title: Late-onset and recurrent neonatal Group B streptococcal disease associated with breast-milk transmission.
abstract: The purpose of the study was to determine the epidemiological relationships in three unrelated cases of neonatal late-onset Group B streptococcal (GBS) disease and maternal breast-milk infection with GBS. All deliveries were by cesarean section; case 1 was at term, and cases 2 and 3 were at 32- and 33-wk gestation, respectively. Case 1 relates to a mother with clinical mastitis and recurrent GBS infection in a 20-day-old male infant. Following antibiotic therapy and cessation of breast-feeding, the infant recovered without sequelae. Case 2 refers to a mother with clinical mastitis and the occurrence of late-onset GBS disease in 5-wk-old male twins. Despite intervention, one infant died and the second became ill. Following antibiotic therapy and cessation of breast-feeding, the surviving infant recovered without sequelae. Case 3 refers to a mother with sub-clinical mastitis and late-onset GBS infection occurring in a 6-day-old female twin. Following intervention, the infant recovered but suffered a bilateral thalamic infarction resulting in developmental delay and a severe seizure disorder. Following recovery of GBS from an inapparent mastitis and cessation of breast-feeding, the second infant remained well. Blood cultures from all affected infants and maternal breast milk were positive for GBS. Epidemiological relationships between neonatal- and maternal-derived GBS isolates were confirmed by a random amplified polymorphic DNA polymerase chain reaction assay (RAPD-PCR). This study is significant in that it has demonstrated that maternal milk (in cases of either clinical or sub-clinical mastitis) can be a potential source of infection resulting in either late-onset or recurrent neonatal GBS disease.
authors.affiliation: Center for Biomedical Research, Department of Biological and Physical Sciences, Faculty of Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia 4350. kotiw@usq.edu.au
authors.forename: Michael
authors.initials: M
authors.lastname: Kotiw
authors.forename: Gwang W
authors.initials: GW
authors.lastname: Zhang
authors.forename: Grant
authors.initials: G
authors.lastname: Daggard
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Reiss-Levy
authors.forename: John W
authors.initials: JW
authors.lastname: Tapsall
authors.forename: Andrew
authors.initials: A
authors.lastname: Numa
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001942:Breast Feeding; D002585:Cesarean Section; D004269:DNA, Bacterial / Q000032:analysis; D004200:Diseases in Twins / Q000209:etiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D008895:Milk, Human / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012008:Recurrence; D013290:Streptococcal Infections / Q000188:drug therapy / Q000635:transmission*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial