What Is Gbs & Why Is It Important
Group B Streptococcus, specifically, Streptococcus agalactiae, also known as Group B Strep or GBS for short, is one of the trillions of organisms that normally inhabit the human intestinal tract. Via migration from the intestines, it also colonizes the rectum, bladder, and vaginal tracts of many women. At any given time, worldwide, as many as 35% of people are colonized with this bacteria. While it can cause infection in people of any age, GBS doesnt seem to play a particularly beneficial role in human health, nor, when kept in check by healthy gut, vaginal, or bladder flora, does it usually cause harm to adults who are colonized with it, and in fact, most people colonized with it will never develop infection that is, illness caused by it.
So what’s the fuss?
In the 1970s, GBS was recognized as a leading cause of serious infection in newborns and infants. Two well-established syndromes exist for GBS disease
- Early-onset disease , which occurs when baby is less than 7 days old, and
- Late-onset disease , which occurs when baby is between 7-90 days old.
Either can cause pneumonia, sepsis, and meningitis, though meningitis is more common with late onset disease (7% of cases of EOD, 25-30% of LOD.
Gbs Hyaluronidase Impedes Immune Detection And Aids In Ascension To The Uterus
Hyaluronan levels increase in the cervix throughout pregnancy, reaching their height during parturition. This glycosaminoglycan plays a structural role in the ECM, and plays additional roles in cell migration, adhesion, and inflammation through its digestion into fragments that interact with a diverse array of host receptors, including toll-like receptor 2 and 4 . HA is crucial for maintaining epithelial polarization and barrier function, and loss of HA is associated with ascending infection and subsequent infection-induced PTB . Additionally, low molecular weight HA serves as a damage-associated molecular pattern that initiates TLR2 and 4-mediated inflammation during tissue injury . GBS exploits this axis through the secretion of hyaluronidase , which cleaves the pro-inflammatory HA DAMPs into disaccharides, which bind to TLR2/4 and block recognition of GBS ligands. This ultimately results in a dampened immune response . Interestingly, GBS clinical strains isolated from cases of PTB or invasive neonatal infection had high HylB activity, and HylB activity was associated with ascending infection, reduced uterine inflammation, and increased rates of PTB in mice . Although these studies partially define interactions in this immune evasion mechanism, the precise timing, immune mediators, and cell types involved remain unidentified.
In 2002 The Cdc Revised Their Guidelines To Recommend The Universal Approach
This decision was based on an important study published in the New England Journal of Medicine . In this study, researchers used CDC lab results and chart reviews to look at 629,912 live births that took place in the U.S. between the years 1998-1999.The researchers randomly selected 5,144 of these births to study, plus all 314 infants who were born with early GBS. They used hospital records to label people as receiving the universal approach or the risk-based approach .
The results? There were 0.5 infants born with GBS per every 1,000 pregnant parents. People in both groups received antibiotics about a third of the time. But people whose care providers used the universal approach had a 54% reduction in the risk of early GBS infection compared to people whose care providers used the risk-based approach. This means that the universal approach worked better than the risk-based approach.
In 2002-2003, the same group of researchers looked at 819,528 births in the U.S. to see whether the revised guidelines had been put into practice. Like the previous study, the researchers picked a random sample of birthing people and infants to analyze, along with the 254 infants who had early GBS infection. Between 1999 and 2002, use of the universal approach rose from about 50% to 85%, and use of antibiotics during labor rose from 27% to 32%.
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Can I Retest For Gbs Before Labor
No. Retesting is not recommended, because if you test positive the first time, its assumed that you have had a colonization and require antibiotics to reduce your risk of passing on an infection to the infant during birth. Even if you retook the test and your results were negative the second time, youd still be treated as if you were positive.
In this regard, the information regarding GBS screening is not foolproofand can seem a bit murky. While the test itself has a high rate of accuracy, its a simple fact that GBS colonization may come and go in peoples bodies. Because your GBS status can change after you have your screening, this may mean that some women are unnecessarily treated, and it may conversely mean that some cases are not detected.
How To Prevent Strep Throat
The best way to avoid unnecessary and unwanted complications is to avoid having strep throat. Unfortunately, there is no vaccine yet for this bacterial infection. But there are other ways to prevent strep throat such as:
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What Are The Risks Of Having A Gbs Infection
In pregnancy , GBS can cause urinary tract infections, but many people who have it are asymptomatic. However, if these bacteria are present in the vagina, and the baby comes in contact with them during birth, they can make the baby sick with a serious infection. This can lead to pneumonia, sepsis and even meningitisan infection of the fluid in the brain and spinal cord, writes midwife Diana Spalding, MS, CNM, in The Motherly Guide to Becoming Mama.
