1887
Volume 2025, Issue 1
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Late-onset group B (LOGBS) sepsis is a notable cause of morbidity and mortality in preterm neonates. While the vertical transmission of group B (GBS) during delivery is well established, the potential role of breast milk in the transmission of LOGBS is not as clearly understood. This case report examines a unique instance of preterm triplets developing LOGBS sepsis following maternal GBS mastitis, with the aim of investigating the possible association between breast milk and LOGBS infection in preterm infants.

A set of preterm male triplets born at 30 weeks of gestation were admitted to the neonatal intensive care unit. At two weeks of age, the infants showed clinical manifestations of LOGBS sepsis, including septicemia. Additionally, one of the triplets developed meningitis complicated by hydrocephalus, while another developed necrotizing enterocolitis (NEC). Concurrently, their mother was diagnosed with mastitis and her breast milk cultures tested positive for GBS. The triplets were treated with systemic antibiotics. However, triplet B subsequently required a ventriculoperitoneal shunt for hydrocephalus management, and triplet C underwent laparotomy for NEC treatment.

The occurrence of LOGBS sepsis in these preterm triplets, coupled with maternal GBS mastitis and positive breast milk cultures, raises critical questions regarding breast milk as a possible route of transmission for LOGBS. Understanding this relationship is vital for improving clinical practice, particularly in the management of recurrent infections in this vulnerable population.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2025.25
2025-03-17
2025-04-02
The full text of this item is not currently available.

References

  1. Berardi A, Trevisani V, Di Caprio A, Bua J, China M, Perrone B, et al. Understanding factors in group B streptococcus late-onset disease. Infect Drug Resist. 2021 Aug 17:14:3207–3218. doi: 10.2147/IDR.S291511.
    [Google Scholar]
  2. Puopolo KM, Lynfield R, Cummings JJ, Hand I, Adams-Chapman I, Poindexter B, et al. Management of infants at risk for group B streptococcal disease. Pediatrics. 2019Aug 1; 144:(2):e20191881. doi: 10.1542/peds.2019-1881.
    [Google Scholar]
  3. Nakwa FL, Lala SG, Madhi SA, Dangor Z. Neurodevelopmental impairment at 1 year of age in infants with previous invasive group B streptococcal sepsis and meningitis. Pediatr Infect Dis J. 2020Sep 1; 39:(9):794–798. doi: 10.1097/INF.0000000000002695.
    [Google Scholar]
  4. Kohli-Lynch M, Russell NJ, Seale AC, Dangor Z, Tann CJ, Baker CJ, et al. Neurodevelopmental impairment in children after group B streptococcal disease worldwide: systematic review and meta-analyses. Clin Infect Dis. 2017Nov 6;65(suppl_2):S190–S199. doi: 10.1093/cid/cix663.
    [Google Scholar]
  5. Dhudasia MB, Flannery DD, Pfeifer MR, Puopolo KM. Updated guidance: prevention and management of perinatal group B Streptococcus infection. Neoreviews. 2021Mar 1; 22:(3):e177–e188. doi: 10.1542/neo.22-3-e177.
    [Google Scholar]
  6. Miselli F, Frabboni I, Di Martino M, Zinani I, Buttera M, Insalaco A, et al. Transmission of group B Streptococcus in late-onset neonatal disease: a narrative review of current evidence. Ther Adv Infect Dis. 2022Dec 21;9:20499361221142732. doi: 10.1177/20499361221142732.
    [Google Scholar]
  7. Zimmermann P, Gwee A, Curtis N. The controversial role of breast milk in GBS late-onset disease. J Infect. 2017Jun 1; 74: Suppl 1:S34–S40. doi: 10.1016/S0163-4453(17)30189-5.
    [Google Scholar]
  8. Nanduri SA, Petit S, Smelser C, Apostol M, Alden NB, Harrison LH, et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance. JAMA Pediatr. 2019Jan 14; 173:(3):224–233. doi: 10.1001/jamapediatrics.2018.4826.
    [Google Scholar]
  9. Pintye J, Saltzman B, Wolf E, Crowell CS. Risk factors for late-onset group B streptococcal disease before and after implementation of universal screening and intrapartum antibiotic prophylaxis. J Pediatr Infect Dis Soc. 2016Dec 1; 5:(4):431–438. doi: 10.1093/jpids/piv067.
    [Google Scholar]
  10. Berardi A, Rossi C, Lugli L, Creti R, Bacchi Reggiani ML, Lanari M, et al. Group B streptococcus late-onset disease: 2003–2010. Pediatrics. 2013Feb 1; 131:(2):e361–e368. doi: 10.1542/peds.2012-1231.
    [Google Scholar]
  11. Kwatra G, Cunnington MC, Merrall E, Adrian PV, Ip M, Klugman KP, et al. Prevalence of maternal colonisation with group B streptococcus: a systematic review and meta-analysis. Lancet Infect Dis. 2016Sep 1; 16:(9):1076–1084. doi: 10.1016/S1473-3099(16)30055-X..
    [Google Scholar]
  12. Milani C, Duranti S, Bottacini F, Casey E, Turroni F, Mahony J, et al. The first microbial colonizers of the human gut: composition, activities, and health implications of the infant gut microbiota. Microbiol Mol Biol Rev. 2017Nov 8; 81:(4):e00036-17. doi: 10.1128/MMBR.00036-17.
    [Google Scholar]
  13. Yue L, Liu H. Neonatal late-onset meningitis caused by serotype III CC17 group B Streptococci aggregating in two families from Southern China. Infect Drug Resist. 2023 May 31:16:3417–3424. doi: 10.2147/IDR.S401545.
    [Google Scholar]
  14. Kotiw M, Zhang GW, Daggard G, Reiss-Levy E, Tapsall JW, Numa A. Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission. Pediatr Dev Pathol. 2003 May–June; 6:(3):251–256. doi: 10.1007/s10024-001-0276-y.
    [Google Scholar]
  15. Gagneur A, Héry-Arnaud G, Croly-Labourdette S, Gremmo-Feger G, Vallet S, Sizun J, et al. Infected breast milk associated with late-onset and recurrent group B streptococcal infection in neonatal twins: a genetic analysis. Eur J Pediatr. 2009Sep; 168:(9):1155–1158. doi: 10.1007/s00431-008-0903-y.
    [Google Scholar]
  16. Nicolini G, Borellini M, Loizzo V, Creti R, Memo L, Berardi A. Group B streptococcus late-onset disease, contaminated breast milk and mothers persistently GBS negative: report of 3cases. BMC Pediatr. 2018July 5;18:214. doi: 10.1186/s12887-018-1192-x.
    [Google Scholar]
  17. Bæk O, Sangild PT, Thymann T, Nguyen DN. Growth restriction and systemic immune development in preterm piglets. Front Immunol. 2019Oct 10;10:2402. doi: 10.3389/fimmu.2019.02402.
    [Google Scholar]
  18. Karampatsas K, Davies H, Mynarek M, Andrews N, Heath PT, Le Doar K. Clinical risk factors associated with late-onset invasive group B streptococcal disease: systematic review and meta-analyses. Clin Infect Dis. 2022Sep 30; 75:(7):1255–1264. doi: 10.1093/cid/ciac206.
    [Google Scholar]
  19. Li A, Fang M, Hao D, Wu Q, Qian Y, Xu H, et al. Late-onset sepsis in a premature infant mediated by breast milk: mother-to-infant transmission of group B Streptococcus detected by whole-genome sequencing. Infect Drug Resist. 2022Sep 9;15:5345–5352. doi: 10.2147/IDR.S381466.
    [Google Scholar]
  20. Fukunaga R, Asano T, Matsui R, Abe M, Ishiwada N, Shima Y. A case of bacteremia and meningitis in a neonate infected with group B Streptococcus via breastfeeding who survived without neurological sequelae: a case report. J Nippon Med Sch. 2024Nov 6; 91:(5):495–498. doi: 10.1272/jnms.JNMS.2024_91-501.
    [Google Scholar]
  21. Ager EP, Steele ED, Nielsen LE, Nestander MA, Mende K, Spencer SE. Hypervirulent Streptococcus agalactiae septicemia in twin ex-premature infants transmitted by breast milk: report of source detection and isolate characterization using commonly available molecular diagnostic methods. Ann Clin Microbiol Antimicrob. 2020Nov 26; 19:(1):55. doi: 10.1186/s12941-020-00396-6.
    [Google Scholar]
  22. Siewert RC, Holida D. Early-and late-onset group B streptococcal infections: overview and case studies. Newborn Infant Nurs Rev. 2010Dec 1; 10:(4):182–186. doi: 10.1053/j.nainr.2010.09.006.
    [Google Scholar]
  23. Arias-Camison JM. Late onset group B streptococcal infection from maternal expressed breast milk in a very low birth weight infant. J Perinatol. 2003Dec; 23:(8):691–692. doi: 10.1038/sj.jp.7210994.
    [Google Scholar]
  24. Ching NS, Buttery JP, Lai E, Steer AC, Standish J, Ziffer J, et al. Breastfeeding and risk of late-onset group B streptococcal disease. Pediatrics. 2021Sep 1; 148:(3). doi: 10.1542/peds.2020-049561.
    [Google Scholar]
/content/journals/10.5339/qmj.2025.25
Loading
/content/journals/10.5339/qmj.2025.25
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error