Meta-analysis on prevalence of vaginal group B streptococcus colonization and preterm births in India

Ashary, Nancy; Singh, Abhishek Dharm; Chhabria, Karisma; Modi, Deepak

doi:10.1080/14767058.2020.1813705

Cited by 14 publications

(24 citation statements)

References 31 publications

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“…A study included in this meta-analysis also reported a prevalence of 62% when polymerase chain reaction (PCR) was used for GBS detection. 27 Transmission of GBS colonization from pregnant women to their newborns was also reported in two studies; the range varied from 6.7% to 11.1%. 28 , 29 …”

Section: Epidemiology Of Gbs Infections In Indiamentioning

confidence: 75%

“…Similar observation was also made by the author in a recent meta-analysis conducted by Ashary and colleagues. 27 As per the WHO, the disease colonization in pregnant women was reported to be highest in India (2.5 million) followed by China (1.9 million), Nigeria (1.1 million), the US (0.9 million), and Indonesia (0.8 million), while the highest burden of disease was found in Africa, accounting for 54% of the estimated cases and 65% of all fetal/infant deaths. 49 Despite these statistics, only a few cases of GBS are reported, which can be attributed to a high number of home births, inadequate or conventional methods of screening, and financial constraints.…”

Section: Discussionmentioning

confidence: 96%

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Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – a narrative review

Ghia

Rambhad

2021

Therapeutic Advances in Infection

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Streptococcus agalactiae, a Gram-positive bacterium, causes invasive infection known as Group B streptococcal disease (GBS). It is a leading cause of neonatal death and complications prior to delivery. The burden of GBS is unknown in India despite the high incidence of preterm and stillbirths. In this study, we performed a narrative review of the available literature (published in the last 10 years) on the epidemiology of GBS, using PubMed and Google Scholar, to understand its impact in India and evaluate potential strategies to prevent the disease in the high-risk population, that is, neonates. The review showed that the incidence of early- and late-onset GBS in neonates (per 1000 live births) was in the ranges of 0.090–0.68 and 0.0–0.07 respectively. The overall case fatality rate reported in only one study was 0.63. In pregnant women, the prevalence of GBS colonization was 2–62% and its transmission to their newborns varied from 6.7% to 11.1%. The serotype distribution of GBS is unclear, but some studies reported the distribution of types Ia, Ib, II, III, V, VII among pregnant women in India. The associated risk factors for GBS colonization in pregnant women are unclear but a few studies suggest the role of age and multigravida, while the risk factors in neonates include preterm birth, prolonged rupture of membrane (⩾18 h), maternal fever, obstetric complications, and prolonged labor >18 h. Screening of GBS is not a routine practice in India and intrapartum antibiotics prophylaxis is limited to only in risk conditions to prevent neonatal disease transmission. A few studies also suggest that high birth rate, poor detection methods, and financial constraints limit routine GBS screening in a developing country such as India. Hence, maternal vaccination is the most promising strategy to prevent neonatal GBS and Pfizer’s hexavalent GBS conjugate vaccine (GBS6) is being developed for GBS neonatal disease.

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Section: Epidemiology Of Gbs Infections In Indiamentioning

confidence: 75%

Section: Discussionmentioning

confidence: 96%

Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – a narrative review

Ghia

Rambhad

2021

Therapeutic Advances in Infection

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“…Further, vaginal colonization of GBS has a direct correlation with vertical transmission of the pathogen ( McDonald et al 1989 ) and resultant invasive infections in the newborn leading to serious implications like pneumonia and meningitis in the newborn ( Heath 2016 ). The associations between maternal GBS colonization and preterm birth were observed in multiple cross-sectional and case–control studies when cultures were performed at delivery ( Ashary et al 2022 , Berikopoulou et al 2021 , Yaseen et al 2021 ). However, this association was not observed in longitudinal cohorts where cultures were performed earlier in pregnancy ( Bianchi-Jassir et al 2017 ).…”

Section: Group B Streptococcus and Preterm Birthsmentioning

confidence: 99%

“…A meta-analysis regarding the recto-vaginal colonization of GBS in 85 countries revealed that 35% of Caribean, North America, and Europe and 25% of South Africa were the regions where the most prevalent colonization was observed with a global average of approximately 20–25% being affected from GBS infections. In India, the carriage rate for GBS is estimated to be 7.4% ( Ashary et al 2022 ). The main factors responsible for GBS recto-vaginal colonization include biological factors like premature rupture of membranes, presence of GBS in the intestinal tract, and mother with age over 40.…”

