No / Although Streptococcus agalactiae, the group B Streptococcus, is a leading cause of invasive neonatal disease worldwide the molecular basis of its virulence is still poorly understood. To investigate the role of lipoproteins in the physiology and interaction of this pathogen with host cells, we generated a mutant S. agalactiae strain (A909DeltaLgt) deficient in the Lgt enzyme and thus unable to lipidate lipoprotein precursors (pro-lipoproteins). The loss of pro-lipoprotein lipidation did not affect the viability of S. agalactiae or its growth in several different media, including cation-depleted media. The processing of two well-characterized lipoproteins, but not a non-lipoprotein, was clearly shown to be aberrant in A909DeltaLgt. The mutant strain was shown to be more sensitive to oxidative stress in vitro although the molecular basis of this increased sensitivity was not apparent. The inactivation of Lgt also resulted in changes to the bacterial cell envelope, as demonstrated by reduced retention of both the group B carbohydrate and the polysaccharide capsule and a statistically significant reduction (P=0.0079) in A909DeltaLgt adherence to human endothelial cells of fetal origin. These data confirm that failure to process lipoproteins correctly has pleiotropic effects that may be of significance to S. agalactiae colonization and pathogenesis.

BACKGROUND AND OBJECTIVES: Streptococcus agalactiae (Group B Streptococcus, GBS) is the leading cause of neonatal infections and deaths in human. It can also cause infections in pregnant women and non-pregnant adults. Penicillin and ampicillin are antibiotics of choice for the treatment of GBS infections. Erythromycin and clindamycin are used as alternative therapy in penicillin allergic patients, however resistance to these agents has been increasingly observed. This present study was undertaken to determine the colonization rate of GBS, susceptibility profile and the mechanism of antibiotic resistance in pregnant women and their babies at Dr. George Mukhari Academic Hospital in Pretoria. METHODS: Rectal and vaginal swabs were collected from pregnant women; ear and umbilical swabs from newborns over an 11 month period. Samples were cultured on selective media (CNA agar and Todd-Hewitt broth) and GBS positively identified using morphological and biochemical tests including Gram staining, hemolytic activity, catalase test, bile esculin, CAMP test and Latex agglutination test. The susceptibility testing was done using the Kirby-Bauer and E-test methods. The D-test method was used to determine the inducible clindamycin resistance. Multiplex PCR with were used to detect different genes coding for resistance. RESULTS: Out of the 413 patients evaluated, 128 (30.9%) were positive with GBS. All isolates were sensitive to penicillin and ampicillin. Erythromycin and clindamycin resistance was 21.1% and 17.2% respectively; of which 69% harbouring constitutive MLBB, 17.4% inducible MLSB. The alteration of ribosomal target encoded by ermB genes was the commonest mechanism of resistance observed in 55% of isolates, 38% of isolates had both ermB and linB genes and efflux pump mediated by mefA genes was detected in one of isolates. Conclusion: This study reaffirms the appropriateness of penicillin as the antibiotic of choice for treating GBS infection. However it raises the challenges of resistance to the macrolides and lincosamides. More GBS treatment options for penicillin allergic patients need to be researched. / Health Studies / M.Sc. (Life Sciences (Microbiology))

Einleitung: Euterinfektionen sowohl mit kuh-, vor allem mit umweltassoziierten Streptokokken nehmen bei Milchkuhherden eine dominierende Rolle ein. Ziel der Untersuchungen: Die Beziehungen zwischen der Innerherdenprävalenz (IHP) von subklinischen Mastitiden mit Streptokokken zur Haltungshygiene und zur Melkhygiene wurden erfasst. Dabei standen laktierende Kühe mit Nachweis von äskulinpositiven Streptokokken und Streptococcus agalactiae in Viertelanfangs-gemelksproben im Mittelpunkt. Tiere, Material und Methoden: Von September 2009 bis Dezember 2010 fanden in 34 Thüringer Milchviehherden zweimalig im Abstand von etwa 100 Tagen bakteriologische Untersuchungen der Viertelanfangsgemelke von allen zu diesem Zeitpunkt laktierenden und klinisch eutergesund erscheinenden Kühen statt. Der Medianwert der Herdengröße der laktierenden Kühe betrug 246. Die bakteriologischen Untersuchungen von 81.567 Viertelanfangsgemelken erfolgten entsprechend den Leitlinien der Deutschen Veterinärmedizinischen Gesellschaft durch das Labor des Tiergesundheitsdienstes der Thüringer Tierseuchenkasse. Während des ersten Bestandsbesuchs wurden die Haltungsbedingungen sowie die Melktechnik und die Melkhygiene im Betrieb mittels eines dreiteiligen, strukturierten Fragebogens erfasst. Die Bewertung der Merkmale erfolgte durch die Einteilung