BackgroundGroup B Streptococcus (GBS) is the leading cause of neonatal sepsis in the developed world. Little is known about its epidemiology in the developing world, where the majority of deaths from neonatal infections occur. Maternal carriage of GBS is a prerequisite for the development of early onset GBS neonatal sepsis but there is a paucity of carriage data published from the developing world, in particular South East Asia.MethodsWe undertook a cross sectional study over a 13 month period in a remote South East Asian setting on the Thai-Myanmar border. During labour, 549 mothers had a combined vaginal rectal swab taken for GBS culture. All swabs underwent both conventional culture as well as PCR for GBS detection. Cultured GBS isolates were serotyped by latex agglutination, those that were negative or had a weak positive reaction and those that were PCR positive but culture negative were additionally tested using multiplex PCR based on the detection of GBS capsular polysaccharide genes.ResultsThe GBS carriage rate was 12.0% (95% CI: 9.4-15.0), with 8.6% positive by both culture and PCR and an additional 3.5% positive by PCR alone. Serotypes, Ia, Ib, II, III, IV, V, VI and VII were identified, with II the predominant serotype. All GBS isolates were susceptible to penicillin, ceftriaxone and vancomycin and 43/47 (91.5%) were susceptible to erythromycin and clindamycin.ConclusionsGBS carriage is not uncommon in pregnant women living on the Thai-Myanmar border with a large range of serotypes represented.
We analyzed 129 paired nasopharyngeal aspirates (stored in viral transport medium [VTM]) and nasopharyngeal swabs (stored in skim milk-tryptone-glucose-glycerol [STGG] bacterial transport and storage medium) using PCRs to detect adenoviruses, influenza virus A or B, and respiratory syncytial virus (RSV). Overall, swabs stored in STGG medium without antimicrobials were found to be an acceptable alternative to aspirates stored in antimicrobial-containing VTM, with PCR agreement of 90.2% (kappa of 0.8).Longitudinal population-based studies of bacterium-virus interactions in the nasopharynx will result in improved understanding of the pathogenesis of respiratory tract infections, a major cause of morbidity and mortality globally (1, 10). Nasopharyngeal aspirates (NPA) or nasopharyngeal swabs (NPS) collected into a viral transport medium (VTM), usually containing antimicrobial agents to prevent bacterial overgrowth, have been considered the optimal specimen for respiratory virus detection (3). However, antimicrobial-containing VTM precludes culture-based detection and characterization of bacterial upper respiratory tract colonizers, necessitating the collection of duplicate samples if both viruses and bacteria are to be studied.We sought to determine whether NPS collected and stored in skim milk-tryptone-glucose-glycerol (STGG) bacterial transport and storage medium could be used to determine the presence of respiratory tract viruses in the upper respiratory tract, thus permitting assessment of bacterium-virus interaction in vivo from a single specimen.We analyzed 129 paired NPA and NPS specimens taken from infants diagnosed with pneumonia during a longitudinal cohort study on the Thailand-Myanmar border (8). NPA were collected in 1 ml of VTM (minimum essential medium with Hanks balanced salt solution [MEM-Hanks] with 0.5% gelatin, amphotericin B, penicillin, and streptomycin; prepared inhouse) and stored at Ϫ80°C until extraction and PCR. Nucleic acid was extracted from these NPA-VTM specimens using spin columns (NucleoSpin RNA virus kit [Macherey-Nagel, Germany] or QIAamp viral RNA minikit [Qiagen, Germany]) following the manufacturer's instructions. Extracts were analyzed by real-time PCR for adenoviruses, influenza viruses, and respiratory syncytial virus (RSV), with a human RNase P PCR to detect the presence of inhibitors as previously described (2, 9). A Rotorgene 6000 real-time PCR thermocycler (Corbett Life Science, Australia) and SuperScript III one-step reverse transcription-PCR (RT-PCR) kit (Invitrogen) were used throughout. The specimens were considered positive if a virus PCR threshold cycle (C T ) value was Ͻ40 with appropriate run control results. Specimens with low positive PCR results (C T values of 35 to 39) were repeated: only if the C T was Ͻ40 in both runs was the virus PCR considered positive. Dacrontipped NPS (Medical Wire & Equipment, United Kingdom) were collected into 1 ml of STGG transport medium (no antimicrobials; prepared in-house) and processed according to the WHO protocol for Streptoc...
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