Section: Group B Streptococcus and Preterm Birthsmentioning

confidence: 99%

Mechanisms of group B Streptococcus-mediated preterm birth: lessons learnt from animal models

Kurian¹,

Modi

2022

Reproduction and Fertility

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Group B Streptococcus (GBS) is an opportunistic pathogenic bacterium which upon colonization in the female reproductive tract can cause preterm births, fetal injury, and demise. Several determinants for GBS pathogenesis have been explored so far through the studies using animal models ranging from mice to non-human primates. The results from these experimental data have identified outer membrane vesicles, β-hemolysin, hyaluronidase, and Cas9 of GBS as major virulence factors leading to preterm births. Most of these factors drive inflammation through activation of NLRP3 and elevated production of IL1-β. However, the absence of one of the factors from the pathogen reduces but does not completely abolish the pathogenesis of GBS suggesting the involvement of more than one factor in causing preterm birth. This makes further exploration of other virulence factors of GBS pathogenesis important in gaining an insight into the mechanistic basis of GBS-mediated preterm births.

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“…As an alternative to blood agar, crome agar and Granda medium are also used for selective and differential isolation of GBS [10]. However, selective enrichment of GBS in Todd-Hewitt broth before subculture on sheep blood agar as well as crome agar Strep B allows for efficient detection of GBS in higher vaginal swab samples [11][12][13]. While enrichment of the sample and the culture are the gold standard methods for the detection of GBS in clinical samples [9,14], they are time-consuming and require more than 72 h for reporting.…”

Section: Introductionmentioning

confidence: 99%

False-positive detection of Group B Streptococcus (GBS) in chromogenic media (Strep B Carrot Broth) due to presence of Enterococcus faecalis in High Vaginal swabs

Singh

Husein

Singh

et al. 2022

Journal of Medical Microbiology

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Introduction. Vaginal colonization of Group B Streptococcus (GBS) is associated with preterm births and neonatal sepsis. Thus routine screening of GBS in prenatal care is recommended. Hypothesis. Chromogenic media (carrot broth) aids in specific and rapid detection of GBS. Aim. To investigate the efficiency of Strep B Carrot Broth for detection of GBS in high vaginal swabs from pregnant women. Methods. In this study 201 vaginal swab samples were collected from pregnant women. Swabs were inoculated in chromogenic media (Strep B Carrot Broth). The positive and negative cultures were inoculated on blood agar and crome agar plates. The colonies were subjected to 16S rRNA sequencing and gene-specific PCR for confirmation. The Christie Atkins Munch Peterson (CAMP) and bile esculin agar (BEA) tests were used for biochemical confirmation. PCR was performed on genomic DNA isolated from uncultured vaginal swabs. Results. It was found that 20/201 (9.9 %) vaginal swab samples were positive in the Strep B Carrot Broth and 17/20 (85 %) and 19/20 (95 %) of these samples yielded colonies on blood agar and crome agar, respectively. Of the 181 carrot broth-negative samples, 1 (0.5 %) and 38 (20.9 %) yielded colonies on blood agar and crome agar plates, respectively. However, 16 s rRNA sequencing revealed that none of the 20 carrot broth-positive cultures were GBS and had sequence similarities to Enterococcus faecalis . This was also confirmed by using gene-specific PCR and BEA positivity. Furthermore, E. faecalis was detected by PCR in DNA isolated from 57 uncultured vaginal swabs samples, GBS could only be detected by PCR in four samples. Conclusion. Carrot broth-based culture can lead to false-positive detection due to the presence of E. faecalis . Thus GBS-positive results in carrot broth must be confirmed by the other molecular and biochemical tests before making a final diagnosis.

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Meta-analysis on prevalence of vaginal group B streptococcus colonization and preterm births in India

Cited by 14 publications

References 31 publications

Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – a narrative review

Disease burden due to Group B Streptococcus in the Indian population and the need for a vaccine – a narrative review

Mechanisms of group B Streptococcus-mediated preterm birth: lessons learnt from animal models

False-positive detection of Group B Streptococcus (GBS) in chromogenic media (Strep B Carrot Broth) due to presence of Enterococcus faecalis in High Vaginal swabs

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