in zwei oder drei vorgegebene Kategorien. Mittels multivariabler Varianzanalyse wurde anschließend geprüft, ob eine Beziehung zwischen der IHP intramammärer Infektionen mit Streptococcus agalactiae bzw. äskulinpositiven Streptokokken und dem jeweiligen Risikofaktor besteht. Ergebnisse: Infektionen mit äskulinpositiven Streptokokken traten in allen Herden auf, während Galtstreptokokken in nur sieben der 34 Herden nachgewiesen werden konnten. Der Median der IHP der Infektionen mit äskulinpositiven Streptokokken lag zur Untersuchung 1 bei 8,5 %, zur Untersuchung 2 bei 4,6 %, für Infektionen mit Streptococcus agalactiae bei 4,9 % bzw. 3,1 %. Signifikante Beziehungen zur IHP von subklinischen Mastitiden mit äskulinpositiven Streptokokken oder Streptococcus agalactiae finden sich für die Sauberkeit der Liegeflächen im Bereich der Trockensteher und der kalbenden Kühe, für die Art der Laufflächen im Bereich der Trockensteher und der milchliefernden Kühe und für die regelmäßige Nutzung der Handwaschgelegenheiten durch das Melkpersonal. Für Galt-Nachweise zeigten sich signifikante Beziehungen und niedrige IHP im Zusammenhang mit der Verwendung einer Rohrmelkanlage für die Frischmelker, guter Sauberkeit der Euter der zum Melken kommenden Kühe und der Verwendung einer Tauchdesinfektion als Melkzeugzwischendesinfektion. Für subklinische Mastitiden mit äskulinpositiven Streptokokken gilt dies für Herden, in denen die Kühe der Leistungsherde mit kaum verschmutzten Eutern zum Melken kommen und stark verschmutzte Euter in der Leistungsherde vor dem Melken intensiv gereinigt werden. Schlussfolgerungen: Die Häufigkeit der Infektionen mit äskulinpositiven Streptokokken steht mit der Sauberkeit der Euter in Beziehung. Das Bereitstellen von sauberen und trockenen Liegeflächen und Laufgängen für alle Kühe in der Herde, auch für die trockenstehenden Tiere, trägt zu einer Senkung der IHP intramammärer Infektionen mit umweltassoziierten Streptokokken bei. Dabei geht es um die Vermeidung von Verschmutzungen der Euter. Weiterhin stellen das Melken der frischmelkenden Kühe in einem separaten Melkstand und die Melkzeugzwischendesinfektion durch Tauchen geeignete Maßnahmen zur Unterbindung der Erregerverbreitung von Euterinfektionen mit Streptococcus agalactiae dar.

BACKGROUND AND OBJECTIVES: Streptococcus agalactiae (Group B Streptococcus, GBS) is the leading cause of neonatal infections and deaths in human. It can also cause infections in pregnant women and non-pregnant adults. Penicillin and ampicillin are antibiotics of choice for the treatment of GBS infections. Erythromycin and clindamycin are used as alternative therapy in penicillin allergic patients, however resistance to these agents has been increasingly observed. This present study was undertaken to determine the colonization rate of GBS, susceptibility profile and the mechanism of antibiotic resistance in pregnant women and their babies at Dr. George Mukhari Academic Hospital in Pretoria. METHODS: Rectal and vaginal swabs were collected from pregnant women; ear and umbilical swabs from newborns over an 11 month period. Samples were cultured on selective media (CNA agar and Todd-Hewitt broth) and GBS positively identified using morphological and biochemical tests including Gram staining, hemolytic activity, catalase test, bile esculin, CAMP test and Latex agglutination test. The susceptibility testing was done using the Kirby-Bauer and E-test methods. The D-test method was used to determine the inducible clindamycin resistance. Multiplex PCR with were used to detect different genes coding for resistance. RESULTS: Out of the 413 patients evaluated, 128 (30.9%) were positive with GBS. All isolates were sensitive to penicillin and ampicillin. Erythromycin and clindamycin resistance was 21.1% and 17.2% respectively; of which 69% harbouring constitutive MLBB, 17.4% inducible MLSB. The alteration of ribosomal target encoded by ermB genes was the commonest mechanism of resistance observed in 55% of isolates, 38% of isolates had both ermB and linB genes and efflux pump mediated by mefA genes was detected in one of isolates. Conclusion: This study reaffirms the appropriateness of penicillin as the antibiotic of choice for treating GBS infection. However it raises the challenges of resistance to the macrolides and lincosamides. More GBS treatment options for penicillin allergic patients need to be researched. / Health Studies / M. Sc. (Life Sciences (Microbiology))

