0.88-78.3; P = 0.065) CONCLUSION:: In this setting, invasive GBS disease is associated with a high mortality. Infant survivors of invasive GBS sepsis compared with controls had 3.5-fold greater odds of neurologic impairment by 1 year of age. This corroborates the need for strategies to prevent invasive GBS disease.
侵袭性 B 组链球菌（GBS）疾病会导致婴幼儿出现相当大的发病率和死亡率，18%的 GBS 脑膜炎幸存者存在中度至重度神经发育障碍。然而，关于 GBS 败血症后神经功能障碍的数据却很少。
在南非约翰内斯堡的 3 所二级和三级医院进行了一项病例对照研究。在 1 岁时使用丹佛发育筛查工具进行神经发育评估。病例定义为年龄小于 90 天的婴儿血液或脑脊液中分离出 GBS。3 名健康对照者（年龄 1-6 岁）与母亲年龄、母亲 HIV 感染状况、胎龄和入组时间相匹配。
在 122 例侵袭性 GBS 病例中，78 例（63.9%）为败血症，44 例（36.1%）为脑膜炎。22 例（18%）侵袭性 GBS 病例（败血症 17 例，占 21.8%；脑膜炎 5 例，占 11.4%）在住院期间死亡，另有 2 例（1.6%；1 例败血症，1 例脑膜炎）在 1 岁前死亡。5 例（1.1%）对照组在 1 岁前死亡。在 45 例 GBS 败血症病例和 141 例匹配的对照组中，11 例（24.4%）病例（3 例为中重度损伤）和 10 例（7.1%）对照组的 Denver 评分异常，调整性别后比值比为 3.51；95%置信区间（CI）：1.23-10.04；P=0.019。与 1 例对照组（1.5%）相比，20 例 GBS 脑膜炎病例中有 4 例（20%）在 1 岁时有神经功能障碍（比值比：8.29；95%CI：0.88-78.3；P=0.065）。
在这种情况下，侵袭性 GBS 疾病与高死亡率相关。与对照组相比，侵袭性 GBS 败血症的婴儿幸存者在 1 岁时发生神经功能障碍的可能性高出 3.5 倍。这证实了需要制定策略来预防侵袭性 GBS 疾病。