These risks, though severe, are relatively rare with treatment. According to statistics from the CDC, if you test positive for GBS and receive treatment, theres a 1 in 4,000 chance of delivering a baby who will develop an infection related to GBS. If you test positive but do not receive treatment, that number jumps to 1 in 200.
In a previous era, GBS infections had a 50% mortality rate, which is why there are strict guidelines in place to screen and treat GBS, writes Spalding. The guidelines have resulted in a dramatic reduction in the rate of infant infection since the 1990s.
Now, its estimated that just 4% to 6% of babies who develop GBS disease may die . Babies at greater risk of infection and serious disease from GBS are typically those born preterm or with low birth weight.
Complications Of Strep Throat
While strep throat might be common, you should know that having a strep throat often is alarming. Frequent strep throat may lead to serious diseases such as:
- Otitis media or ear infection
- Retropharyngeal abscess
- Kidney disorders
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Can A Mother Develop Gbs Antibodies That Protect Her Baby ^
YES. In this landmark study that the CDC draws many of its GBS recommendations from, researchers concluded that Sufficient amounts of GBS capsular polysaccharide type-specific serum IgG in mothers have been shown to protect against invasive disease in their infants. In plain English, this means that women who have developed an immunity to GBS bacteria pass immunity on to their children.
On the other hand, low antibody levels in the mother put baby at an increased risk for early-onset GBS. Why is that? Some people believe that the women who were found to have low antibody levels either had compromised immune function, a genetic inability to make GBS antibodies, or a recent exposure to GBS that they had not yet built an immunity to, and therefore could not pass on.
Production Of Specific Antimicrobials By The Lactobacilli Strains
Bacteriocin production was assayed using an agar diffusion method as described by Dodd et al. and modified by Martín et al. , using the S. agalactiae strains as the indicator bacteria employed for the overlay method. The lactobacilli strains were screened for hydrogen peroxide production following the procedure described by Song et al. . In the case of positive strains, hydrogen peroxide production was also measured by the quantitative method of Yap and Gilliland . The concentration of L- and D-lactic acid in the supernatants of MRS cultures of the lactobacilli strains was quantified using an enzymatic kit , following the manufacturers instructions. The pH values of the supernatants were also measured. All these assays were performed in triplicate and the values were expressed as the mean ± SD.
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How Will Antibiotics During Labor Affect A Newborns Microbiome
When this Evidence Based Birth® article was first published in early 2014, I could not find any evidence on the effects of in-labor antibiotics for GBS on the newborns microbiome. However, since that time, I have found 8 studies in which researchers have looked at the microbiota consequences of IV antibiotics during labor for Group B Strep.
In these studies , researchers enrolled infants whose mothers had IV antibiotics during labor and compared them to infants whose mothers did not have IV antibiotics during labor. Most researchers studied the infant microbiome by collecting and analyzing stool samples at time points ranging from 3 days of life to 1 year of age.
Overall, researchers found that receiving IV antibiotics during labor does impact the infants microbiome, at least temporarily. Seven of eight studies found that IV antibiotics during labor had at least a short-term effect on reducing beneficial bacteria and/or increasing levels of non-beneficial bacteria. Of the four studies that followed the infant microbiome over time, two found that the infants microbiome had either recovered or mostly recovered by 4-8 weeks, while two other studies found important differences that persisted up to 3 months or a year later in some infants.
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The Best Probiotic Strains For Strep Throat
Various probiotic strains help in combating diseases. However, each strain targets specific ailments. Therefore, you need to use a probiotic strain that specifically targets the bacteria that cause strep throat.
Studies suggest that the best probiotic strain in treating strep throat is Streptococcus Salivarius K12. Its a newly discovered probiotic strain that is beneficial for those suffering from certain oral and respiratory diseases. It naturally grows in the mouth and throat of healthy adults and children.
BLIS K12, a specific strain of Streptococcus Salivarius K12, especially targets mouth and throat diseases such as step throat. It colonizes your oral cavities and pushes out the harmful bacteria. This strain is also scientifically proven to reduce upper respiratory infections and halitosis.
A study conducted with children in Italy also suggests that BLIS K12 inhibits the growth of streptococcal bacteria in childrens throats. Almost all of the children who were treated with BLIS K12 probiotics for 90 days reported up to 90% lesser incidence of strep throat infections. Follow-up studies also reported no side effects.