Introdução: Gestações múltiplas apresentam alta morbidade relacionada a fatores como prematuridade, baixo peso ao nascer e sepse. Em gemelares, a aquisição de imunidade passiva por meio do cordão umbilical e do colostro ainda não é bem conhecida. O objetivo geral do estudo foi descrever a concentração de IgG total e específico anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no cordão umbilical de recém-nascidos gemelares e a concentração de IgA secretora total e específica destes anticorpos no colostro. O objetivo específico foi analisar a associação entre infecção neonatal e concentração dos anticorpos no sangue de cordão umbilical e no colostro. Métodos: estudo prospectivo transversal de uma coorte de recémnascidos gemelares internados no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da FMUSP no período de 20 meses. Foram excluídos: recém-nascidos com malformação; mães com infecção ou imunodeficiência. Variáveis analisadas: idade gestacional; peso de nascimento; classificação gestacional; concentrações de IgG total e específicos e IgA total e específicas anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no sangue de cordão umbilical e no colostro; nutrição enteral; episódios de infecção; desfecho. As dosagens de IgG total foram realizadas por nefelometria e dos demais anticorpos através de ensaio imunoenzimático. Os testes t-Student pareado ou teste de Wilcoxon pareado, teste de Mann-Whitney e teste de Kruskal-Wallis, foram utilizados, considerando-se significante p< 0,005. Resultados: Foram incluídos 57 pares de gêmeos, compondo a casuística de 114 recém-nascidos. A idade gestacional foi 36±1,65 semanas (média±DP) e o peso de nascimento foi 2.304,8 ± 460g (média±DP). As concentrações de anticorpos encontradas foram (média±DP): IgG total 835,71 ± 190,73 mg/dL, IgG anti-Streptococcus B 295,1 ± 250,66 UA/mL, IgG antilipopolissacarídeos de Pseudomonas aeruginosa 280,04 ± 498,66 UA/mL e IgG antilipopolissacarídeos de Klebsiella pneumoniae 504,75 ± 933,93 UA/mL; IgA total 210,2 ± 285,3 g/L, IgA anti-Streptococcus B 6640 ± 9526,8 UA/mL, IgA antilipopolissacarídeos de Pseudomonas aeruginosa 3231,0 ± 2935,2 UA/mL, IgA antilipopolissacarídeos de Klebsiella pneumoniae 3070,1±2886,6 UA/mL. A concentração de IgG total foi menor nos recém-nascidos prematuros (p < 0,001). Em gemelares com idade gestacional < 34 semanas a concentração de IgG total (p=0,013) e IgG antilipopolissacarídeos de Pseudomonas aeruginosa (p=0,032) foi menor. A concentração de anticorpos IgG antilipopolissacarídeos de Klebsiella pneumoniae foi menor nos recém-nascidos pequenos para a idade gestacional (p=0,013). No colostro, houve detecção de IgA total, IgA anti-Streptococcus B, IgA antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa em 98,1% das mães. A concentração de IgA antilipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de recém-nascidos prematuros (p=0,013). A concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae foi menor no colostro das mães com parto antes de 34 semanas (p=0,001). Houve infecção em cinco recém-nascidos, cuja concentração de IgG total foi menor (p<0,05). Os neonatos que receberam colostro apresentaram menor incidência de infecção (p < 0,001). Conclusões: Os anticorpos IgG total e específicos foram detectados no sangue do cordão umbilical em todos os gemelares, comprovando sua passagem transplacentária. Houve diminuição significativa na concentração de anticorpos IgG total nos gemelares prematuros e de IgG total e IgG antilipopolissacarídeos de Pseudomonas aeruginosa nos gemelares com idade gestacional inferior a 34 semanas. No colostro houve detecção de IgA total e específica em 98,1% das mães. A concentração de IgA anti-lipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de gemelares prematuros. Nas mães com parto antes de 34 semanas houve diminuição da concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae, sugerindo que a prematuridade possa ter influenciado a transferência de anticorpos maternos pelo colostro. A maior incidência de infecção no grupo de recém-nascidos, que não receberam colostro e naqueles que apresentavam concentração sérica de IgG total significativamente menor, reforça a importância da proteção anti-infecciosa conferida pela imunidade passiva transferida da mãe / Introduction: Multiple pregnancies have high morbidity related to factors such as prematurity, low birth weight and sepsis. In twins, acquisition of passive immunity through the umbilical cord and colostrum is not yet known. The overall aim of the study was to describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and anti-lipopolysaccharide of Pseudomonas aeruginosa in the umbilical cord of newborn twins and the concentration of total and specific secretory IgA antibodies in the colostrum. The specific aim was to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood and colostrum. Methods: A prospective cross-sectional study of a cohort of newborn twins admitted to the Neonatal Center of Children\'s Institute, University of São Paulo during the period of 20 months. Patients with malformations and mothers with infection or immunodeficiency were excluded from our analysis. Variables analyzed: gestational age; birth weight; sex; gestational classification; antibody concentrations of total and specific IgG and IgA anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and antilipopolysaccharide of Pseudomonas aeruginosa in umbilical cord blood and colostrum; enteral nutrition; infection episodes; outcome. Total IgG measurements were performed using nephelometry and the specific antibodies were evaluated by enzyme immunoassay. We used paired Student t test or Wilcoxon test, Mann-Whitney test and Kruskal-Wallis test considering significant p < 0.005. Results: During the study period a total of 57 pairs of twins were included, making the sample of 114 newborns. Gestational age was 36 ± 1.65 weeks (mean±SD) and birth weight was 2304.8 ± 460g (mean±SD). We found the following antibody concentrations (mean±SD): total IgG 835.71 ± 190.73 mg/dL, anti-Streptococcus B IgG 250.66 ± 295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgG 280.04 ± 498.66 AU/mL and anti-lipopolysaccharide of Klebsiella pneumoniae IgG 504.75±933.93 AU/mL; total IgA 210.2 ± 285.3 g/L, anti- Streptococcus B IgA 6640±9526.8 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgA 3231.0±2935.2 AU/mL, antilipopolysaccharide Klebsiella pneumoniae IgA 3070.1±2886.6 AU/mL. The concentration of total IgG was lower in preterm infants (p < 0.001). In twins with gestational age < 34 weeks both total IgG concentration (p = 0.013) and anti-lipopolysaccharide of Pseudomonas aeruginosa IgG concentration (p = 0.032) were lower. The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgG was lower in small for gestational age newborns (p=0,013). There was detection of total IgA and specific antibodies in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in the colostrum of premature\'s mothers (p = 0.013). The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgA was lower in the colostrum of mothers with delivery before 34 weeks (p = 0.001). Five newborns were diagnosed with sepsis and in this group the concentration of total IgG was lower (p < 0.05). Neonates receiving colostrum had a lower incidence of infection (p < 0.001). Conclusion: This study showed detection of total and specific IgG antibodies in umbilical cord blood for all twin newborn, proving its transplacental passage. There was a significant decrease in the concentration of total IgG antibodies in premature twins and antilipopolysaccharide of Pseudomonas aeruginosa IgG in twins with gestational age less than 34 weeks. There was detection of total and specific IgA in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in mothers of premature twins. Among the newborns with gestational age less than 34 weeks there was a decrease in the concentration of anti-lipopolysaccharide Klebsiella pneumoniae IgA, suggesting that prematurity may have influenced the transfer of maternal antibodies through colostrum. The highest incidence of infection in the newborn group who did not receive colostrum and in those who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother

Introdução: Gestações múltiplas apresentam alta morbidade relacionada a fatores como prematuridade, baixo peso ao nascer e sepse. Em gemelares, a aquisição de imunidade passiva por meio do cordão umbilical e do colostro ainda não é bem conhecida. O objetivo geral do estudo foi descrever a concentração de IgG total e específico anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no cordão umbilical de recém-nascidos gemelares e a concentração de IgA secretora total e específica destes anticorpos no colostro. O objetivo específico foi analisar a associação entre infecção neonatal e concentração dos anticorpos no sangue de cordão umbilical e no colostro. Métodos: estudo prospectivo transversal de uma coorte de recémnascidos gemelares internados no Centro Neonatal do Instituto da Criança do Hospital das Clínicas da FMUSP no período de 20 meses. Foram excluídos: recém-nascidos com malformação; mães com infecção ou imunodeficiência. Variáveis analisadas: idade gestacional; peso de nascimento; classificação gestacional; concentrações de IgG total e específicos e IgA total e específicas anti-Streptococcus B, antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa no sangue de cordão umbilical e no colostro; nutrição enteral; episódios de infecção; desfecho. As dosagens de IgG total foram realizadas por nefelometria e dos demais anticorpos através de ensaio imunoenzimático. Os testes t-Student pareado ou teste de Wilcoxon pareado, teste de Mann-Whitney e teste de Kruskal-Wallis, foram utilizados, considerando-se significante p< 0,005. Resultados: Foram incluídos 57 pares de gêmeos, compondo a casuística de 114 recém-nascidos. A idade gestacional foi 36±1,65 semanas (média±DP) e o peso de nascimento foi 2.304,8 ± 460g (média±DP). As concentrações de anticorpos encontradas foram (média±DP): IgG total 835,71 ± 190,73 mg/dL, IgG anti-Streptococcus B 295,1 ± 250,66 UA/mL, IgG antilipopolissacarídeos de Pseudomonas aeruginosa 280,04 ± 