Group B streptococcal carriage and disease: a 6-year prospective study.

A prospective study of group B streptococcal (GBS) carriage and disease was conducted over 6 years. Carriage rates at delivery for mothers and infants were 20% and 12%, respectively. Forty-five cases of GBS disease occurred in infants, 24 "early-onset" disease and 21 "late-onset" disease. The combined attack rate for early and late disease was 3.3 per 1000 live births over the 6 years. The rate of early-onset disease was highest in infants found to be heavily colonized at birth: 50 per 1000 live births. Twenty-three of 24 had evidence of intrauterine-acquired infection. All GBS serotypes were represented. Preterm delivery, prolonged labor, premature rupture of membranes, and maternal infection enhanced the risk of early disease. Septicemia was the predominant form of late-onset disease (15 of 21 cases); GBS type III accounted for 19 of 21 cases. Ten of 21 infants with late infections were colonized at birth with the GBS type that subsequently caused disease. Thus a maternal source of infection was identified in 34 of the 45 infants. These data reveal consistent year-to-year carriage and disease rates in the study population.

Post-streptococcal glomerulonephritis following pyoderma.

Studies of the epidemiology of acute glomerulonephritis (AGN) following pyoderma reported over the past 15 years have been reviewed. Investigations in Alabama, at Red Lake in Minnesota, and in Trinidad proved of special interest because they contribute new information concerning the natural history of streptococcal skin infections and the role of such infections in AGN. Interesting contrasts between streptococcal infections of the skin and those of the throat are now apparent. Compared with pharyngeal infections, skin infections are more common in young preschool children, are caused by different serotypes, and differ in the nature of the streptococcal antibody response. A number of new M-serotypes of group A streptococci, including several of importance in AGN, were found in studies of pyoderma. In contrast to M-types 1 and 12 (those of major importance in AGN followng pharyngitis), M-types 2, 49, 55, 57, and 60 are now recognized to be of major importance in AGN following pyoderma. Although streptococcal skin infections are quire important in AGN, they do not result in acute rheumatic fever.

A prolonged nursery epidemic associated with a newly recognized type of group A streptococcus.

During a six-month period 69 infants in a newborn nursery were colonized with group A streptococci. Fifty-one had omphalitis, two infected circumcision wounds, and one each had meningitis, primary peritonitis, and conjunctivitis. Thirteen infants were asymptomatically colonized. Control of the epidemic was difficult. Benzathine penicillin prophylaxis to all infants suppressed active infection but did not eradicate asymptomatic colonization of the umbilical cord. Triple dye treatment of the umbilical cord plus benzathine penicillin prophylaxis eradicated the infection from the nursery. The epidemic streptococcus was a newly recognized ""skin strain,'' provisional type strain 5656-S, not previously known to cause epidemic disease or serious systemic infections.