Summary
Group B streptococci (GBS) have become a main cause of serious neonatal infections in the last decade, leading to an absolute increase in the incidence of neonatal bacterial disease throughout the world. Five serotypes of GBS are known (I a, I b, I c, II and III). An overall predominance and a striking meningeal tropism has been reported for GBS type III. Each serotype may cause anearly-onset or alate-onset form of clinical GBS disease, the one acquired vertically pre- or intrapartum, the other horizontally as a nosocomial and probably cohort-type infection. The colonization rate of parturient women is the single most significant determinant of GBS infection in the neonate. But a colonization to disease ratio in the order of 100:1 suggests host factors in the genesis of the disease, of which the most important one seems to be the presence of maternally acquired protective levels of type-specific antibodies in the newborn. Modes of their induction should be developed for preventive control. Until such solutions are available, early detection and prompt treatment are indicated. Antibiotic eradication of GBS from the maternal genital tract remains a controversial issue.
Zusammenfassung
Streptokokken der Gruppe B (GBS) sind in den vergangenen zehn Jahren zu einer der führenden Ursachen für ernste Neugeboreneninfektionen geworden und haben weltweit zu einer Zunahme der absoluten Inzidenz bakterieller Erkrankungen beim Neugeborenen geführt. Bekannt sind fünf Serotypen von GBS (I a, I b, I c, II, III). Es wird berichtet, daß GBS-Typ III insgesamt dominiert und eine auffallende Meningotropie besitzt. Jeder der genannten Serotypen kann eine frühe oder späte Manifestationsform der klinischen GBS Erkrankung verursachen, wobei die erstere vertikal prä- oder intrapartal und die letztere horizontal, nosokomial und wahrscheinlich als Gruppeninfektion erworben wird. Die Besiedlungsrate der Gebärenden ist der bedeutendste Einzelfaktor für die GBS-Infektion beim Neugeborenen. Doch läßt eine Kolonisations : Erkrankungsrate im Bereich von 100:1 darauf schließen, daß Wirtsfaktoren für die Krankheitsgenese eine bedeutsame Rolle spielen, von denen der wichtigste die Anwesenheit protektiver Spiegel von mütterlichen Typen-spezifischen Antikörpern beim Neugeborenen zu sein scheint. Als vorbeugende Maßnahme sollten Methoden zur Induktion dieser schützenden Antikörper entwickelt werden, um die Krankheit unter Kontrolle zu bringen. Bis jedoch eine solche Lösung verfügbar ist, bleiben Frühdiagnose und Sofort-therapie das Vorgehen der Wahl. Die Beseitigung von GBS aus dem mütterlichen Genitaltrakt mit Antibiotika bleibt ein umstrittenes Kapitel.
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Kretschmer, R., Becker, I. Group B streptococcal disease in the newborn: An immunological challenge. Infection 8, 245–249 (1980). https://doi.org/10.1007/BF01639046
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DOI: https://doi.org/10.1007/BF01639046