498,66 UA/mL e IgG antilipopolissacarídeos de Klebsiella pneumoniae 504,75 ± 933,93 UA/mL; IgA total 210,2 ± 285,3 g/L, IgA anti-Streptococcus B 6640 ± 9526,8 UA/mL, IgA antilipopolissacarídeos de Pseudomonas aeruginosa 3231,0 ± 2935,2 UA/mL, IgA antilipopolissacarídeos de Klebsiella pneumoniae 3070,1±2886,6 UA/mL. A concentração de IgG total foi menor nos recém-nascidos prematuros (p < 0,001). Em gemelares com idade gestacional < 34 semanas a concentração de IgG total (p=0,013) e IgG antilipopolissacarídeos de Pseudomonas aeruginosa (p=0,032) foi menor. A concentração de anticorpos IgG antilipopolissacarídeos de Klebsiella pneumoniae foi menor nos recém-nascidos pequenos para a idade gestacional (p=0,013). No colostro, houve detecção de IgA total, IgA anti-Streptococcus B, IgA antilipopolissacarídeos de Klebsiella pneumoniae e antilipopolissacarídeos de Pseudomonas aeruginosa em 98,1% das mães. A concentração de IgA antilipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de recém-nascidos prematuros (p=0,013). A concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae foi menor no colostro das mães com parto antes de 34 semanas (p=0,001). Houve infecção em cinco recém-nascidos, cuja concentração de IgG total foi menor (p<0,05). Os neonatos que receberam colostro apresentaram menor incidência de infecção (p < 0,001). Conclusões: Os anticorpos IgG total e específicos foram detectados no sangue do cordão umbilical em todos os gemelares, comprovando sua passagem transplacentária. Houve diminuição significativa na concentração de anticorpos IgG total nos gemelares prematuros e de IgG total e IgG antilipopolissacarídeos de Pseudomonas aeruginosa nos gemelares com idade gestacional inferior a 34 semanas. No colostro houve detecção de IgA total e específica em 98,1% das mães. A concentração de IgA anti-lipopolissacarídeos de Pseudomonas aeruginosa foi menor no colostro das mães de gemelares prematuros. Nas mães com parto antes de 34 semanas houve diminuição da concentração de IgA antilipopolissacarídeos de Klebsiella pneumoniae, sugerindo que a prematuridade possa ter influenciado a transferência de anticorpos maternos pelo colostro. A maior incidência de infecção no grupo de recém-nascidos, que não receberam colostro e naqueles que apresentavam concentração sérica de IgG total significativamente menor, reforça a importância da proteção anti-infecciosa conferida pela imunidade passiva transferida da mãe / Introduction: Multiple pregnancies have high morbidity related to factors such as prematurity, low birth weight and sepsis. In twins, acquisition of passive immunity through the umbilical cord and colostrum is not yet known. The overall aim of the study was to describe the concentration of total and specific IgG antibodies anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and anti-lipopolysaccharide of Pseudomonas aeruginosa in the umbilical cord of newborn twins and the concentration of total and specific secretory IgA antibodies in the colostrum. The specific aim was to analyze the association between neonatal infection and antibody concentration in the umbilical cord blood and colostrum. Methods: A prospective cross-sectional study of a cohort of newborn twins admitted to the Neonatal Center of Children\'s Institute, University of São Paulo during the period of 20 months. Patients with malformations and mothers with infection or immunodeficiency were excluded from our analysis. Variables analyzed: gestational age; birth weight; sex; gestational classification; antibody concentrations of total and specific IgG and IgA anti-Streptococcus B, anti-lipopolysaccharide of Klebsiella pneumoniae and antilipopolysaccharide of Pseudomonas aeruginosa in umbilical cord blood and colostrum; enteral nutrition; infection episodes; outcome. Total IgG measurements were performed using nephelometry and the specific antibodies were evaluated by enzyme immunoassay. We used paired Student t test or Wilcoxon test, Mann-Whitney test and Kruskal-Wallis test considering significant p < 0.005. Results: During the study period a total of 57 pairs of twins were included, making the sample of 114 newborns. Gestational age was 36 ± 1.65 weeks (mean±SD) and birth weight was 2304.8 ± 460g (mean±SD). We found the following antibody concentrations (mean±SD): total IgG 835.71 ± 190.73 mg/dL, anti-Streptococcus B IgG 250.66 ± 295.1 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgG 280.04 ± 498.66 AU/mL and anti-lipopolysaccharide of Klebsiella pneumoniae IgG 504.75±933.93 AU/mL; total IgA 210.2 ± 285.3 g/L, anti- Streptococcus B IgA 6640±9526.8 AU/mL, anti-lipopolysaccharide of Pseudomonas aeruginosa IgA 3231.0±2935.2 AU/mL, antilipopolysaccharide Klebsiella pneumoniae IgA 3070.1±2886.6 AU/mL. The concentration of total IgG was lower in preterm infants (p < 0.001). In twins with gestational age < 34 weeks both total IgG