What About Late Onset Gbs ^
Currently No strategies exist to prevent late-onset disease, although more than half of reported cases of neonatal GBS disease now occur during the late-onset period. In addition, concern continues among health officials that widespread intrapartum antimicrobial use might delay, rather than prevent, GBS disease onset, resulting in increased rates of late-onset disease. No evidence exists to suggest an increase however, careful monitoring of disease trends remains a priority.
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Risks Associated With Group B Streptococcus Colonisation During Pregnancy
- A positive result for Group B streptococcus on urine culture may be a risk factor for preterm labour, premature rupture of the membranes, intrapartum fever and chorioamnionitis .
- Early onset Group B streptococcus may affect babies before birth and increase the risk of preterm birth or caesarean section . In the newborn, the infection is usually evident as respiratory disease, general sepsis, or meningitis within the first week after birth. Population-based surveillance in the United States suggests a neonatal death rate of around 5% of affected babies .
Placental Chorioamniotic Weakening After Gbs Infection
GBS infection and inflammation of the amniotic fluid can contribute to preterm premature rupture of membranes through weakening of the placental chorioamniotic membranes, ultimately inducing PTB. Multiple factors contribute to membrane weakening, including matrix metalloproteinases, apoptosis, oxidative stress, and other neutrophil proteases . An important mechanism contributing to pPROM was demonstrated using a nonhuman primate model of GBS is EMT . EMT is a coordinated process whereby epithelial cells change morphology, retract their cytoskeleton, lose cell-cell adhesions and become motile overall, this process reduces tissue integrity. In a nonhuman primate model, a choriodecidual inoculation of GBS was associated with transcriptional responses in the chorioamniotic membranes characterized by downregulation of cytostructural genes and microRNA gene expression consistent with EMT . Immunohistochemistry of the chorioamniotic membranes also demonstrated partial loss of surface E-cadherin, increased N-cadherin expression, and vimentin staining near areas of neutrophil influx, all signs of reduced amniotic epithelial integrity . Thus, in addition to the role of EMT in vaginal exfoliation, EMT may also impair chorioamniotic membrane tissue integrity and predispose GBS-infected pregnant women to pPROM.
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Hemolysis Formation Of Biogenic Amines And Degradation Of Mucin
For investigation of hemolysis, strains were streaked onto layered fresh horse blood agar plates and grown for 24 h at 37 °C. Zones of clearing around colonies indicated hemolysin production. The capacity of the strains to synthesize biogenic amines from their respective precursor amino acids was evaluated using the method described by Bover-Cid and Holzapfel . The potential of the strains to degrade gastric mucine was evaluated in vitro as indicated by Zhou et al. .
Bacterial And Host Determinants Of Group B Streptococcal Vaginal Colonization And Ascending Infection In Pregnancy
- 1Center for Global Infectious Disease Research, Seattle Childrens Research Institute, Seattle, WA, United States
- 2Department of Global Health, University of Washington, Seattle, WA, United States
- 3Department of Obstetrics & Gynecology, University of Washington, Seattle, WA, United States
- 4Department of Pediatrics, University of Washington, Seattle, WA, United States
- 5Department of Obstetrics and Gynecology, University of Washington and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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What Other Side Effects Might There Be
Although rare, severe allergic reactions in mothers have been reported. The risk is estimated to be 1 in 10,000 for a severe reaction, and 1 in 100,000 for a fatal reaction. .
Other side effects due to the way antibiotics alter the microbiome may be significant, but they have not yet been thoroughly studied.
How Can I Lower My Chances Of Testing Positive For Gbs
If youre wondering whether you can prevent GBS colonization from happening in the first place, there are certain traditional remedies many women use to try to prevent and treat GBS. This includes taking garlic, yogurt, tea tree oil, and more. Unfortunately, at this time the research around these methods is fairly limited, so we dont know for certain that they will work, writes Spalding. They may end up working for some women, but not for others.
Theres also some research around using oral probiotics in pregnancy and anecdotal evidence on using vaginal probiotics in the third trimester leading up to the GBS test. Ask your obstetric care provider and/or a naturopath trained in herbal medicine and supplements for more information on this front. Dr. Romm also provides more resources on this.
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How To Treat Group B Strep Without Antibiotics
If you test positive for GBS, the following strategies promote healthy vaginal flora, which may lower your chances of having GBS at delivery and passing it on to baby. No matter which method of Group B Strep treatment you and your healthcare provider decide on, these home remedies are worth a try with your doctors approval.
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