concentration (p = 0.013) and anti-lipopolysaccharide of Pseudomonas aeruginosa IgG concentration (p = 0.032) were lower. The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgG was lower in small for gestational age newborns (p=0,013). There was detection of total IgA and specific antibodies in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in the colostrum of premature\'s mothers (p = 0.013). The concentration of anti-lipopolysaccharide of Klebsiella pneumoniae IgA was lower in the colostrum of mothers with delivery before 34 weeks (p = 0.001). Five newborns were diagnosed with sepsis and in this group the concentration of total IgG was lower (p < 0.05). Neonates receiving colostrum had a lower incidence of infection (p < 0.001). Conclusion: This study showed detection of total and specific IgG antibodies in umbilical cord blood for all twin newborn, proving its transplacental passage. There was a significant decrease in the concentration of total IgG antibodies in premature twins and antilipopolysaccharide of Pseudomonas aeruginosa IgG in twins with gestational age less than 34 weeks. There was detection of total and specific IgA in the colostrum of 98.1% mothers. The concentration of anti-lipopolysaccharide of Pseudomonas aeruginosa IgA was lower in mothers of premature twins. Among the newborns with gestational age less than 34 weeks there was a decrease in the concentration of anti-lipopolysaccharide Klebsiella pneumoniae IgA, suggesting that prematurity may have influenced the transfer of maternal antibodies through colostrum. The highest incidence of infection in the newborn group who did not receive colostrum and in those who had significantly lower total IgG serum antibodies reinforces the importance of anti-infectious protection afforded by passive immunity transferred from the mother

Streptococcus agalactiae est la première cause d’infections invasives chez le nouveau né et, malgré la mise en place de stratégies de prévention, cette bactérie reste le principal agent étiologique des infections néonatales. Les souches de séquence type 17, dites hyper-virulentes, sont particulièrement associées avec les méningites, type d’infection ayant des conséquences lourdes en terme de mortalité et morbidité. Ce clone possède des caractéristiques uniques, telle que la fixation au fibrinogène, ainsi qu’un répertoire de protéines de surface qui lui sont spécifiques. Parmi ces protéines, Srr2 appartient à une famille de larges glycoprotéines streptococcales et staphylococcales impliquées dans la pathogénicité. Un domaine central de Srr2, le domaine BR, est responsable de la fixation spécifique du fibrinogène par le clone ST-17, ainsi qu’au plasminogène et à divers composants de la matrice extracellulaire. Cette protéine promeut ainsi l’adhésion et le franchissement des barrières cellulaires. L’interaction de Srr2 avec les systèmes fibrinolytique et de coagulation de l’hôte favorise la dissémination bactérienne par l’activation de la fibrinolyse, et la persistance de la bactérie dans l’organisme par la formation d’agrégats bactériens. La liaison de Srr2 avec le fibrinogène semble également promouvoir la persistance bactérienne en favorisant l’internalisation et la survie dans les macrophages. Ainsi, la protéine Srr2 confère un avantage pour le processus infectieux du clone ST-17 dans l’hôte, et constitue une cible vaccinale intéressante pour la prévention des infections à S. agalactiae. / Streptococcus agalactiae is the leading cause of invasive infections in neonates. Despite the implementation of prevention strategies, this bacterium remains the main etiological agent of neonatal infections. Hyper-virulent sequence-type 17 strains are particularly associated with meningitis, a type of infection with serious consequences in terms of mortality and morbidity. This clone has unique characteristics, such as fibrinogen binding, and a panel of specific surface proteins. Among these proteins, Srr2 belongs to a family of large streptococcal and staphylococcal glycoproteins involved in pathogenicity. A central domain of Srr2, BR domain, is responsible for the specific binding of fibrinogen by the ST -17 clone and also binds plasminogen and various components of the extracellular matrix. Thereby, it promotes adhesion and crossing of cellular barriers. The interaction of Srr2 with fibrinolytic and coagulation systems of the host could promote bacterial spread through the activation of fibrinolysis and the persistence of the bacteria in the host by the formation of bacterial aggregates. The interaction of Srr2 with fibrinogen also seems to promote bacterial persistence in promoting the internalization and survival of the bacteria in macrophages. Thus, Srr2 confers an advantage to the infectious process of the ST- 17 clone in the host and is an attractive vaccine candidate for the prevention of S. agalactiae infections.

Einleitung: Euterinfektionen sowohl mit kuh-, vor allem mit umweltassoziierten Streptokokken nehmen bei Milchkuhherden eine dominierende Rolle ein. Ziel der Untersuchungen: Die Beziehungen zwischen der Innerherdenprävalenz (IHP) von subklinischen Mastitiden mit Streptokokken zur Haltungshygiene und zur Melkhygiene wurden erfasst. Dabei standen laktierende Kühe mit Nachweis von äskulinpositiven Streptokokken und Streptococcus agalactiae in Viertelanfangs-gemelksproben im Mittelpunkt. Tiere, Material und Methoden: Von September 2009 bis Dezember 2010 fanden in 34 Thüringer Milchviehherden zweimalig im Abstand von etwa 100 Tagen bakteriologische Untersuchungen der Viertelanfangsgemelke von allen zu diesem Zeitpunkt laktierenden und klinisch eutergesund erscheinenden Kühen statt. Der Medianwert der Herdengröße der laktierenden Kühe betrug 246. Die bakteriologischen Untersuchungen von 81.567 Viertelanfangsgemelken erfolgten entsprechend den Leitlinien der Deutschen Veterinärmedizinischen Gesellschaft durch das Labor des Tiergesundheitsdienstes der Thüringer Tierseuchenkasse. Während des ersten Bestandsbesuchs wurden die Haltungsbedingungen sowie die Melktechnik und die Melkhygiene im Betrieb mittels eines dreiteiligen, strukturierten Fragebogens erfasst. Die Bewertung der Merkmale erfolgte durch die Einteilung in zwei oder drei vorgegebene Kategorien. Mittels multivariabler Varianzanalyse wurde anschließend geprüft, ob eine Beziehung zwischen der IHP intramammärer Infektionen mit Streptococcus agalactiae bzw. äskulinpositiven Streptokokken und dem jeweiligen Risikofaktor besteht. Ergebnisse: Infektionen mit äskulinpositiven Streptokokken traten in allen Herden auf, während Galtstreptokokken in nur sieben der 34 Herden nachgewiesen werden konnten. Der Median der IHP der Infektionen mit äskulinpositiven Streptokokken lag zur Untersuchung 1 bei 8,5 %, zur Untersuchung 2 bei 4,6 %, für Infektionen mit Streptococcus agalactiae bei 4,9 % bzw. 3,1 %. Signifikante Beziehungen zur IHP von subklinischen Mastitiden mit äskulinpositiven Streptokokken oder Streptococcus agalactiae finden sich für die Sauberkeit der Liegeflächen im Bereich der Trockensteher und der kalbenden Kühe, für die Art der Laufflächen im Bereich der Trockensteher und der milchliefernden Kühe und für die regelmäßige Nutzung der Handwaschgelegenheiten durch das Melkpersonal. Für Galt-Nachweise zeigten sich signifikante Beziehungen und niedrige IHP im Zusammenhang mit der Verwendung einer Rohrmelkanlage für die Frischmelker, guter Sauberkeit der Euter der zum Melken kommenden Kühe und der Verwendung einer Tauchdesinfektion als Melkzeugzwischendesinfektion. Für subklinische Mastitiden mit äskulinpositiven Streptokokken gilt dies für Herden, in denen die Kühe der Leistungsherde mit kaum verschmutzten Eutern zum Melken kommen und stark verschmutzte Euter in der Leistungsherde vor dem Melken intensiv gereinigt werden. Schlussfolgerungen: Die Häufigkeit der Infektionen mit äskulinpositiven Streptokokken steht mit der Sauberkeit der Euter in Beziehung. Das Bereitstellen von sauberen und trockenen Liegeflächen und Laufgängen für alle Kühe in der Herde, auch für die trockenstehenden Tiere, trägt zu einer Senkung der IHP intramammärer Infektionen mit umweltassoziierten Streptokokken bei. Dabei geht es um die Vermeidung von Verschmutzungen der Euter. Weiterhin stellen das Melken der frischmelkenden Kühe in einem separaten Melkstand und die Melkzeugzwischendesinfektion durch Tauchen geeignete Maßnahmen zur Unterbindung der Erregerverbreitung von Euterinfektionen mit Streptococcus agalactiae dar.

<p>Streptococcus agalactiae, also designated group B streptococcus (GBS), is a Gram-positive coccus, and it is an important pathogen that causes invasive disease in neonates, pregnant adults, and non-pregnant adults with predisposing conditions. The group II intron GBSi1 is one of the major mobile genetic elements identified in S. agalactiae. The aim of this thesis was to characterize the GBSi1 distribution pattern, the population structure, and the influence of serotype- and clone-specific properties on the invasive capacity among clinical invasive and non-invasive isolates of S. agalactiae.</p><p>Two additional copies of GBSi1 were identified at sites different from the primarily identified scpB-lmb locus. The distribution of GBSi1 was uneven among different serotypes. Three intron copies were only found in isolates of serotype III, and these targeted all the three identified gene loci. In contrast, a single copy of GBSi1 was found in isolates of serotype II and V and only located at the scpB-lmb locus. Furthermore, at the 5′ flanking region of the scpB-lmb gene locus, a novel 2.1 kb DNA fragment with plasmid features was identified only in intron carrying isolates. This may suggest that GBSi1 once was brought into the S. agalactiae genome by an integrated plasmid.</p><p>Multilocus sequence typing was used to characterize totally 314 invasive and non-invasive S. agalactiae isolates collected in Northern and Western Sweden from the years 1988 to 2004. Five major genetic lineages (clonal complexes) were identified among both invasive and non-invasive isolates, including serotype Ia, Ib, and II to V, indicating a clonal population structure of S. agalactiae isolates. A number of genetically highly related isolates were found to express different capsular types, suggesting that capsule switching occurs rather frequently between isolates. Furthermore, non-invasive isolates belonging to the same clonal complexes displayed more heterogeneity in capsule expression as well as in the distribution patterns of mobile genetic elements than invasive isolates. This indicates that less variability is allowed in a highly selective environment such as the blood. All major clonal complexes and serotypes caused invasive disease, although their ability to do so varied greatly. CC17 was significantly associated with neonatal invasive disease; whereas CC19 was equally common among isolates from adult and neonatal disease, despite that both CC17 and CC19 expressed capsular type III. This striking difference seen between CC17 and CC19 suggests that clonal complex associated properties, in addition to capsular type, play important roles in the virulence of S. agalactiae. CC1, a new emerging clone since early 1990s, has caused substantial amount of disease among adults. In addition, mutually exclusive distribution of mobile elements GBSi1 and IS1548 was seen, and they were shown to constitute genetic markers for serotype III CC17 and CC19 isolates, respectively.</p>

Streptococcus agalactiae, also designated group B streptococcus (GBS), is a Gram-positive coccus, and it is an important pathogen that causes invasive disease in neonates, pregnant adults, and non-pregnant adults with predisposing conditions. The group II intron GBSi1 is one of the major mobile genetic elements identified in S. agalactiae. The aim of this thesis was to characterize the GBSi1 distribution pattern, the population structure, and the influence of serotype- and clone-specific properties on the invasive capacity among clinical invasive and non-invasive isolates of S. agalactiae. Two additional copies of GBSi1 were identified at sites different from the primarily identified scpB-lmb locus. The distribution of GBSi1 was uneven among different serotypes. Three intron copies were only found in isolates of serotype III, and these targeted all the three identified gene loci. In contrast, a single copy of GBSi1 was found in isolates of serotype II and V and only located at the scpB-lmb locus. Furthermore, at the 5′ flanking region of the scpB-lmb gene locus, a novel 2.1 kb DNA fragment with plasmid features was identified only in intron carrying isolates. This may suggest that GBSi1 once was brought into the S. agalactiae genome by an integrated plasmid. Multilocus sequence typing was used to characterize totally 314 invasive and non-invasive S. agalactiae isolates collected in Northern and Western Sweden from the years 1988 to 2004. Five major genetic lineages (clonal complexes) were identified among both invasive and non-invasive isolates, including serotype Ia, Ib, and II to V, indicating a clonal population structure of S. agalactiae isolates. A number of genetically highly related isolates were found to express different capsular types, suggesting that capsule switching occurs rather frequently between isolates. Furthermore, non-invasive isolates belonging to the same clonal complexes displayed more heterogeneity in capsule expression as well as in the distribution patterns of mobile genetic elements than invasive isolates. This indicates that less variability is allowed in a highly selective environment such as the blood. All major clonal complexes and serotypes caused invasive disease, although their ability to do so varied greatly. CC17 was significantly associated with neonatal invasive disease; whereas CC19 was equally common among isolates from adult and neonatal disease, despite that both CC17 and CC19 expressed capsular type III. This striking difference seen between CC17 and CC19 suggests that clonal complex associated properties, in addition to capsular type, play important roles in the virulence of S. agalactiae. CC1, a new emerging clone since early 1990s, has caused substantial amount of disease among adults. In addition, mutually exclusive distribution of mobile elements GBSi1 and IS1548 was seen, and they were shown to constitute genetic markers for serotype III CC17 and CC19 isolates, respectively.